| Deep burns to the face and lips often lead to the formation of scar tissue and contracture of the perioral tissues with marked reduction of the ability of the patient to open his mouth. The mouth tends to be turned into a wrinkled, rigid, unyielding structure, resembling the semi-rigid mouth of the fish. Such burns are most frequently caused by electricity or flames, and less frequently by chemical substances. The deformity caused by microstomia is painful both to the patient and to his family. Additionally, there is serious functional loss, it is practically impossible to smile, speech becomes difficult, and the movement of the mandible is limited. In severe cases feeding has to be performed with a straw. oral hygiene is compromised and access for the administration of dental care is impossible, hence limited to extractions. Techniques to prevent or, if not prevented, surgically correct the resultant microstomia are described, followed by a case report on a pediatric patient, whose microstomia was surgically corrected several years following the injury. ( info) |
2/477. diabetes insipidus caused by craniofacial trauma. A patient is presented with diabetes insipidus secondary to craniofacial trauma. diabetes insipidus can occur in any patient within ten days of craniofacial trauma. Even the masked disease in the unconscious patient can be diagnosed by observation of intake and output, urinary specific gravities, and appropriate chemical studies. The disease can recur following operative reduction of facial fractures. diabetes insipidus can be successfully treated by intramuscular Pitressin and appropriate fluid intake. ( info) |
3/477. Some missile injuries due to civil unrest in northern ireland. Some missile injuries are reviewed after nearly 8 years of continuous warfare. A feature of many of these injuries is the early admission to hospital which has had a profound effect on the survival rate and the recovery period. Some examples are given of injuries inflicted by rubber bullets. The effects of wounding by low and high velocity missiles are described and examples given. An injury caused by a missile incorporated in a bomb is also shown. ( info) |
4/477. 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. ( info) |
5/477. Induced hypothermia: electrocardiographic abnormalities. hypothermia was induced intermittently in a patient to combat hyperpyrexia. The electrocardiogram taken during the hypothermic phase displayed typical abnormalities and consisted of: pronounced sinus bradycardia, marked prolongation of the Q-T interval, muscle tremor artifact, and the characteristic "Osborn wave." Spontaneous rewarming resulted in disappearance of the electrocardiographic alterations, underscoring the functional and reversible nature of the abnormalities. ( info) |
6/477. Self-inflicted shotgun injuries to the face: a case report. Shotgun injuries to the face are difficult to care for due to the often massive tissue and bone destruction and the complications that can accompany these injuries. Psychological responses from the family, significant other, and nursing staff in dealing with disfiguring and sometimes fatal injuries are additional challenges that nurses will face. ( info) |
7/477. death due to concussion and alcohol. We encountered 5 deaths following blunt trauma to the face and head in which the injuries were predominantly soft tissue in nature with absence of skull fractures, intracranial bleeding, or detectable injury to the brain. All individuals were intoxicated, with blood ethanol levels ranging from 0.22 to 0.33 g/dl. We feel that in these deaths, ethanol augmentation of the effects of concussive brain injury, with resultant posttraumatic apnea, was the mechanism of death. ( info) |
8/477. The intubating laryngeal mask for maxillo-facial trauma. We report the successful use of the intubating laryngeal mask airway in a patient with maxillo-facial trauma for whom the facemask and laryngoscope were relatively contraindicated and the fibreoptic scope potentially difficult to use. ( info) |
9/477. lightning strikes at a mass gathering. Among natural disasters, lightning is a leading cause of morbidity and mortality throughout the world. A well-informed bystander and an astute physician can make the difference between an outcome of death or lifelong disability versus complete or near-complete recovery. What is done in the first few minutes after such an event is the predominant predictor of success. This case report describes a young woman who was struck by lightning while talking on a cellular telephone at a mass gathering in an outdoor stadium. The discussion that follows the case centers on the pathophysiology of being struck by lightning and on issues unique to being struck in a stadium full of people. ( info) |
10/477. Oral electrical and thermal burns in children: review and report of case. Oral burns in children, whether electrical or thermal, can result in severe local and systemic complications. Use of an oral burn splint following perioral electrical burns in children is a widely accepted treatment. It is felt that these appliances reduce oral scarring and, in some cases, may eliminate the need for future surgical procedures. These appliances, however, can also be beneficial in case of thermal burns in children. ( info) |