1/18. Reconstruction of the horizontal rami of the mandible following avulsion in childhood.A 7-year-old boy was involved in a road traffic accident in October 1971, and apparently had been dragged along face downwards with resultant avulsion of the entire horizontal mandibular rami, and most of the mandibular alveolar soft tissue and teeth. Repair by metal implants was attempted but these proved unsatisfactory, and soft tissue replacement for the missing alveolus was carried out by flap raised from arm. Rib grafting was carried out on three occasions at almost yearly intervals, but each time, probably owing to vascular insufficiency, non-union (or more correctly non-replacement) occurred in the left canine region. To "import" a new blood supply, and free some of the scar tissue, a compound muscle/bone/skin flap bearing the clavicle and sternomastoid muscle was transposed to the mandibular bed. This form of grafting was used extensively in world war i to repair facial gunshot wounds, and the transposed blood supply enabled success in the pre-antibiotic period. Bony union is now satisfactory 5 years after injuries and dentures have been recently fitted; speech is normal, the child's facial contours acceptable, and mastication has been satisfactory during this period.- - - - - - - - - - ranking = 1keywords = gunshot, wound (Clic here for more details about this article) |
2/18. Non-free osteoplasty of the mandible in maxillofacial gunshot wounds: mandibular reconstruction by compression-osteodistraction.We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.- - - - - - - - - - ranking = 5.9778062517452keywords = gunshot, wound (Clic here for more details about this article) |
3/18. Management of a gunshot wound to the face resulting in a mandibular body fracture with burying of a bicuspid crown into the tongue.Gunshot wounds to the maxillofacial region are unpredictable and run the gamut from minor injuries to severe mutilating and life threatening injuries. This patient although unfortunate to have been the victim of mistaken identify resulting in the gunshot wound, was fortunate that the bullet hit his bicuspid, which probably served to deflect its path away from vital structures, thus saving his life. This accounts for the buried bicuspid crown found in the midline of the body of the tongue. Rigid internal fixation of maxillofacial fractures minimizes risks to the airway that may occur if patients are in post-operative maxillo-mandibular fixation during the post-anesthetic recovery phase. In addition, the use of rigid internal fixation speeds up the recovery and the patient's ability to return to function after surgery. Above, we presented an interesting case of a mandibular anterior body fracture resulting from a gunshot wound in the face and resulting in the burying of a bicuspid crown in the substance of the tongue, treated under general nasoendotracheal anesthesia and the use of rigid internal fixation (EDCP).- - - - - - - - - - ranking = 6.0221937482548keywords = gunshot, wound (Clic here for more details about this article) |
4/18. Delayed repair of lip avulsion following gun-shot injury--a case report.A case of delayed repair of lower lip repair tissue avulsion following gun shot injury in a 35 year old commercial driver is presented. The report illustrates the need for adequate wound debridement over a period of time to demarcate viable tissues before surgical reconstruction. It also serves as a reminder of the problems that may be faced in managing facial gun shot injuries in the civilian population in our environment.- - - - - - - - - - ranking = 0.022193748254772keywords = wound (Clic here for more details about this article) |
5/18. Treatment of traumatic mandibular nonunion.BACKGROUND AND OBJECTIVES: Nonunion is a complication in mandibular fractures. The causative factors include delay in treatment, infection, inadequate immobilization, and improper internal fixation; concomitant infection may be present. pain, mobility of the fracture segments, and radiographic evidence of radiolucency did in diagnosis. methods AND MATERIALS: Three clinical cases are used to present the methods of treatment to manage nonunion following a gunshot wound, assault with a blunt object, and a fall. Treatment included antimicrobial therapy, fracture site debridement, segment immobilization, and bone grafting. Maxillomandibular fixation, debridement, and placement of a reconstruction plate were used in the first case; reconstruction plate, autogenous bone graft in a polyglactin resorbable mesh, and screw buttons in the second; and custom reconstruction plate and iliac crest bone graft in the third. RESULTS AND/OR CONCLUSIONS: All cases healed uneventfully. Due to rapid revascularization, use of autogenous cancellous bone grafts is preferred to cortical bone. Custom-molded polyglactin mesh provides control of the loose cancellous bone graft.- - - - - - - - - - ranking = 1keywords = gunshot, wound (Clic here for more details about this article) |
