-
Journal of Neuroimaging : Official... 2024Skull lesions in pediatric population are common findings on imaging and sometimes with heterogeneous manifestations, constituting a diagnostic challenge. Some lesions... (Review)
Review
Skull lesions in pediatric population are common findings on imaging and sometimes with heterogeneous manifestations, constituting a diagnostic challenge. Some lesions can be misinterpreted for their aggressiveness, as with larger lesions eroding cortical bone, containing soft tissue components, leading to excessive and, in some cases, invasive inappropriate etiological investigation. In this review, we present multiple several conditions that may present as skull lesions or pseudolesions, organized by groups (anatomic variants, congenital and development disorders, traumatic injuries, vascular issues, infectious conditions, and tumoral processes). Anatomic variants are common imaging findings that must be recognized by the neuroradiologist. Congenital malformations are rare conditions, such as aplasia cutis congenita and sinus pericranii, usually seen at earlier ages, the majority of which are benign findings. In case of trauma, cephalohematoma, growing skull fractures, and posttraumatic lytic lesions should be considered. Osteomyelitis tends to be locally aggressive and may mimic malignancy, in which cases, the clinical history can be the key to diagnosis. Vascular (sickle cell disease) and tumoral (aneurismal bone cyst, eosinophilic granuloma, metastases) lesions are relatively rare lesions but should be considered in the differential diagnosis, in the presence of certain imaging findings. The main difficulty is the differentiation between the benign and malignant nature; therefore, the main objective of this pictorial essay is to review the main skull lytic lesions found in pediatric age, describing the main findings in different imaging modalities (CT and MRI), allowing the neuroradiologist greater confidence in establishing the differential diagnosis, through a systematic and simple characterization of the lesions.
Topics: Humans; Child; Skull; Magnetic Resonance Imaging; Head; Diagnosis, Differential; Hematoma
PubMed: 37933199
DOI: 10.1111/jon.13166 -
Journal of Oral and Maxillofacial... Apr 2024Naso-orbital-ethmoid (NOE) complex fractures present a challenge to repair. The classification system used to categorize the fracture type was established in 1991 based... (Review)
Review
PURPOSE
Naso-orbital-ethmoid (NOE) complex fractures present a challenge to repair. The classification system used to categorize the fracture type was established in 1991 based off the medial canthal tendon attachment. The primary objective was to systematically review the literature outlining repair techniques for NOE fracture after the adoption of the Markowitz classification system.
METHODS
A systematic search was performed in PubMed, Embase, and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on operative techniques used to repair NOE fractures in adult patients after 1991. Two investigators independently reviewed all articles and extracted data. Level of evidence was assessed by Oxford Center for Evidence-based Medicine guidelines.
RESULTS
This review identified 16 articles that met inclusion/exclusion criteria representing 517 patients. One article outlined a closed reduction technique with transnasal wiring. The remaining articles discussed open approaches with various exposure techniques, most common being the coronal incision. Miniplates and screws were most often implemented for rigid fixation as well as transnasal wiring to repair disrupted medial canthal tendon and canthal bearing bone in Type 2 and 3 NOE fractures. Ten of the studies included in this review had a level of evidence of 4.
CONCLUSIONS
NOE fractures present a complex fracture pattern and challenge to repair. New exposure techniques and multidisciplinary approaches have been described. However, fixation techniques have remained relatively consistent through the years. Surgeon preference and comfort with performing the specific techniques leads to the best patient outcomes. With the low level of evidence referenced, more robust research is needed to evaluate these techniques.
Topics: Adult; Humans; Nasal Bone; Orbital Fractures; Skull Fractures; Nose; Eyelids; Ethmoid Bone; Facial Injuries
PubMed: 38215791
DOI: 10.1016/j.joms.2023.12.015 -
Clinical Oral Investigations Oct 2023Since the introduction of miniplate osteosynthesis and the use of prophylactic antibiotics, the complication rate related to the teeth in the fracture gap has...
OBJECTIVES
Since the introduction of miniplate osteosynthesis and the use of prophylactic antibiotics, the complication rate related to the teeth in the fracture gap has significantly decreased. Currently, there are still no established guidelines for the management of such teeth in mandibular fracture lines. However, the long-term viability of these teeth within the fracture gap remains uncertain. Therefore, this study aimed to assess the survival rate of teeth located within the mandibular fracture line and evaluate related follow-up treatments over a minimum period of one year.
MATERIALS AND METHODS
This retrospective study examined 184 patients who underwent surgical treatment for mandibular fractures between January 2018 and December 2021. A total of 189 teeth located in the fracture line were analyzed. Clinical and radiological parameters were collected, including patient age and gender, fracture etiology and location, intraoperative tooth treatment, as well as complications related to both the fracture and the affected teeth in long term.
