1/51. Cranio-cerebral erosion: delayed diagnosis and treatment.Cranio-cerebral erosion is a well-known complication of calvarian fracture with underlying dural tear and cerebral injury in infancy and early childhood. The anatomy, pathogenesis and natural evolution of these lesions remain obscure. The common clinical symptoms are seizures, focal neurological deficits, impairment of consciousness and a soft subgaleal mass. Three patients of cranio-cerebral erosion who underwent delayed surgery in their adult lives are presented to illustrate the common and uncommon features, and their long-term outcome is discussed.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/51. Nasoethmoid orbital fractures: diagnosis and management.BACKGROUND AND OBJECTIVES: Trauma to the central midface may result in complex nasoethmoid orbital fractures. Due to the intricate anatomy of the region, these challenging fractures may often be misdiagnosed or inadequately treated. The purpose of this article is to aid in determining the appropriate exposure and method of fixation. methods AND MATERIALS: This article presents an organized approach to the management of nasoethmoid orbital fractures that emphasizes early diagnosis and identifies the extent and type of fracture pattern. It reviews the anatomy and diagnostic procedures and presents a classification system. The diagnosis of a nasoethmoid orbital fracture is confirmed by physical examination and CT scans. Fractures without any movement on examination or displacement of the NOE complex on the CT scan do not require surgical repair. Four clinical cases serve to illustrate the surgical management of nasoethmoid fractures. RESULTS AND/OR CONCLUSIONS: Early treatment using aggressive techniques of craniofacial surgery, including reduction of the soft tissue in the medial canthal area and restoration of normal nasal contour, will optimize results and minimize the late post-traumatic deformity. A high index of suspicion in all patients with midfacial trauma avoids delays in diagnosis.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
3/51. Orbital deformity after craniofacial fracture repair: avoidance and treatment.BACKGROUND AND OBJECTIVES: To achieve the optimal preoperative appearance following craniofacial fracture repair, the surgeon must be facile in the most sophisticated reconstructive techniques and able to determine their application. The purpose of this article is to describe the common deformities following such repairs, outline a strategy to avoid them, and review the surgical techniques to correct them. methods AND MATERIALS: The deformities are categorized by the anatomic zones of the orbit, i.e., zygomatic, frontal, and nasoethmoidal, affected by low-, middle-, and high-energy impact. The common types of deformity and acute and late treatments are discussed for each category. RESULTS AND/OR CONCLUSIONS: The optimal time to correct posttraumatic orbital deformities is during the acute phase. Extended open reduction and rigid fixation techniques have their own morbidity, which must not outweigh the deformity of an untreated or partially treated injury. The results of late reconstruction are always limited by scarring of the overlaying soft tissue envelope.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
4/51. Management of avulsive injuries of the nasal bones: review of the literature and three case reports.Blunt contusions, lacerations, and avulsion-type trauma are the most often reported nasal injuries sustained in motor vehicle accidents. The nasal skeleton and soft tissues are frequently involved and may require surgical repair of the injuries. The primary reconstruction often requires the use of autogenous grafts, and secondary revision surgery may be necessary. The treatment may require a multidisciplinary surgical team or a single surgeon who knows how to manage the injury. Optimally, the reconstruction of nasal bone avulsions is performed primarily, using autogenous graft materials. This article presents reconstruction of the nasal deformities in 3 patients involved in motor vehicle accidents. The authors describe and evaluate the various graft materials and surgical techniques utilized. The advantages and disadvantages of autogenous and alloplastic materials are discussed. Studies with more patients and long-term follow-up are required for a definitive evaluation.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
