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Facial Plastic Surgery Clinics of North... Feb 2022A dentoalveolar fracture requires thorough clinical and radiographic examination for an accurate diagnosis to guide appropriate treatment. Dentoalveolar fractures can be... (Review)
Review
A dentoalveolar fracture requires thorough clinical and radiographic examination for an accurate diagnosis to guide appropriate treatment. Dentoalveolar fractures can be classified into the following 4 groups: (1) crown/root fractures, (2) luxation/displacement of teeth, (3) avulsion, and (4) alveolar fractures. Treatment can be divided into nonrigid fixation (splinting with wires and composite) and/or rigid fixation (Erich arch bars, Risdon cable wires) depending on the extent of dentoalveolar fractures. Special considerations must be made for primary teeth and mixed dentition to avoid injuring tooth buds and arising permanent dentition.
Topics: Humans; Skull Fractures; Tooth Avulsion; Tooth Fractures
PubMed: 34809882
DOI: 10.1016/j.fsc.2021.08.010 -
Oral and Maxillofacial Surgery Clinics... Nov 2023Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols... (Review)
Review
Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
Topics: Adult; Child; Humans; Facial Bones; Fracture Fixation; Skull Fractures
PubMed: 37280142
DOI: 10.1016/j.coms.2023.04.006 -
The British Journal of Oral &... Jun 2022Maxillofacial injuries sustained playing sports are becoming increasingly common, and in the UK where football is the most popular team sport, associated maxillofacial...
Maxillofacial injuries sustained playing sports are becoming increasingly common, and in the UK where football is the most popular team sport, associated maxillofacial injuries are a regular occurrence. This study retrospectively examined data on patients who were referred with facial injuries sustained playing football between 2007 and 2019 (n = 265). Demographics, mechanism of injury, diagnosis, and treatment received were analysed. The mean (SD) age was 25 (11.0) years (range 3-85) and there was a strong male predominance (n = 256, 97% male). Facial fractures were diagnosed in 143 (54%) patients. The most common injury was a midface fracture and the most common mechanism of injury was a clash of heads. Patients with a facial fracture were significantly more likely to have sustained a concurrent head injury (p = 0.006). Those who were elbowed or punched were significantly more likely to have a facial fracture than a soft tissue or dentoalveolar injury (p ≤ 0.05). Players who clashed heads were significantly more likely to have a midface fracture (p ≤ 0.001). In conclusion, football-related maxillofacial injuries predominantly affect young adult males following a clash of heads. An elbow or punch to the face carries a significant risk of facial fracture and concurrent head injury. Therefore, to reduce the percentage of maxillofacial injuries seen in this sport, observed intentional contact between players, using an elbow or fist to the face in particular, must continue to carry the highest sanction.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Athletic Injuries; Child; Child, Preschool; Craniocerebral Trauma; Female; Football; Humans; Male; Maxillofacial Injuries; Middle Aged; Retrospective Studies; Skull Fractures; Young Adult
PubMed: 35027217
DOI: 10.1016/j.bjoms.2021.10.002 -
Der Radiologe Aug 2021Basilar skull fractures are fractures of the lower part of the skull. They make up about 20% of all skull fractures and are mainly caused by high-velocity blunt trauma... (Review)
Review
CLINICAL ISSUE
Basilar skull fractures are fractures of the lower part of the skull. They make up about 20% of all skull fractures and are mainly caused by high-velocity blunt trauma and falls from high heights. Depending on their precise location, they can be divided into frontobasal, laterobasal and frontolateral fractures. Possible clinical signs are the presence of cerebrospinal fluid rhinorrhea or otorrhea, periorbital ecchymosis (raccoon eyes), retroauricular ecchymosis (battle sign) and cranial nerve injuries. Furthermore, fractures of the petrous bone can lead to a conductive hearing loss, sensorineural hearing loss as well as dizziness and nausea due to a failure of the labyrinth.
PRACTICAL RECOMMENDATIONS
If there are any clinical signs of a basilar skull fracture, neurological deficits or limited consciousness (GCS < 15), a CT should be performed to rule out a basilar skull fracture and accompanying pathologies. In addition, if vascular injury is suspected, a CT angiography should be performed. Treatment is usually interdisciplinary and depends mainly on the accompanying injuries and possible complications. A purely conservative approach with close controls (with imaging) is often sufficient. The surgical approach is primarily used to treat possible complications, for example intracerebral bleeding.
Topics: Diagnostic Imaging; Humans; Petrous Bone; Skull Fracture, Basilar; Skull Fractures; Wounds, Nonpenetrating
PubMed: 34236447
DOI: 10.1007/s00117-021-00879-3 -
Facial Plastic Surgery Clinics of North... Feb 2022This article outlines current methods in the evaluation and management of nasal fractures including clinical workup, imaging, and treatment. (Review)
Review
This article outlines current methods in the evaluation and management of nasal fractures including clinical workup, imaging, and treatment.
