Cases reported "Zygomatic Fractures"

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1/22. Oculocardiac reflex induced by zygomatic fracture; a case report.

    Oculocardiac reflex has been recognized as the result of mechanical stimulation to the orbital tissue. The authors encountered a case of severe arrhythmia due to oculocardiac reflex in a patient with a zygomatic fracture. Previous health examinations suggested no abnormalities in the heart in his schooldays, and the initial diagnosis of his arrhythmia as complete A-V block due to injury (using ECG and cardiac ultrasonography). Because his arrhythmia did not improve spontaneously, he underwent cardiac pacing. After repair of the fracture, his arrhythmia completely disappeared. The pacemaker was removed on the first postoperative day. The pathogenesis of this rare case will be discussed.
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ranking = 1
keywords = operative
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2/22. Miniplate osteosynthesis and cellular phone create disturbance of infraorbital nerve.

    A 37-year-old man with a zygomatic fracture underwent surgical treatment with reduction of the fracture and osteosynthesis with a miniplate on the infraorbital rim. Postoperatively, he had numbness in the distribution area of the infraorbital nerve, but he also suffered from dysesthesia in the same area during periods when he was using his hand-held mobile phone. After surgical removal of the osteosynthesis plate, the dysesthesia associated with his mobile phone was no longer present. The plate was examined in a setup where we measured the electric current that developed on the surface of the plate under the influence of the magnetic field between the phone antenna and the metal plate. The highest currents measured on the actual plate were 141 mV in air, and 21 mV in saline. These findings indicate that there might have been a correlation between the presence of the miniplate close to the infraorbital nerve, and the dysesthesia experienced by the patient, under the influence of the energy emitted from the cellular phone.
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ranking = 1
keywords = operative
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3/22. Orbital deformity after craniofacial fracture repair: avoidance and treatment.

    BACKGROUND AND OBJECTIVES: To achieve the optimal preoperative appearance following craniofacial fracture repair, the surgeon must be facile in the most sophisticated reconstructive techniques and able to determine their application. The purpose of this article is to describe the common deformities following such repairs, outline a strategy to avoid them, and review the surgical techniques to correct them. methods AND MATERIALS: The deformities are categorized by the anatomic zones of the orbit, i.e., zygomatic, frontal, and nasoethmoidal, affected by low-, middle-, and high-energy impact. The common types of deformity and acute and late treatments are discussed for each category. RESULTS AND/OR CONCLUSIONS: The optimal time to correct posttraumatic orbital deformities is during the acute phase. Extended open reduction and rigid fixation techniques have their own morbidity, which must not outweigh the deformity of an untreated or partially treated injury. The results of late reconstruction are always limited by scarring of the overlaying soft tissue envelope.
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ranking = 1
keywords = operative
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4/22. 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 = 4
keywords = operative
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5/22. Superior orbital fissure syndrome: current management concepts.

    The superior orbital fissure syndrome is an uncommon complication of craniofacial fractures: middle-third facial fractures and lesions of the retrobulbar space. This article reviews the anatomy and etiology of the superior orbital fissure as it relates to pathophysiology and physical findings. Cases reported in the literature are reviewed, emphasizing diagnosis and established treatment options. Two cases are presented and their management discussed, including the use of pre- and postoperative steroids as an adjunct to standard fracture reduction and stabilization therapy.
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ranking = 1
keywords = operative
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6/22. 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 = 1
keywords = operative
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7/22. Orbital volumetric analysis: clinical application in orbitozygomatic complex injuries.

    Fifteen patients with unilateral orbitozygomatic complex fractures and five with bilateral injuries were analyzed with respect to the differences in orbital volume between the affected and the uninjured, or other, side. The study was conducted using the ALLEGRO Workstation and software package from ISG Technologies, which was capable of calculating volume partitions from either axial or coronal images. patients without postoperative enophthalmos demonstrated a maximum volume difference of 3.8%; those with enophthalmos demonstrated differences of 4% or greater. The Critical Volume Difference at which enophthalmos becomes clinically apparent (whereby the orbital-corneal distance measured by Hertel exophthalmometry is greater than 3 mm on the affected side) is in the range of 4% to 5%. Volume analysis of the orbits by manipulation of the computed tomography data may allow a better understanding of changes in orbital configuration, which can result in better-directed primary and secondary reconstructions.
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ranking = 1
keywords = operative
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8/22. Computer-aided reduction of zygomatic fractures.

    Reconstruction of the craniofacial skeleton after traumatic injury relies on immediate adjacent nondisplaced bone for restoration of contour. In complex fractures, neighboring bone may be lost or significantly fragmented, leaving little guidance to the 3-dimensional skeletal architecture. Recently, image guidance systems have been used in neurosurgery and sinus and spine surgery for intraoperative corroboration using preoperative radiologic images. We report the intraoperative use of an image guidance system for real-time localization of displaced facial skeletal segments during reduction and internal fixation.
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ranking = 3
keywords = operative
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9/22. Coincidental finding of a bipartite atlas during assessment of facial trauma.

    We report a patient with a bipartite atlas that was noted on preoperative skull radiographs for fractures of facial bones.
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ranking = 1
keywords = operative
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10/22. Optimizing the management of orbitozygomatic fractures.

    Our understanding of the biomechanics and current management of orbitozygomatic fractures has evolved with the development of craniomaxillofacial surgery. Early management was minimal, with reduction alone as the uniform treatment, and the only variation was the approach used. However, a critical review of the literature using these methods revealed that many of these fractures were unstable after simple reduction alone. Using the principles of craniofacial surgery, our clinical experience, and the data presented in this article, a pragmatic algorithm for optimizing the management of orbitozygomatic fractures is presented. Our approach to this problem has been graduated, with orbitozygomatic fractures being divided into two general categories: nondisplaced and displaced. The nondisplaced orbitozygomatic fracture is treated nonoperatively, with close patient follow-up to detect signs of malunion. Displaced fractures are openly reduced and rigidly fixed internally with mini- and/or microplates. The orbit is routinely explored, especially in high-velocity injuries. The orbit is anatomically as well as volumetrically reconstructed with bone grafts, if needed, to prevent postoperative enophthalmos.
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ranking = 2
keywords = operative
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