6/18. Traumatic avulsion and reconstruction of the midface.Traumatic loss of midface soft tissue and supporting structures may result in communication between the oral and nasal cavities. Reconstruction requires both oral and nasal lining, as well as supporting structures. The need for multilaminar tissue, as well as the paucity of local tissue, creates a reconstructive challenge. This case report describes the reconstruction of a traumatic defect of the alveolus, hard palate, inferior orbits, and local soft tissues. An intraoperative alginate mold facilitated a three-dimensional understanding of the wound, and allowed translation of an osseomyocutaneous groin flap to reconstruct the defect in one stage.- - - - - - - - - - ranking = 0.022193748254772keywords = wound (Clic here for more details about this article) |
7/18. Miniplate fixation of high condylar fracture and postoperative exercise regimen.The aim of this report is to present three cases of high condylar fracture treated with vertical ramus osteotomy, miniplate fixation of fractured condylar neck, and free grafting. The authors also introduce a simple and easy postoperative exercise regimen. A submandibular incision is made and the ascending ramus divided between the sigmoid notch and the angle of the mandible. After the fragment is removed, the dislocated head of the condyle is readily visible and can be retrieved. The reconstructed osteotomized ramus and condylar head can now be reinserted through the wound and plated. Intermaxillary fixation with arch bar is used. The length of the fixation period is about 14 days after surgery. At the end of this period, the bracket is applied to maxillary incisors, the occlusion becomes stable and reproducible, and then aggressive jaw-opening exercise begins. On postoperative day 21, elastics are applied 24 hours a day. They are placed lightly during the daytime to assist guiding protrusion of the mandible. The patient is instructed to protrude the mandible and to open the mouth simultaneously. The exercise is modified to lateral movement. After the bracket is removed on postoperative day 28, the patient exercises the chin laterally without any guiding elastic fixation for approximately 1 week. This regimen can be widely used in ostectomy-osteosynthesis cases.- - - - - - - - - - ranking = 0.022193748254772keywords = wound (Clic here for more details about this article) |
8/18. Treatment of mandibular fractures by external fixation.This series encompasses thirteen fractures of the mandible treated by external fixation. The indications were five fractures of edentulous mandible, four fractures through missile wounding, and four fractures without soft tissue lesion treated in africa. Twelve patients were found to show good or excellent results. In our indications, this method is a successful approach to the treatment of the fractured jaw.- - - - - - - - - - ranking = 0.022193748254772keywords = wound (Clic here for more details about this article) |
9/18. Internal carotid pseudoaneurysm as a late complication of maxillofacial missile wound.A delayed formation of a pseudoaneurysm of the internal carotid artery occurred secondary to a gunshot wound of the maxillofacial region. Its treatment concurrent with the treatment of a severely comminuted fracture of the mandible has been reported.- - - - - - - - - - ranking = 1.0887749930191keywords = gunshot, wound (Clic here for more details about this article) |
10/18. Pneumomediastinum and cervical emphysema subsequent to mandibular injury associated with a flare pistol shot.Pneumomediastinum in patients with war injuries to the maxillofacial region can be a life-threatening condition. A case is presented of a flare-pistol-shot wound to the mandible which subsequently resulted in cervical emphysema, mediastinal emphysema, and pneumomediastinum, causing a critical condition. Maxillofacial surgeons should be alert to this problem when treating blast or multiple-shell injuries to the maxillofacial region.- - - - - - - - - - ranking = 0.022193748254772keywords = wound (Clic here for more details about this article) |
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