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Radiologia 2019Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with... (Review)
Review
Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.
Topics: Cochlea; Ear; Ear Canal; Ear Ossicles; Facial Nerve; Facial Nerve Injuries; Humans; Petrous Bone; Skull Fractures; Symptom Assessment; Temporal Bone
PubMed: 30777299
DOI: 10.1016/j.rx.2018.12.005 -
Journal of Cranio-maxillo-facial... Feb 2022The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A...
The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.
Topics: Ear Canal; Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34810109
DOI: 10.1016/j.jcms.2021.11.004 -
Emergencias : Revista de La Sociedad...
Topics: Accidents, Traffic; Attitude of Health Personnel; Brain Injuries; Emergencies; Fractures, Comminuted; Humans; Male; Skull Fractures; Survivors; Sutures; Tissue and Organ Procurement; Young Adult
PubMed: 31347811
DOI: No ID Found -
Annals of Palliative Medicine Apr 2022We conducted a literature review on the epidemiology and emergency nursing care of oral and craniomaxillofacial trauma in order to facilitate rescue and care planning.... (Review)
Review
BACKGROUND AND OBJECTIVE
We conducted a literature review on the epidemiology and emergency nursing care of oral and craniomaxillofacial trauma in order to facilitate rescue and care planning. Traumatic accidents alter oral and craniomaxillofacial anatomy and physiology, resulting in craniomaxillofacial scars and deformities, temporomandibular disorders, and oromandibular dysfunction. Such trauma affects speech, chewing, and eating; results in long hospitalization and burdensome healthcare expenses; and in severe cases may lead to potentially life-threatening complications such as respiratory obstruction and brain injury.
METHODS
EMBASE, MEDLINE, and PubMed were investigated for relevant systematic reviews. By conducting a literature review of reports on oral and craniomaxillofacial trauma to summarize the epidemiological characteristics and emergency care of oral and craniomaxillofacial trauma.
KEY CONTENT AND FINDINGS
Numerous studies, both domestic and foreign, have investigated the epidemiological characteristics of oral and craniomaxillofacial trauma and have reported different incidences of this trauma, with significant inter- and intraregional variation. The studies show that most patients with maxillofacial trauma are young adults, and males consistently outnumber females. Maxillofacial trauma can be physical or chemical, though most are physical injuries, the road traffic accident (RTA) is the leading cause of oral and maxillofacial trauma. Oral and maxillofacial trauma can be simple soft tissue trauma, simple bone trauma, or soft tissue plus bone trauma, the brain injury is the most common concomitant injury of patients with maxillofacial trauma. Different studies have reached different conclusions about the temporal distribution of maxillofacial trauma. Several important emergency care models in the management of oral and craniomaxillofacial trauma have resulted in improved outcomes. These include accurate assessment, effective airway maintenance, careful management. The more common use of virtual surgical planning, surgical navigation, computer-aided surgery and 3D printing will no doubt continue to improve accuracy and efficiency in the management of these patients.
CONCLUSIONS
By conducting a literature review of domestic and foreign reports on oral and craniomaxillofacial trauma to summarize the epidemiological characteristics and emergency care of oral and craniomaxillofacial trauma, we aimed to provide a reference for the rescue and care planning for patients with oral and craniomaxillofacial trauma.
Topics: Brain Injuries; Emergency Nursing; Female; Humans; Male; Maxillofacial Injuries; Retrospective Studies; Skull Fractures; Young Adult
PubMed: 35523757
DOI: 10.21037/apm-21-2995 -
Journal of Feline Medicine and Surgery Feb 2023Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular... (Review)
Review
PRACTICAL RELEVANCE
Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular fracture repair will facilitate evidence-based decision-making in clinical practice.
CLINICAL CHALLENGES
Feline maxillofacial and oral anatomy brings unique challenges in comparison with dogs. It has been commonplace to adapt techniques and equipment that are better suited to other body regions or are species-inappropriate for use in feline maxillofacial surgery, and this has traditionally resulted in high morbidity.
AIMS
This review presents an overview of the diagnosis of, and decison-making for, maxillofacial trauma in cats, specifically with reference to the feline mandible. The challenges associated with the management of these injuries are presented. Techniques for repair that can be employed in general practice, as well as more advanced surgical options, are discussed, as well as the indications for invasive vs non-invasive management. Underutilised methods involving composite dental materials and their versatility for the repair of mandibular fractures in cats, and miniplates for caudal mandibular fractures in cats, are specifically covered, as well as other recent advances in the field, including three-dimensional printing and custom-printed implants.
EVIDENCE BASE
Management of feline facial fractures is an often neglected topic, with very few published studies choosing to focus on head trauma outcomes in cats. Where available, however, this review draws on the published literature, as well as the authors' own clinical experience.
Topics: Animals; Cats; Humans; Craniocerebral Trauma; Dentists; Mandibular Fractures
PubMed: 36744847
DOI: 10.1177/1098612X231152521 -
Emergency Radiology Aug 2022To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV). (Review)
Review
PURPOSE
To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV).
METHODS
A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution's violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns.
RESULTS
The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19-76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients.
CONCLUSION
/advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.