RESULTS
Most of the examined teeth remained uneventful, with postoperative tooth-related complications seen in 14 (7.4%) teeth. The most common complications were symptomatic apical periodontitis (n = 9, 4.8%) and increased tooth mobility (n = 3, 1.5%). A correlation was found between complications and trauma-related tooth luxation (p = 0.002, OR = 15.2), as well as prior teeth connected to retainers or orthodontic appliances (p = 0.001, OR = 10.32).
CONCLUSION
Tooth-related complications are rare when intact teeth are retained within the fracture gap. Therefore, unless there is a definitive intraoperative indication for extraction, it is recommended to preserve the teeth in the fracture line.
CLINICAL RELEVANCE
Intact teeth in the fracture line of the mandible should not be primarily extracted.
Topics: Humans; Retrospective Studies; Mandibular Fractures; Tooth Extraction; Tooth; Mandible; Postoperative Complications
PubMed: 37610459
DOI: 10.1007/s00784-023-05218-5 -
Scientific Reports Nov 2023Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most...
Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most common cause of death of pedestrians is head injuries, there is a lack of knowledge on the epidemiology and characteristics of head injury in terms of the Glasgow Outcome Scale to be used for prevention. However, this study aimed to determine the epidemiology of pedestrian-motor vehicle accidents, the characteristics of head injury, and differences in the Glasgow Outcome Scale in terms of gender. In this retrospective analytical study, the data of 917 eligible injured pedestrians were obtained from the two databases of the Trauma System and the Hospital Information System. The data were analyzed using SPSS software (Version 21). The mean age of all 917 injured pedestrians was 47.55 ± 19.47 years. Most of the injured pedestrians (42.10%) were in the age range of 41-69 years and 81.31% were male. Moreover, 83.07% did not have any acute lesions on the CT scan. The most common brain lesion was brain contusion (n = 33, 3.60%), subarachnoid hemorrhage (n = 33, 3.60%), and skull fracture (n = 29, 3.16%). Among all concurrent injuries, lower extremity/pelvic injuries were observed in 216 patients (23.56%). Outpatient treatment (n = 782, 85.27%), airway control/endotracheal intubation (n = 57, 6.22%), and resuscitation (n = 35, 3.82%) were the most applied treatments respectively. There were significant differences in the Glasgow Outcome Scale between men and women (P- value = 0. 012). The high rate of mortalities, disability, head injuries, contusion, subarachnoid hemorrhage, and skull fractures in pedestrians involved in MVAs emphasizes the need for developing and implementing prevention strategies including appropriate management and risk reduction. Male pedestrians were at higher risk of motor vehicle accidents and worse Glasgow Outcome Scale. The presented data identified the main types of pedestrian injuries and suggested the importance of adopting appropriate preventive strategies to achieve the most effective interventions for creating a safer community.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Pedestrians; Subarachnoid Hemorrhage; Retrospective Studies; Craniocerebral Trauma; Accidents, Traffic; Skull Fractures; Motor Vehicles; Wounds and Injuries
PubMed: 37985796
DOI: 10.1038/s41598-023-47476-z -
JBMR Plus Nov 2023The incidence of major osteoporotic fractures has declined in men and women in Western countries over the last two decades. Although fracture risk is higher in persons...
The incidence of major osteoporotic fractures has declined in men and women in Western countries over the last two decades. Although fracture risk is higher in persons with diabetes mellitus, trends of fractures remain unknown in men and women with diabetes. We investigated the trends in fracture incidence rates (IRs) in men and women with type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D) in Denmark between 1997 and 2017. We identified men and women aged 18+ years who sustained a fracture (excluding skull and facial fractures) between 1997 and 2017 using the Danish National Patient Registry. We calculated sex-specific IRs of fractures per 10,000 person-years separately in persons with T1D, T2D, or without diabetes. Furthermore, we compared median IRs of the first 5 years (1997-2002) to the median IRs of the last 5 years (2012-2017). We identified 1,235,628 persons with fractures including 4863 (43.6% women) with T1D, 65,366 (57.5% women) with T2D, and 1,165,399 (54.1% women) without diabetes. The median IRs of fractures declined 20.2%, 19.9%, and 7.8% in men with T1D, T2D, and without diabetes, respectively (-trend <0.05). The median IRs decreased 6.4% in women with T1D (-trend = 0.35) and 25.6% in women with T2D (-trend <0.05) but increased 2.3% in women without diabetes (-trend = 0.08). Fracture IRs decreased in men with both diabetes types and only in women with T2D, highlighting the need for further attention behind the stable trend observed in women with T1D. © 2023 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
PubMed: 38025040
DOI: 10.1002/jbm4.10836 -
Medizinische Klinik, Intensivmedizin... Apr 2024Emergency situations involving the ears, nose, and throat (ENT) area can pose considerable challenges for clinicians and often require an interdisciplinary approach due... (Review)
Review
Emergency situations involving the ears, nose, and throat (ENT) area can pose considerable challenges for clinicians and often require an interdisciplinary approach due to the involvement of different organ systems. To avoid damage to highly relevant sensory and perception organs and life-threatening bleeding or respiratory complications, strategies that are as quick and targeted as possible are necessary. This article aims to provide an overview of ENT emergency management strategies. The entire spectrum from simple conservative to highly complex surgical measures plays a role here, both diagnostically and therapeutically. Aspects such as bleeding, respiratory problems, inflammation, hearing disorders, vertigo, facial palsy and injuries to the head and neck area are discussed. In addition, important topics such as preventive measures and possible complications are also addressed to ensure optimal patient care.
