1/16. Bizarre paediatric facial burns.child abuse and neglect account for a significant number of paediatric burn injuries. It is of great importance because of the high mortality, high frequency of repeated abuse, as well as the physical, psychological and social sequelae that it causes. Burn abuse is often under-recognized and under-reported because it is difficult to define non-accidental injury. On the other hand, false accusation of burn abuse is extremely damaging to the family. Bizarre and unusual burn injuries can be caused by accident and should not automatically be assumed to be deliberate injury. Three boys of age 1-7 years with bizarre facial burns were admitted to the burns Unit at the Prince of wales Hospital between February 1995 and July 1999. One was burned by his baby-sitter with hot water steam and the other two were burned by their mothers with hot boiled eggs. The unusual causes of their burns raised the suspicion of child abuse and formal investigations were carried out by the Social Services Department. Detail assessment including a developmental history of the child and the psychosocial assessment of the family revealed that these three boys were burned because of poor medical advice and innocent cultural belief.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. Temporoparietal fascial flap in orbital reconstruction.OBJECTIVE: To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques. DESIGN: Retrospective analysis. SETTING: Tertiary medical center. patients: Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment. INTERVENTIONS: Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction. MAIN OUTCOME MEASURES: Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs. RESULTS: All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. CONCLUSIONS: The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.- - - - - - - - - - ranking = 2.6315429105311keywords = physical examination, physical (Clic here for more details about this article) |
3/16. Internal carotid artery pseudoaneurysm masquerading as a peritonsillar abscess.Blunt carotid arterial injuries are uncommon. Motor vehicle crashes are the most frequent cause, but this type of vascular injury can be secondary to any direct blow to the neck, intraoral trauma, or strangulation. Types of vascular injuries include dissection, pseudoaneurysm, thrombosis, rupture, and arteriovenous fistula formation. patients with pseudoaneurysm of the internal carotid artery will usually present with neurologic complaints, ranging from the minor to complete stroke. On physical examination, neck hematoma, bruits, pulsatile neck mass, or a palpable thrill may be found. However, in 50% of cases, no external signs of neck trauma are observed. Onset of symptoms may occur within a few hours to several months after the initial injury. angiography is considered the gold standard for diagnosis, but carotid Doppler ultrasound recently has been shown to be very sensitive in detecting these types of injuries. Treatment of pseudoaneurysm is often surgical, with endovascular stenting.- - - - - - - - - - ranking = 2.6315429105311keywords = physical examination, physical (Clic here for more details about this article) |
4/16. Functional reconstruction for severe postburn microstomia.A man with severe burn microstomia refractory to traditional management (Z release, skin grafting, splinting, bilateral commissuroplasty, and extensive physical therapy) is presented. Successful functional microstomia reconstruction was achieved with a three-stage approach consisting of the following: (1) lip, commissure, and cheek reconstruction with bilateral temporalis muscle transfers; (2) free flap neck and lower lip contracture release; and (3) vestibuloplasty with a stented full-thickness skin graft.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/16. Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations.In contrary to "physical restraint", describing a fixed body position due to external devices, "positional restraint" is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon's sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and therefore, aggravated the potentially lethal impact of positional restraint.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/16. Post-traumatic severe trismus caused by impairment of the masticatory muscle.Restriction of the mouth opening from a pathologic condition outside the temporomandibular joint is called a pseudo- or extra-articular ankylosis. The authors report two cases of severe post-traumatic pseudoankylosis. One case showed fibrous degeneration of the bilateral masseter muscles without a facial bone fracture, which caused severe trismus, a mouth opening of less than 2 mm, and gradually appeared after blunt injuries to the face. The other was a rare case accompanied with the bone formation in the masseter muscle and was diagnosed as myositis ossificans traumatica, which also presented as severe trismus, with a maximal mouth opening of 5 mm after facial violence. Both were surgically treated with dissection of the affected muscles. In addition, a hemicoronoidotomy was performed in the case of myositis ossificans traumatica. Although a conservative therapy with physical rehabilitation is the basic policy for the management of pseudoankylosis of the temporomandibular joint, a surgical treatment should be considered when the origin of the problems is an osteogenic character or severe extra-articular ankylosis resistant to conservative therapy before completion of true temporomandibular joint ankylosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/16. dissection of the internal carotid artery following trauma of the soft palate in children.OBJECTIVES: We undertook this report to underline the risks of lesions of the internal carotid artery after lateral oropharyngeal trauma in children and to discuss the diagnosis and treatment of this complication. methods: We present 2 pediatric cases of carotid dissection following lateral soft palate trauma. RESULTS: In 1 case, transient symptomatic cerebral ischemia occurred 24 hours after the initial traumatic injury. In both patients, the carotid dissection was assessed by magnetic resonance imaging with vascular and diffusion sequences. Treatment with low-molecular weight heparin calcium was maintained for several months. At the end of follow-up, both children were asymptomatic. CONCLUSIONS: We suggest noninvasive imaging of the carotid artery by enhanced computed tomographic scanning after trauma to the lateral part of the soft palate in children. magnetic resonance imaging with vascular and diffusion sequences is useful in assessing the extension of the dissection toward the cerebral circulation and in early detection of cerebral ischemia. Anticoagulation with heparin probably reduces the risks of cerebral infarction. patients must regularly undergo physical examination and noninvasive imaging of the carotid artery for at least 1 year after the traumatic injury.- - - - - - - - - - ranking = 2.6315429105311keywords = physical examination, physical (Clic here for more details about this article) |
8/16. Anesthetic management of neck trauma.In a retrospective review of one year's experience in the management of neck trauma, 88 cases comprising 42 gunshot wounds, 29 stab or slash injuries, and 17 injuries by blunt trauma were reviewed. Multiple injuries were noted in all groups, but a higher percentage was found in the blunt trauma series. Anesthetic management is reviewed, and emphasis is placed on careful evaluation of the patient's airway, using physical and roentgenographic examination to plan adequate airway management.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/16. Atypical brown-sequard syndrome following gunshot wound to the face.A case report of an atypical brown-sequard syndrome following a gunshot wound to the face has been described. Initial physical examination gave no evidence of spinal cord injury. Later examination revealed neurologic deficits consistent with a brown-sequard syndrome. This article shows the possibly delay in onset of clinical manifestations of cord injuries that may occur following head and neck trauma and the importance of a thorough physical, neurologic, and radiographic examination of the traumatized patient.- - - - - - - - - - ranking = 3.6315429105311keywords = physical examination, physical (Clic here for more details about this article) |
10/16. Lucilia sericata (diptera: Calliphoridae) causing hospital-acquired myiasis of a traumatic wound.A case of traumatic nosocomial myiasis caused by the green bottle fly Lucilia sericata (Meigen, 1826) occurred in a patient hospitalized following a serious road traffic accident. The patient had suffered extensive polytrauma particularly in the facial area of the skull. A total of 50 larvae was discovered in the oral cavity, nose, paranasal sinuses and enucleated eye-socket. Projected timing indicated that the eggs were laid while the patient was hospitalized. The development of myiasis was facilitated by the mental and physical debility and dependency of the patient, numerous and deep facial necrotic wounds and a lengthy period of hot weather which led to prolonged open window ventilation of his room.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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