Topics: Adult; Aged; Facial Injuries; Female; Humans; Intimate Partner Violence; Male; Middle Aged; Retrospective Studies; Skull Fractures; Young Adult
PubMed: 35505264
DOI: 10.1007/s10140-022-02052-2 -
Chinese Journal of Traumatology =... Oct 2019A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture...
PURPOSE
A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI.
METHODS
Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided.
RESULTS
A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF.
CONCLUSION
SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.
Topics: Adult; Brain Injuries, Traumatic; Craniocerebral Trauma; Female; Humans; Incidence; Intracranial Hemorrhages; Male; Retrospective Studies; Skull Base; Skull Fractures
PubMed: 31521457
DOI: 10.1016/j.cjtee.2019.05.006 -
Cureus Jul 2018Head injury is the most common cause of neurologic disability and mortality in children. We had hypothesized that in children with isolated skull fractures (SFs) and a...
Head injury is the most common cause of neurologic disability and mortality in children. We had hypothesized that in children with isolated skull fractures (SFs) and a normal neurological examination on presentation, the risk of neurosurgical intervention is very low. We retrospectively reviewed the medical records of all children aged six to sixteen years presenting to our Level 1 trauma center with traumatic brain injuries between January 1, 2006 and December 31, 2014. We also analyzed the National Trauma Data Bank (NTDB) research data set for the years 2012-2014 using the same metrics. During this study period, our center admitted 575 children with skull fractures, 197 of which were isolated (no associated intracranial lesions (ICLs)). Of the 197 patients with isolated SFs, 155 had a normal neurological examination at presentation. In these patients, there were no fatalities and only three (1.9%) required surgery, all for the elevation of the depressed skull fracture. Analyzing the NTDB yielded similar results. In 5,194 children with isolated SFs and a normal neurological examination on presentation, there were no fatalities and 249 (4.8%) required neurosurgical intervention, almost all involving craniotomy/craniectomy and/or elevation of the SF segments. In conclusion, children with non-depressed isolated skull fractures and a normal Glasgow coma scale (GCS) at the time of initial presentation are at extremely low risk of death or needing neurosurgical intervention.
PubMed: 30280073
DOI: 10.7759/cureus.3078 -
Journal of Ayub Medical College,... 2017The presence of skull fracture in patients sustaining traumatic brain injury is an important risk factor for intracranial lesions. Assessment of integrity of dura in...
BACKGROUND
The presence of skull fracture in patients sustaining traumatic brain injury is an important risk factor for intracranial lesions. Assessment of integrity of dura in depressed skull fracture is of paramount importance because if dura is torn, lacerated brain matter may be present in the wound which needs proper debridement followed by water tight dural closure to prevent meningitis, cerebral abscess, and pseudomeningocoele formation. The objective of this study was to determine the frequency of dural tear in patients with depressed skull fractures.
METHODS
This cross-sectional study was conducted at Department of Neurosurgery Ayub Teaching Hospital Abbottabad. All the patients of either patients above 1 year of age with depressed skull fracture were included in this study in consecutive manner. Patients were operated for skull fractures and per-operatively dura in the region of depressed skull fracture was closely observed for any dural tear. The data were collected on a predesigned pro forma.
RESULTS
A total of 83 patients were included in this study out of which 57 (68.7%) were males and 26 (31.3%) were females. The age of the patients ranged from 1-50 (mean 15.71±13.49 years). Most common site of depressed skull fracture was parietal 32 (38.6%), followed by Frontal in 24 (28.9%), 21(25.3%) in temporal region, 5(6.0%) were in occipital region and only 1 (1.2%) in posterior fossa. Dural tear was present in 28 (33.7%) patients and it was absent in 55 (66.3%) of patients.
CONCLUSIONS
In depressed skull fractures, there are high chances of associated traumatic dural tears which should be vigilantly managed.
Topics: Adolescent; Adult; Brain Injuries, Traumatic; Child, Preschool; Cross-Sectional Studies; Dura Mater; Female; Humans; Infant; Male; Middle Aged; Neurosurgical Procedures; Risk Factors; Rupture; Skull Fracture, Depressed; Tomography, X-Ray Computed; Young Adult
PubMed: 28718255
DOI: No ID Found -
Facial Plastic Surgery : FPS Aug 2015Optimal management of patients with traumatic brain injury (TBI) remains a challenge, despite significant improvements in pathophysiologic understanding and treatment... (Review)
Review
Optimal management of patients with traumatic brain injury (TBI) remains a challenge, despite significant improvements in pathophysiologic understanding and treatment strategies in recent decades. Because primary brain injury sustained at the time of trauma is irreversible, the TBI management mainly aims for early detection and treatment of secondary brain injury such as space-occupying intracerebral hematomas and brain edema. Prevention of secondary brain injury requires a high standard of care and understanding of both medical and surgical treatment modalities. This review focuses on practical recommendations for neurosurgical and intensive care management in patients with severe TBI.
Topics: Brain Injuries, Traumatic; Critical Care; Frontal Sinus; Glasgow Coma Scale; Hematoma, Epidural, Cranial; Hematoma, Subdural, Acute; Humans; Skull Fractures
PubMed: 26372706
DOI: 10.1055/s-0035-1562884