1/7. Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the united states seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization before his transfer to Manila and then ultimately to our Maxillo-Facial Unit. There was a two week-plus delay in the definitive management because of this. As a result of the delay, fibrous tissue and bone callus formation occurred between the various fracture lines, thus once definitive fracture management was attempted, it took on a more reconstructive nature. Hospital based Oral and Maxillo-Facial Surgeons are uniquely trained to manage all aspects of the maxillo-facial trauma, and their dental background uniquely qualifies them in functional restoration of lower and midface fractures where occlusion plays a most important role. Likewise, their training in clinical medicine which is usually integrated into their residency education (12 months or more) puts them in a unique position to comfortably manage the basic medical needs of these patients. In instances where trauma may affect other regions of the body, an inter-multi-disciplinary approach may be taken or consults called for. In this instance, an opthalmology consult was important. In fresh trauma, often seen in major trauma centers (i.e. overseas), a "Trauma Team" is on standby 24 hours a day, and is prepared to assess and manage trauma patients almost immediately upon their arrival in the ER. The trauma team is usually composed of a Trauma Surgeon who is a general surgeon with subspecialty training in traumatology who assesses and manages the visceral injuries, an Orthopedic Surgeon who manages fractures of the extremities, a Neurosurgeon for cerebral injuries and an Oral and Maxillo-Facial Surgeon for facial injuries. In some institutions, facial trauma call is alternated between the "three major head and neck specialty services", namely Oral and Maxillo-facial Surgery, otolaryngology-head & neck Surgery and Plastic & Reconstructive Surgery. (ABSTRACT TRUNCATED)- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/7. Selective laser sintering: application of a rapid prototyping method in craniomaxillofacial reconstructive surgery.Advances in technology have benefited the medical world in many ways and a new generation of computed tomography (CT) scanners and three-dimensional (3-D) model making rapid prototyping systems (RPS) have taken craniofacial surgical planning and management to new heights. With the development of new rapid prototyping systems and the improvements in CT scan technology, such as the helical scanner, biomedical modelling has improved considerably and accurate 3-D models can now be fabricated to allow surgeons to visualise and physically handle a 3-D model on which simulation surgery can be performed. The principle behind this technology is to first acquire digital data (CT scan data) which is then imported to the RPS to fabricate fine layers or cuts of the model which are gradually built up to form the 3-D models. Either liquid resin or nylon powder or special paper may be used to make these models using the various RPS available today. Selective laser sintering (SLS), which employs a CO2 laser beam to solidify special nylon powder and build up the model in layers is described in this case report, where a 23-year old Chinese female with panfacial fracture and a skull defect benefited from SLS biomodelling in the preoperative workup.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/7. Secondary craniomaxillofacial deformities. Current principles of management.This article focuses on secondary reconstruction of naso-orbital frontal injuries. Pertinent clinical anatomy, physical examination/documentation, and radiographic imaging are examined first. Pretreatment planning, operative exposures, and case examples are discussed in the second part of the article.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/7. Management of traumatic facial injuries.Whether minor or major, traumatic injuries to the maxillofacial area have far-reaching physical and emotional effects. Because the dentition dictates facial form and function, the oral and maxillofacial surgeon, a dental specialist with a minimum of four years of hospital-based surgical training, is uniquely qualified to manage these injuries. At times, the expertise of the general dentist and other dental specialists may be needed to provide definitive care. Several cases are provided to illustrate management of facial trauma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/7. The effects of nasomaxillary injury on future facial growth.The appearance of results of injury to the columella, the nasal septum, and the nasal bones, in particular, has been well described. Anomalies of the maxilla and global facial balance secondary to nasomaxillary injury are less well known. Three cases involving children, aged 11, 14, and 17 years, who had suffered nasomaxillary injury at least 8 years earlier as a result of physical beating, were studied with the use of photographs and architectural craniofacial lateral cephalometric radiographic analysis. The architectural craniofacial analysis of Delaire produced a graphic representation of the resultant maxillofacial deformities rather than a description of the deformities in terms of deviation from a statistical mean. Traumatic injury to the nasomaxillary complex provides an experimental model that implicates the role of the cartilaginous nasal septum and local functional conditions in the growth of the nasomaxillary complex. The importance of the functional premaxillary skeletal unit in balanced facial growth allows better understanding of the pathophysiology of malformation of this region.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/7. osteoradionecrosis of the maxilla and skull base.osteoradionecrosis of the maxilla and base of skull are rare phenomena, usually seen after combined therapy for malignancies of the maxillary sinus. While the mandible is most commonly affected by osteoradionecrosis, the maxilla and skull base may also be affected when preoperative or postoperative radiotherapy is combined with surgery. Contributing factors may be: high radiation dosage delivered to the treatment volume (greater than 6000 rads), loss of tissue protective effects due to surgery, decreased vascularity caused by surgery and radiation, and proximity of a contaminated field. Onset of symptoms may vary. One patient presented 25 years after postoperative radiotherapy. Major symptoms were pain, trismus, and purulent discharge. The best diagnostic modality remains the history and physical exam, as the area is readily accessible. CT scans may be helpful in diagnosis and treatment planning. Therapy should follow time honored principles of local wound care. Home irrigations and hyperbaric therapy have been helpful in encouraging early sequestration and rapid healing.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/7. chiropractic management of capsulitis and synovitis of the temporomandibular joint.Localized inflammatory conditions (eg, synovitis and capsulitis) of the temporomandibular joint are commonly seen in clinical practice. Regardless of their frequency of occurrence, these conditions must be differentially diagnosed from conditions that also may cause pain in the temporomandibular joint region. Capsulitis or synovitis should be considered if such pain is present and historical, physical, and laboratory findings do not indicate a referred pain phenomena or systemic, tumorous, or infectious involvement. This article reviews the clinical characteristics, etiology, physical examination methods, treatment, and prognosis for capsulitis and synovitis, and three cases that illustrate these conditions are reported.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |