Cases reported "Facial Injuries"

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11/52. Pre-expanded arterialised venous free flaps for burn contracture of the cervicofacial region.

    Despite the fact that arterialised venous flaps provide thin good-quality tissue to repair defects of the face and neck, their clinical applications have been limited by an unstable postoperative course and variable flap necrosis. In an effort to resolve these problems, a tissue-expansion technique has been applied to the arterialised venous flap before flap transfer. Three pre-expanded arterialised venous free flaps have been used to treat post-burn scar contracture of the cervicofacial region. The donor site was confined to the forearm in each case. A rectangular expander was usually placed over the fascia of the flexor muscles in the proximal two-thirds of the forearm. The mean expansion period, volume and flap size were 44 days, 420 cm(3)and 147 cm(2), respectively. There were no complications caused by insertion and expansion. The cervicofacial region was successfully reconstructed, after excision of the post-burn contractures, with pre-expanded arterialised venous flaps, with no marginal necrosis or postoperative instability. Large thin arterialised venous flaps are well matched with the recipient defect in the cervicofacial area and the colour and texture match obtained with forearm tissue produced an aesthetically favourable result. Pre-expanded arterialised venous flaps are another new option for free flap reconstruction of the face and neck.
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ranking = 1
keywords = operative
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12/52. 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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ranking = 0.5
keywords = operative
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13/52. Delayed post-traumatic subdural empyema.

    A case of subdural empyema is reported, treated through a frontal bone flap, with exenteration of the infected frontal sinus at operation, and subdural instillation of antibiotics for 48 hours postoperatively. Diagnostic findings are reviewed, and the likelihood of anaerobic infection this case and similar cases discussed.
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ranking = 0.5
keywords = operative
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14/52. The use of the C-Arm in reduction of isolated zygomatic arch fractures: a technical overview.

    Isolated zygomatic arch fractures account for approximately 10% of all zygoma fractures. Numerous techniques have been described to reduce these fractures using a variety of approaches. Successful reductions are often difficult to evaluate clinically because of the great amount of swelling that often accompanies these fractures. Postoperative radiographs are often the only way to assess the adequacy of the reduction. This article describes a technique that uses the C-Arm to quickly and accurately evaluate the reduction intraoperatively so that appropriate corrections can be made. A case report of a patient who suffered multiple orthopedic injuries and a w-shaped depressed fracture of the left zygomatic arch is presented. The C-Arm can obviate the need for intraoperative radiographs that, due to technician and film processing delays, add significantly to operative time.
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ranking = 2
keywords = operative
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15/52. Posttraumatic scar revision: a review and case presentation.

    Scar revision is a well-established procedure, but the achievement of satisfying long-term results may present a challenge. An appropriate initial management of wounds is of importance, since it has a role in determining the degree of revision required postoperatively. In addition to the conventional treatment and maturation of the scar tissue, a combination of procedures are now available which may alter the appearance of the final scar. Scar revision, followed by wound care that consists of silastic sheeting, steroid injection, and laser skin resurfacing with carbon dioxide laser (CO2), may be used as adjuncts to achieve camouflage of facial scars. Two case reports are presented to document the procedure, followed by treatment evaluation and protocol.
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ranking = 0.5
keywords = operative
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16/52. Orbitocraniofacial gunshot wounds: craniofacial reconstruction and preparation of the anophthalmic socket.

    This article is a retrospective clinical and radiographic analysis of four patients who survived high caliber orbitocraniofacial gunshot injuries. Early multidisciplinary craniofacial reconstruction included repair of comminuted orbital fractures with multiple autogenous bone grafts and/or porous polyethylene implants, enucleation, and insertion of a hollow silicone sphere as an anophthalmic socket implant. Migration of the silicone implant occurred in one case, requiring replacement with an autogenous dermis fat graft. There were no cases of extrusion or infection. Socket motility remained limited in all cases, despite reapposition of the extraocular muscles. In two cases with autogenous bone grafts along the orbital roof, there was no radiographic evidence of graft resorption after three years. Soft tissue volume deficiency and superior sulcus deformity developed in the three cases which were followed for more than six months. Despite these limitations, all four patients are wearing comfortable ocular prostheses. The postoperative results support immediate preparation of the anophthalmic socket after craniofacial reconstruction of these injuries.
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ranking = 0.5
keywords = operative
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17/52. 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.
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ranking = 0.5
keywords = operative
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18/52. Perioperative risk factors for posterior ischemic optic neuropathy.