5/51. The use of osseointegrated implants in craniofacial trauma.The objective in treating patients with injuries sustained in craniofacial trauma is to reinstate preinjury facial projection and function. The capability of providing spatially related facial reconstruction is predicated on basic craniofacial surgical principles, generally accepted as the standard of care. These principles include early surgical intervention, immediate bone grafting, and the use of internal rigid fixation. The introduction of osseointegrated dental implants has significantly improved the overall reconstruction of patients with cranio-maxillofacial injuries, including soft tissue repair and cosmetic surgery. The purpose of this article is to review the utilization of dental implants in the context of maxillofacial trauma, using three cases to document the clinical procedure.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/51. 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 = 2keywords = soft (Clic here for more details about this article) |
7/51. Self-inflicted gunshot wounds of the lower half of the face: the evolution toward early reconstruction.The self-inflicted gunshot wound of the lower half of the face traditionally has been treated by multistaged and prolonged reconstructive maneuvers that often left significant and uncorrectable secondary deformities. Modern cranio-maxillofacial methods for reduction and rigid fixation of the facial skeleton, using immediate autogenous bone grafts when required, also has been efficacious for the acute management of these severe gunshot injuries. These methods can reduce the previously expected morbidity. Today's improved outcomes also are a consequence of the use of more reliable regional flaps and microsurgical techniques, which permit the early and simultaneous restoration of bone and soft tissue loss once all devitalized tissues have been adequately debrided.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/51. February 2002: 29-year-old woman with a skull mass for 2 months.A 29-year-old woman had a 2-month history of an enlarging lesion over her left frontal bone following minor trauma. CT scan showed an osteolytic lesion with an overlying soft tissue mass, thought to be an unhealed skull fracture with pseudomeningocele. Left frontal craniotomy revealed a soft tissue mass, which was resected. Histologic examination revealed multinucleated giant cells mixed with Langerhan's cells that showed the characteristic "coffee bean nuclei." eosinophils were scant. Immunostaining for CD1a and S100 revealed strong positive staining primarily in the Langerhans' cells while giant cells and inflammatory cells were negative. Immunostaining for CD68, in contrast, stained the osteoclast-like giant cells and macrophages. Electron microscopy confirmed the presence Birbeck granules. The final diagnosis was Langerhans' cell histiocytosis (histiocytosis X) of the skull.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
9/51. head injury by gunshots from blank cartridges.BACKGROUND: Blank cartridge handguns are generally underestimated in their capacity to inflict serious and potentially life threatening injuries. The predominant reasons for these injuries are suicide or suicide attempts, followed by accidental injuries. methods: A series of 26 gas gunshots to the neurocranium is presented. The injury pattern relevant to neurosurgical practice is illustrated in a case summary of 7 selected cases and the clinical courses as well as outcomes are presented. RESULTS: The injury pattern demonstrates that the energy density of the gas jet and the high temperatures of the exploding gas volume cause extensive soft tissue injuries. In close-range shots the gas jet takes on physical properties of a projectile. In these injuries impression fractures and dislocation of bone fragments are common. CONCLUSIONS: Gas handguns, contrary to public opinion, are dangerous weapons and may inflict potentially fatal injuries to the neurocranium when fired at close range. These weapons are frequently used in criminal or careless activities predominantly by young males. Extensive CNS injuries including hematomas, subarachnoid hemorrhage, foreign body contamination, and increased intracranial pressure are frequently observed.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/51. Severe panfacial fracture with facial explosion: integrated and multistaged reconstructive procedures.Midface fractures, especially if related to traffic accidents, represent a remarkable problem from a surgical, psychological, and social standpoint. In trauma dynamics, the pattern of the fractures can extend to all bony fragments and is often associated with soft tissue injuries and loss of bony structures. This can lead to posttraumatic deformities that greatly influence the patient psychologically and limit his social rehabilitation, sometimes permanently. Panfacial trauma includes midface fractures associated with fractures of other areas (i.e., mandible, frontal bone). Orbits and the nasoethmoidal area are often involved with loss of soft tissue and, in severe cases, loss of orbital contents. We report an unusual complex clinical case representative of this kind of pathological profile in which the guidelines described in the literature were followed in the reconstructive procedure.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
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