Topics: Humans; Nasal Bone; Nasal Septum; Retrospective Studies; Rhinoplasty; Skull Fractures
PubMed: 34809884
DOI: 10.1016/j.fsc.2021.08.002 -
Clinical Imaging Sep 2023Given the demands of a busy high-volume trauma center, trauma radiologists are expected to evaluate an enormous number of images covering a multitude of facial bones in... (Review)
Review
Given the demands of a busy high-volume trauma center, trauma radiologists are expected to evaluate an enormous number of images covering a multitude of facial bones in a short period of time in severely traumatized patients. Therefore, a comprehensive checklist, search pattern, and practical approach become indispensable for evaluation. Moreover, fracture complex classification conveys abundant information in a succinct shorthand fashion, which can be a large asset in a busy high-volume trauma center: reliably helping clinicians communicate urgent findings, make early treatment decisions, and effectively plan surgical approaches. Traditionally, radiologists' approach the CT axial dataset in top-down fashion: navigating their descent craniocaudal. However, a bottom-up approach may be advantageous, especially when it comes to facial fracture complex classification. Four key anatomic landmarks of the face, when evaluated sequentially in bottom-up fashion, are favorable to rapid single-sweep facial fracture characterization: the mandible, the pterygoid plates, the zygoma, and the bony orbits. That is, when done in succession: 1. Clearing the mandible rules out a panfacial smash fracture. 2. Clearing the pterygoid plates effectively rules out a Le Fort I, II, and III fracture. 3. Clearing the zygoma effectively rules out a zygomaticomaxillary complex (ZMC) type fracture. 4. Clearing the bony orbits effectively rules out a naso-orbital-ethmoid (NOE) fracture. Following this process of exclusion and elimination; as one ascends through the face, fracture characterization becomes more manageable and straightforward. Besides identifying all of the fractures and using the appropriate classification system, the radiologist also needs to recognize key clinically relevant soft tissue injuries that may be associated with facial fractures and thus should address these in the report.
Topics: Humans; Tomography, X-Ray Computed; Skull Fractures; Facial Bones; Ethmoid Bone; Orbit
PubMed: 37379713
DOI: 10.1016/j.clinimag.2023.06.015 -
The Journal of Craniofacial Surgery Jun 2020Panfacial fracture represent a challenge for maxillofacial surgeons due to paucity of useful landmark and stable bone that can be used for fixation. Nowadays, with the...
INTRODUCTION
Panfacial fracture represent a challenge for maxillofacial surgeons due to paucity of useful landmark and stable bone that can be used for fixation. Nowadays, with the availability of rigid and semi rigid fixations, understanding of the importance of the facial buttresses, bone grafting, and early intervention, the functional and cosmetic outcomes showed a significant improvement. Many treatment sequences exist in the literature including top to bottom, bottom to top, lateral to medial, and medial to lateral approach.
AIM OF THE STUDY
To evaluate the outcome of "bottom to top, lateral to medial" sequence that we used in the management of panfacial fractures in term of function and cosmesis.
PATIENTS AND METHODS
This study included 73 patients with panfacial fractures admitted to the Maxillofacial and Plastic Surgery Department, Alexandria University.
RESULTS
Most of the patients (n = 52, 71.23%) were aged between 21 and 40 years old. 83.56% (n = 61) of patients were male. Road traffic accidents was the most common cause of trauma (n = 57). The most common site involved in panfacial fracture was the middle and lower third (58%). The common complication observed was malocclusion (n = 6). Of these, 5 patients had minor malocclusion that was corrected orthodontically and only one patient required surgical intervention.
CONCLUSION
The "bottom to top, lateral to medial' sequence for reduction and fixation of panfacial fractures is reliable with satisfactory results in term of function and cosmesis.
Topics: Adult; Bone Transplantation; Facial Bones; Female; Humans; Male; Plastic Surgery Procedures; Skull Fractures; Young Adult
PubMed: 32049920
DOI: 10.1097/SCS.0000000000006208 -
Oral and Maxillofacial Surgery Clinics... Nov 2023Cranial vault and skull base fractures in children are distinctly different from those seen in adults. Pediatric skull fractures have the benefit of greater capacity to... (Review)
Review
Cranial vault and skull base fractures in children are distinctly different from those seen in adults. Pediatric skull fractures have the benefit of greater capacity to remodel; however, the developing pediatric brain and craniofacial skeleton present unique challenges to diagnosis, natural history, and management. This article discusses the role of surgical treatment of these fractures, its indications, and techniques.
Topics: Adult; Child; Humans; Skull Fractures; Skull Base; Skull
PubMed: 37442667
DOI: 10.1016/j.coms.2023.04.008 -
Oral and Maxillofacial Surgery Clinics... Nov 2023Pediatric nasal bone and septal fractures represent a large number of craniofacial injuries in children each year. Due to their differences in anatomy and potential for... (Review)
Review
Pediatric nasal bone and septal fractures represent a large number of craniofacial injuries in children each year. Due to their differences in anatomy and potential for growth and development, the management of these injuries varies slightly from that of the adult population. As with most pediatric fractures, there is a bias toward less-invasive management to limit disruption to future growth. Often this includes closed reduction and splinting in the acute setting followed by open septorhinoplasty at skeletal maturity as needed. The overall goal of treatment is to restore the nose to its preinjury shape, structure, and function.
Topics: Adult; Child; Humans; Nasal Bone; Nasal Septum; Rhinoplasty; Skull Fractures; Fractures, Bone
PubMed: 37302947
DOI: 10.1016/j.coms.2023.04.005 -
Otolaryngologic Clinics of North America Dec 2023The pediatric patient population has unique anatomic characteristics that bring challenges and increased risk to management. The purpose of this article is to guide the... (Review)
Review
The pediatric patient population has unique anatomic characteristics that bring challenges and increased risk to management. The purpose of this article is to guide the head and neck trauma surgeon in decision making for the treatment of pediatric head and neck trauma with an emphasis on facial fracture management.
Topics: Humans; Child; Skull Fractures; Retrospective Studies
PubMed: 37460373
DOI: 10.1016/j.otc.2023.05.012