1/4. An extraction complicated by lateral and medial pterygoid tethering of a fractured maxillary tuberosity.We report a case in which the extraction of an upper second molar was complicated by a maxillary tuberosity fracture. Delivery of the tooth and bone fragment under local anaesthesia was unable to be achieved because of pain, brisk bleeding and tethering by the lateral and medial pterygoid muscles. The eventual removal of the fragment under general anaesthetic required the control of haemorrhage deep within the infratemporal fossa. When this complication is recognised by the general dentist the maxillary tuberosity should not be removed and the patient referred to a specialist unit.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/4. Combined cranio-facial fractures.Clinically, fronto-maxillary injuries may constitute a diagnostic problem, as their severity need not correlate with the patient's general condition. To establish a definitive radiological diagnosis, both normal standard films and tomographs are required. These will help to identify fracture lines involving the base of the skull. Most serious among the complications which may be associated with fronto-maxillary injuries is the occurrence of cerebrospinal rhinorrhoea with potential ascending infection. Other complications include oculomotor dysfunction, obstruction of lacrimal drainage and nasal airways as well as dental malocclusion. Primary surgical management is indicated in compound fractures, suspected intracranial haemorrhage and compression of the optic nerve, while fractures with associated dural injuries and involvement of orbital roofs as well as all other combined maxillo-facial fractures with functional impairment require early secondary management. Open exposure of the fracture site is best obtained through a coronal hair-line incision. Dural injuries are preferentially approached through craniotomies.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
3/4. Traumatic aneurysm of the maxillary artery: the role of interventional radiology. A report of two cases.Two cases of post-traumatic aneurysm of the maxillary artery are described. The first patient was a 20-year-old man who sustained a Le Fort III type fracture in a road traffic accident. He experienced two episodes of significant maxillofacial haemorrhage, the first following admission and the second 5 days after initial reduction and fixation of his midfacial fractures. The second patient was a 23-year-old man with a bilateral cleft palate and extreme midfacial hypoplasia who underwent Le Fort I osteotomy. Significant bleeding commenced 3 h postoperatively and was not completely controlled by anterior and posterior nasal packing. Both the aneurysms were diagnosed on selective carotid angiography and successfully treated by embolization.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
4/4. Nasopharyngeal cavity narrowing associated with posterior maxilla and pterygoid plate fracture: report of three cases.The CT appearances of three cases with severe nasopharyngeal cavity narrowing are described. In all cases the facial trauma was due to a motor vehicle accident. These cases demonstrate that posterior maxilla and pterygoid plate fractures can cause significant nasopharyngeal soft tissues swelling, most likely due to haemorrhage and/or oedema. Severe nasopharyngeal cavity narrowing could cause difficulty in elective nasogastric tube and endotracheal tube intubation via the nasopharyngeal route.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |