Cases reported "Facial Injuries"

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1/31. skin and soft tissue artifacts due to postmortem damage caused by rodents.

    Five cases of postmortem bite-injuries inflicted by rodents are presented (five males between 41 and 89 years; three cases caused by mice, one case by rats, one case of possible mixed rodent activity by rats and mice). The study presents a spectrum of phenomenological aspects of postmortem artifacts due to rodent activity to fresh skin and soft tissue: the majority of the injuries have a circular appearance. The wound margins are finely serrated with irregular edges and circumscribed 1-2 mm intervals within, partly showing protruding indentations up to 5 mm. Distinct parallel cutaneous lacerations deriving from the biting action of the upper and lower pairs of the rodents incisors are diagnostic for tooth marks of rodent origin but cannot always be found. No claw-induced damage can be found in the skin beyond the wound margins. Areas involved in the present study were: exposed and unprotected parts of the body, such as eyelids, nose and mouth (representing moist parts of the face); and the back of the hands. Postmortem rodent activity may occasionally be expected on clothed and therefore protected parts of the body. The phenomenon of postmortem rodent activity to human bodies can be found indoors especially under circumstances of low socioeconomic settings; outdoors this finding is particularly observed among fatalities among homeless people.
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2/31. 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).
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3/31. Unusual parotid gland foreign body.

    A foreign body in the parotid gland whether from the oral cavity or through the skin is extremely uncommon. A case is described of the tip of a golden-colored pencil accidentally piercing the deep lobe after a fall. Emergency surgical removal was performed, and the diagnosis of the foreign body was quite easy. In contrast, determination of the location in the gland had to be done by a microscope, with fluoroscopy during the operation and was quite difficult. During removal, great attention was paid to avoiding facial nerve injury. This was done by identifying the facial trunk at the pointer using a microscope. The dissolved material including copper and zinc metal powder, paste, and clay, was found in the deep lobe associated with the surrounding abscess. Although these materials are assumed to be harmless to human tissues, the complete and immediate removal is to prevent salivary fistule resulting from inflammation.
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4/31. zinc burns: a rare burn injury.

    A patient was presented with significant burns resulting from a workplace accident in a zinc production unit. This occurred as a result of the spontaneous combustion of zinc bleed under high pressure. The patient sustained burns to the face, body, and hands and suffered significant injury to the left cornea. Computed imaging revealed solid particles in the ethmoid sinus and also in the right nasal fossa, dissecting the right lacrimal duct. Photographic documentation is presented. This injury was potentially preventable and resulted from poor observance of safety procedures.
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5/31. Wooden foreign bodies in facial injury: a radiological pitfall.

    foreign bodies can present a diagnostic challenge to the maxillofacial surgeon. Three patients, who suffered from a penetrating injury with a wooden foreign body, were examined and treated. Their preoperative CT and MRI scans were evaluated. In an acute case, the penetrating wooden body mimicked air bubbles. In the other two patients, the wood was retained for several months and appeared with a much higher density on CT. In MRI the wooden foreign bodies gave a low signal intensity. In all injuries removal of the foreign body was delayed, because it was initially radiologically missed or misdiagnosed. In the appropriate trauma setting a penetrating wooden body must always be considered. Its attenuation value increases with time as water is absorbed from the surrounding tissues. Although the radiological appearance may show a great variety, CT imaging is the basic diagnostic technique. MRI is the method of second choice.
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6/31. An unusual mode of injury-implantation of a broken toothbrush medial to ramus: report of a case.

    Impalement injury and implantation of a foreign body in the oral cavity is common in young children. Typically the child falls with the foreign body in the mouth resulting in implantation of the object at various sites in the oral cavity. It is quite unusual to have the head of a toothbrush with bristles implanted fully in the soft tissue medial to the ramus, in the region of pterygomandibular space, following an injury with a cricket ball without a history of fall. A case of an unusual foreign body implanted at an unusual site by an unusual injury is being presented.
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7/31. Use of surface scanning for creation of transparent facial orthoses. A report of two cases.

