Cases reported "Skull Fractures"

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1/106. The blood supply of the reverse temporalis muscle flap: anatomic study and clinical implications.

    Although the reverse temporalis muscle flap has been used clinically, the exact vascular connection between the superficial and deep temporal vessels has not been clearly defined. The purpose of this study was to investigate the vascular territory of the reverse temporalis muscle supplied by the superficial temporal vessels. Six cadaver heads were studied using a colored lead oxide injection through the superficial temporal artery. The specimens were examined macroscopically and radiographically. The reverse temporalis muscle flap was then applied to a clinical case presenting with traumatic anterior skull base defect communicating with the nasal cavity. The cadaver specimens demonstrated that the superficial temporal artery formed an average 1.3 /- 0.2 cm in width of dense vascular zone, which was located within 1.8 cm below the superior temporal line. The dense vascular network further perfused the anterior and posterior deep temporal arteries and the muscular branch of the middle temporal artery to supply the temporalis muscle. The mean perfused area of the temporalis muscle was 83 percent, ranging from 79 to 89 percent, in five cadaver heads. One cadaver revealed only 55 percent of perfused area in the absence of the muscular branch of the middle temporal artery. The consistent area without perfusion was located in the distal third of the posterior portion of the reverse temporalis muscle. In clinical cases, the reverse temporalis muscle flap was used successfully to obliterate the anterior skull base defect without evidence of muscle flap necrosis. The exact blood supply to the distal third of the posterior portion of the reverse temporalis muscle flap needs to be investigated further in vivo. Particular attention was paid to the inclusion of the muscular branch of the middle temporal artery in this flap to augment the blood supply to the temporalis muscle.
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keywords = nasal
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2/106. A surgical method for treating anterior skull base injuries.

    skull base surgery was performed on 18 patients with anterior skull base injuries. The operative technique consisted of opening the operative field in the anterior skull base via a coronal incision and a frontal craniotomy, debridement of the anterior skull base including the injured dura mater, performing drainage from the anterior skull base to the nasal cavity by ethmoidectomy, and reconstructing the resulting dural and anterior skull base defect using bilateral temporal musculo-pericranial flaps and a bone graft. Seventeen of the 18 patients recovered without any complications, although epidural abscesses in the anterior skull base had been present in four patients at the time of the operation. Only one patient developed an epidural abscess in the anterior skull base after the operation. None of the patients developed any other complications including meningitis, recurrent liquorrhoea or cerebral herniation. Satisfactory aesthetic results were achieved in 16 of the 18 patients. In one patient, uneven deformity of the forehead, which was caused by the partial sequestration of the frontal bone due to postoperative infection, was observed. In another patient, a depressed deformity of the forehead, which was caused by the partial loss of the frontalis muscle following the use of the frontal musculo-pericranial flap instead of a temporal musculo-pericranial flap, was observed. Anterior skull base reconstruction using bilateral temporal musculo-pericranial flaps provides excellent results in terms of patient recovery and aesthetics.
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keywords = nasal
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3/106. Reduction of nasal orbital fractures and simultaneous dacryocystorhinostomy.

    A technique for restoration of structure and function in naso-orbital fractures has been described. Three case reports demonstrate a few of the final results. The case reports also indicate that many of these fractures require late definitive surgery in spite of optimal surgical treatment immediately subsequent to injury.
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keywords = nasal
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4/106. Human hypersensitivity angiitis: an uncommon cause of death after trauma.

    INTRODUCTION: The article demonstrates, using a case report, that death following an accident may have rarely encountered causes that are not a direct result of trauma and that can only be detected by autopsy. CASE: An unconscious woman aged 57 years was admitted to hospital. Despite immediate surgery for intracranial haemorrhage diagnosed by means of cranial computed tomography, the patient died showing clinical symptoms of circulatory depression after a brief period of stabilisation. The autopsy established myocardial infarction with hypersensitivity angiitis as the cause of death. CONCLUSION: In this case, the authors hold the opinion that the intravenous application of antibiotics during the patient's stay in hospital resulted in hypersensitivity angiitis. The factors causing hypersensitivity angiitis, the morphological picture (clinical, histological) and therapeutic measures are described.
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ranking = 0.24454989116865
keywords = nose
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5/106. The use of nasal endoscopy to control profuse epistaxis from a fracture of the basi-sphenoid in a seven-year-old child.