    BACKGROUND: infarction of the optic nerve posterior to the lamina cribrosa, called posterior ischemic optic neuropathy (PION), is a condition that can result in profound bilateral blindness. Cases of PION treated at this institution and those described in the literature were analyzed to identify clinical features that profile those individuals at risk of PION in an attempt to identify major contributing factors that could be addressed prophylactically to enable effective prevention. STUDY DESIGN: Salient clinical features in seven cases of PION diagnosed at the Doheny eye Institute between 1989 and 1998 are compared with 46 cases of PION reported in the literature. RESULTS: In the Doheny series there were six men and one woman aged 12 to 66 years (mean, 47 years). Five patients were status-post spine surgery, one was status-post knee surgery, and one had a bleeding stomach ulcer. Vision loss was simultaneously bilateral in six of seven patients (85.7%) and was apparent immediately after surgery. There were no abnormal retinal or choroidal findings including diabetic retinopathy, in any of the patients. Notable contributing factors were blood loss in all seven patients, ranging from 2,000 to 16,000 mL, with a drop in hematocrit of 9.5% to 19% (mean, 14%), and intraoperative systemic hypotension in all patients. Facial edema was a factor in three of six spine surgery patients (50%). patients reported in the literature had a mean age of 50 years and were also predominantly men (34 of 46, 74%) who underwent spine surgery (30 of 46, 65.2%). CONCLUSIONS: Middle-aged men undergoing spine surgery with prolonged intraoperative hypotension and postoperative anemia and facial swelling are at risk of developing PION from hypovolemic hypotension. Avoiding or immediately correcting these contributory factors can reduce the incidence of PION.
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ranking = 3.5
keywords = operative
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19/52. Facial reconstruction after a complicated gunshot injury.

    Facial gunshot injuries are unusual and complicated clinical entities. Because of the mechanism of injury, early aggressive primary reconstruction might not be ideal. Initial conservative management followed by staged secondary reconstruction could be performed to obtain satisfactory functional and aesthetic results. Reconstruction of the cranio-maxillo-facial deformities requires a multi-disciplinary approach, the same way as for patients with cleft lip/palate deformities. We present a male patient with severe facial gunshot injuries. A team approach revealed maxilla recession, dental malocclusion, a large oronasal fistula over his hard palate, velopharyngeal insufficiency, and a stable psychosocial status. His main concern was facial appearance, which included the nose, lip, and scars. Staged reconstructions were performed, consisting of orthognathic surgery, rhinoplasty, lip-switch flap, and revisions of scars. A satisfactory outcome was obtained. The results indicated the importance of preoperative evaluation and treatment planning for this uncommon problem.
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ranking = 0.5
keywords = operative
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20/52. Usefulness and limitations of artificial dermis implantation for posttraumatic deformity.

    We have previously reported the use of artificial dermis implantation to cover exposed major vessels and to correct a depressed region after tissue resection and bone deformity with satisfactory results. In this paper, we present cases with depressed lesions and adhesive lesions after trauma, treated with artificial dermis implantation. Artificial dermis (Terudermis, Terumo Co. Ltd., tokyo, japan) was implanted in 12 cases of posttraumatic deformity. Eight of the 12 cases involved a depressed lesion, and the other four involved adhesive lesions. There was no postoperative infection or allergic reaction in any of the patients. Improvement of the deformity was obtained in all cases, but the degree of volume reduction in traumatic cases is likely to be more severe than that in the non-traumatic cases previously reported. In conclusion, artificial dermis implantation is an easy, safe, and useful method to correct a posttraumatic deformity, such as a depression or an adhesion, although it is important to note that depressions require overcorrection in order to obtain satisfactory results, as compared with non-traumatic cases treated with artificial dermis.
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ranking = 0.5
keywords = operative
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