    OBJECTIVE: To introduce the advantages of surface scanning over conventional burn mask construction to produce better fitting transparent facial orthoses (TFO). DESIGN: Two case reports. SETTING: Regional burn center. PARTICIPANTS: Two burn survivors who sustained 25% and 82% total body surface area second and third degree flame burns, respectively. DESCRIPTION: A 50-year-old male who sustained 4.5% second and third degree facial burns and a 41-year-old female who sustained 6% second and third degree facial burns during the World Trade Center were fitted with a digitally produced TFO approximately 4 months after injury. After the patients were scanned, the images were edited to smooth existing scars and replicated as a mold through which the healing process was observed. RESULTS/DISCUSSION: Facial burns represent many psychological and rehabilitation challenges. We recommend the use of a digitally produced device in patients with severe facial burns who require constant pressure to minimize hypertrophic scarring and to improve cosmesis. Scar management studies have shown that surface scanning results in a better fitting mask than conventional fabrication, without the labor-intensive, time-consuming, and imprecise process, which may delay treatment effects. The conventional process is slow and anxiety-provoking, especially for children, who often require anesthesia. In contrast, the head scanner rotates 360 degrees around the pateint's head, painlessly and accurately capturing the profile and contour of the face in 7s. Since the procurement of this scanner, our two patients, as well as many other burn victims, have greatly benefited from the creation of face masks utilizing this equipment. We believe that all rehabilitation professionals caring for burn patients should be aware of this new technology.
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8/31. Fatal and non-fatal injuries caused by crossbows.

    Today in modern times, traumatic injuries caused by crossbows are a rarity. The largest collection of cases so far is presented in this study, consisting of four fatalities (two homicides and two suicides) and two non-fatal injuries (grievous bodily harm and an accident). All the victims were male having an age between 31 and 54. The weapons, which were used, were mainly high-performance precision crossbows with telescopic sights and hunting bolts. The parts of the body involved were the facial/head area in three of the cases and the thorax in three of them. There were either deep or total penetration injuries to the cranium and thorax with the bolt remaining in the wound in four out of six cases. The persons with non-fatal crossbow injuries exhibited comparatively few symptoms, despite the sometimes extensive involvement of the interior of the cranium (cerebrocranial penetration, in one instance). The two cases of suicide favoured the body areas often found with gun-users. The aetiological classification of crossbow injuries may be difficult after the removal of the bolt. The external morphology is strongly dependent on the type of tip used. Multiple-bladed hunting broadheads produce radiating incised wounds, whereas conical field tips produce circular to slitlike defects. Correspondingly, the external injuries can be reminiscent of the effects of a violent attack by sharp force or of a gunshot wound. The possibility, supported by clinical data, that the victim might have the ability to act or even to survive for a period of time, even with penetration of the brain, should be taken into account when the cause of death is being investigated.
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9/31. Cervical impalement injury.

    Impacted injuries of the head and neck are uncommon. Associated injuries can be present and can be a serious problem. We present an unusual clinical case and discuss the management of this complex injury. Head and neck injuries deserve special attention because of their enormous functional and esthetic significance. Contusion, abrasion, retained foreign bodies, laceration, and avulsion are some of the most frequent injuries. Impalement injuries are not so common. These lesions combine aspects of blunt and penetrating trauma and usually result from penetration by a large, rigid, blunt-tipped object that traverses a certain body area in a through-and-through fashion and often remains in situ at the time of presentation. There have been many case reports describing these injuries in the trunk and extremities; however, cases of head and neck impalement are still lacking in number. A case of an unusual cervical impalement is presented, together with a discussion of the management of this complex injury.
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10/31. Control of massive bleeding from facial gunshot wound with a compact elastic adhesive compression dressing.

    The issue of immediate control of acute external traumatic hemorrhage is poorly dealt with in the medical literature. A compact unit incorporating the desired components capable of applying significant compression over diverse body areas has been suggested in the past but not formally demonstrated effective in practice. In this report we describe the treatment of a young man presenting with a very large, complex, profusely bleeding facial gunshot wound. The calvarium remained intact. The upper airway was diverted and secured by performing a cricothyroidotomy. A transparent elastic adhesive dressing was then applied by covering the anterior aspect of the face by a contact pad followed by sequential wrapping of the roll covering all structures between the forehead and the neck. This procedure successfully controlled the hemorrhage and maintained the victim's condition hemodynamically stable until definitive surgical intervention at the level 1 medical center. We attribute the survival of this victim to the innovative dressing technique and excellent cooperation between the trauma team and hospital staff. This case demonstrates the contribution of elastic adhesive compression dressing towards saving the lives of those inflicted by severely challenging bleeding wounds. We suggest this technique be considered by Emergency personnel working in the prehospital arena in selected cases.
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