    A seven-year-old child sustained a fracture of her basisphenoid resulting in profuse, life-threatening haemorrhage which could not be controlled with a post-nasal pack. The fracture site was identified using rigid endoscopy and packed with oxidized cellulose, resulting in immediate control of the haemorrhage. The use of the nasal endoscope in the management of posterior epistaxis is discussed.
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ranking = 6
keywords = nasal
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6/106. Reconstruction of the upper portion of the ear by using an ascending helix free flap from the opposite ear.

    Reconstruction of partial, marginal defects of the ear has been a challenge. The ascending helix free flap based on superficial temporal vessels has been described and used solely to repair nose defects. We used reversed pedicle helical free flap for the repair of a major loss of the upper one-third of the opposite auricle. The method permits the transfer of tissue of the same quality with satisfactory cosmetic result. The equalization of the ears in dimension was accomplished with minimal donor-site deformity.
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ranking = 0.24454989116865
keywords = nose
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7/106. Management of severe postnasal haemorrhage: the Kingsley splint revisited.

    Postnasal haemorrhage accompanying severe craniofacial trauma may have catastrophic consequences if not arrested promptly. The airway has usually been secured and the cervical spine stabilized, but apart from fluid replacement, other attempts to control haemorrhage in the resuscitation room of the accident and emergency department may be to no avail. We wish to draw attention to a simple device that was introduced over 100 years ago and which may rapidly aid haemostasis and prevent the onset of hypovolaemic shock.
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ranking = 5
keywords = nasal
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8/106. Intracranial placement of a nasogastric tube after severe craniofacial trauma.

    Complications of intracranial placement of a nasogastric tube in patients with complex facial and skull base fractures are infrequent, though the associated morbidity and mortality are high. In such situations some authors advocate craniotomy to allow removal of the tube in several linear segments under direct visualization. Others advise tube removal nasally under antibiotic coverage. We present a case of complex craniofacial fracture in which a nasogastric tube was positioned intracranially 48 hours after admission. The tube was quickly removed through the nose, and the patient was discharged without neurologic problems.
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ranking = 1.2445498911686
keywords = nasal, nose
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9/106. Traumatic occipital condyle fractures.

    Trauma to the brain or calvaria may cause some cranial nerve damage. This may be transitory or permanent. Occipital condyle fracture (OCF) is a rarely encountered pathology not easily diagnosed by routine clinical and radiological evaluation and one of the causes of lower cranial nerve disability. Frequently, the hypoglossal nerve is involved. Here we present two cases of OCF caused by motor vehicle accidents. Both of the patients complained of dysphagia and voice disturbance. After detailed neurologic and radiologic evaluation, they were diagnosed with OCF. They were both treated conservatively. OCF as a cause of lower cranial nerve damage is rarely reported. Since it is hard to diagnose OCF by routine cranial and cervical evaluation, detailed radiological study in suspected cases is a must. Since one of our patients was admitted 6 years after the trauma, this article is also noteworthy as a report on radiological changes of the OCF.
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ranking = 0.73364967350594
keywords = nose
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10/106. titanium mesh repair of the severely comminuted frontal sinus fracture.

    BACKGROUND: Severely comminuted frontal sinus fractures are difficult to contour and immobilize. Frequently, plates or wires are inadequate in fixating all fragments together, resulting in less than optimal outcomes. Advancements in the development of biomaterials have now made titanium mesh a new option for the repair of severely comminuted fractures. methods: Fourteen patients with severely comminuted frontal sinus fractures were treated with titanium mesh from 1994 to 1999. The fractures were reduced and immobilized using a simple algorithm: (1) Isolated anterior table fractures were repaired with reduced bony fragments attached to titanium mesh. (2) Anterior table fractures with nasofrontal duct involvement were repaired by sinus obliteration and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. (3) Anterior and posterior table fractures with cerebrospinal fluid leak or displacement were treated with the cranialization of the sinus and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. RESULTS: Of the 14 patients treated, 12 were available for postoperative evaluation. Parameters such as nasal function, cranial nerve V and VII function, cosmesis, and complications (hardware extrusions, sinusitis, meningitis, osteomyelitis, mucopyocele, brain abscess, pneumocephalus, and cerebrospinal fluid leak) were evaluated. All patients had good function of the superior division of cranial nerves V and VII. Two patients (16%) had minor wound infections, which resolved under treatment with antibiotics. All had excellent cosmetic results as measured by postreduction radiographs and personal and family perceptions of forehead contour. CONCLUSION: titanium mesh reconstruction of severely comminuted frontal sinus fractures has few complications while providing excellent forehead contour and cosmesis.
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keywords = nasal
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