Topics: Humans; Emergencies; Inflammation; Nose
PubMed: 38441579
DOI: 10.1007/s00063-024-01114-2 -
The Journal of Craniofacial SurgeryIn our previous study, we classified nasal bone fractures into 6 types based on computed tomography and the patterns of the nasal bone fractures (NBF) in 503 patients...
In our previous study, we classified nasal bone fractures into 6 types based on computed tomography and the patterns of the nasal bone fractures (NBF) in 503 patients treated between 1998 and 2004. In the present study, we analyzed 3785 patients treated between 2005 and 2021. The age, sex, etiology, associated injuries, pattern of fractures, and treatments were reviewed, and radiographic studies were analyzed. The highest incidence was in the age group of 10 to 19 years (N=870, 23.0%), followed by 20 to 29 years (N=792, 20.9%) and 30 to 39 years (N=635, 16.8%). The most common causes of injury were slip or fall-down (42.3%), violence (24.3%), sports (19.2%), traffic accidents (8.9%), and work-related (5.3%). Most of the patients had tenderness (96.1%) and swelling (78.8%). Other findings were depression (27.1%) and nasal deviation (25.8%). Crepitus was heard in only 0.4% of the patients. The patterns of the NBFs classified by computed tomography findings were type IIA (unilateral simple fracture with displacement/without telescoping, 1283 cases, 33.9%), IIB (bilateral simple fracture with displacement/without telescoping, 786 cases, 20.8%), IIAs (unilateral simple fracture with septal fracture and displacement/without telescoping, 566 cases, 14.9%), IIBs (bilateral simple fracture with septal fracture and displacement/without telescoping 530 cases, 14.0%), I (simple fracture without displacement, 522 cases, 13.8%), and III (comminuted with telescoping or depression, 98 cases, 2.6%). In most of the cases (3,666, 96.9%), closed reduction was performed. The present analysis is one of the largest data sets on NBF in Korea, which could provide reference values for diagnosing and managing nasal bone fractures.
Topics: Humans; Child; Adolescent; Young Adult; Adult; Nasal Bone; Skull Fractures; Facial Bones; Fractures, Bone; Fractures, Multiple; Nose Diseases; Retrospective Studies
PubMed: 37439559
DOI: 10.1097/SCS.0000000000009550 -
Children (Basel, Switzerland) Dec 2023The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute... (Review)
Review
BACKGROUND
The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF).
MATERIALS AND METHODS
This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered.
RESULTS
A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies.
CONCLUSIONS
Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.
PubMed: 38136115
DOI: 10.3390/children10121913 -
Frontiers in Immunology 2023There has been an association between changes in body composition, fracture incidence, and age in previous studies. Telomere length (TL) has been proposed as a biomarker...
PURPOSE
There has been an association between changes in body composition, fracture incidence, and age in previous studies. Telomere length (TL) has been proposed as a biomarker of aging. However, the relationship between body composition, fractures, and TL has rarely been studied. Therefore, this study aimed to investigate the correlation between TL and body composition and fractures.Patients and methods: 20950 participants from the 2001-2002 National Health and Nutrition Examination Survey (NHANES) were included in the final analysis. In NHANES, body compositions were measured with DXA, and TL was determined with quantitative PCR. Correlation analysis of TL and body composition was conducted using multivariate weighted linear regression and logistic regression models.
RESULTS
The results showed that TL positively correlated with bone mineral density (BMD) and bone mineral content (BMC) in most body parts. However, BMD and BMC were negatively connected with TL in the upper limbs and skull. Fat content was negatively associated with TL, while muscle content was positively linked to TL. In addition, TL's trend analysis results were consistent with the regression model when transformed from a continuous to a classified variable. An increase in TL was associated with a higher incidence of wrist fractures, while a decrease in spine fractures. The above correlation also has a certain degree of sex specificity.
CONCLUSION
Our study indicate that TL is associated with body composition as well as fractures, but further research is needed to confirm these contrasting associations in the skull, upper limbs, and wrists.
Topics: Humans; Nutrition Surveys; Fractures, Bone; Bone Density; Body Composition; Telomere
PubMed: 37744360
DOI: 10.3389/fimmu.2023.1181544