scholarly journals An Aesthetically Possible Alternative Approach for Craniomaxillofacial Trauma: The “Pretrichial Incision”

2011 ◽  
Vol 4 (3) ◽  
pp. 161-170 ◽  
Author(s):  
Olindo Massarelli ◽  
Roberta Gobbi ◽  
Damiano Soma ◽  
Maria Teresa Raho ◽  
Antonio Tullio
Keyword(s):  
Trauma Surgery ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Surgical Incision ◽  
Scar Assessment ◽  
Alternative Approach ◽  
Craniomaxillofacial Trauma ◽  
Surgical Field ◽  
Upper Third ◽  
Coronal Incision

Frontal sinus and supraorbital rim fractures are common in facial trauma patients. Coronal incision is the standard approach for surgical management of these injuries. Nevertheless, with this incision, complications can occur as wide scars and alopecia. Because surgical repair of fronto-orbital fractures is often indicated for aesthetic reasons, surgical incision might be an “aesthetic incision.” So we have adopted the pretrichial incision, already used in brow-lift and foreheadplasty but never described in craniomaxillofacial trauma surgery. Nineteen upper-third facial trauma patients were treated: five cases were approached via an existing laceration, four cases via a coronal incision, and 10 cases via a unilateral zigzag pretrichial incision. To assess the postsurgical scar, the Patient and Observer Scar Assessment Scale was used and the scar's width was measured. In all cases, a wide surgical field was obtained to perform correct fracture reduction. Unlike straight or stealth coronal incisions, with pretrichial incision no wide scar or alopecia was registered. We think that pretrichial incision is an aesthetically reasonable alternative to the standard coronal approach for craniomaxillofacial trauma patients.

scholarly journals Extended Transcaruncular Approach Using Detachment and Repositioning of the Inferior Oblique Muscle for the Traumatic Repair of the Medial Orbital Wall

2009 ◽  
Vol 2 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Javier Rodriguez ◽  
Ramon Galan ◽  
Gabriel Forteza ◽  
Mario Mateos ◽  
Jens Mommsen ◽  
...  
Keyword(s):  
Oblique Muscle ◽  
Facial Trauma ◽  
Inferior Oblique Muscle ◽  
Orbital Trauma ◽  
Standard Material ◽  
Orbital Wall ◽  
Surgical Field ◽  
Medial Orbital Wall ◽  
Traditional Approaches ◽  
Upper Third

The fracture of the medial orbital wall is relatively common in orbital trauma. Titanium mesh is possibly the actual standard material for orbital wall reconstruction. When the floor of the orbit and the medial wall are simultaneously affected, one larger mesh gives better results than two independent meshes that need to be fixated independently. However, large meshes need a wider surgical field. To gain sufficient exposure to the medial and inferior orbital walls simultaneously, we present an approach that combines the transconjunctival and transcaruncular incisions, detaching if needed the inferior oblique muscle and, placing our mesh, repositioning it beside the lacrimal duct. This technique should not entirely displace traditional approaches, but it widens the surgical exposure for middle- and upper-third facial trauma. This alternative has minimum morbidity and can save a great deal of surgery time.

Pneumomediastinum as a Complication of Oral and Maxillofacial Injuries: Report of 3 Cases and a 50-Year Systematic Review of Case Reports

2021 ◽  
pp. 194338752199723
Author(s):  
Ioannis (Yiannis) Papadiochos ◽  
Stavros-Evangelos Sarivalasis ◽  
Meg Chen ◽  
Lampros Goutzanis ◽  
Aristotelis Kalyvas
Keyword(s):  
Case Reports ◽  
Maxillofacial Trauma ◽  
Facial Trauma ◽  
Pathologic Finding ◽  
Trauma Patients ◽  
Maxillofacial Injuries ◽  
Thoracic Pain ◽  
Craniomaxillofacial Trauma ◽  
Swallowing Difficulties ◽  
Thoracic And Abdominal

Objectives: Pneumomediastinum (PM) secondary to oromaxillofacial trauma (OMF) is a rare but well-described complication/pathologic finding. The aim of this study was twofold: first, to report our experience in treatment of maxillofacial trauma patients with PM, and second, to review the literature regarding the clinical features, severity, course, and management of the aforementioned complication. Material and methods: We retrospectively reviewed the medical records and charts of patients who suffered from maxillofacial trauma and treated in our hospital between September 1, 2013 and September 31, 2017. The inclusion criteria were patients with radiologically confirmed PM. In addition, the electronic databases PubMed, Scopus, and Science Direct were queried for articles reporting PM cases secondary to OMF injuries and published in English, French, and German language. Results: Three cases of PM out of 3,514 cases of craniomaxillofacial trauma were found; there were 3 male patients who presented in our emergency department with the chief complaint of cervicofacial swelling. Literature search isolated 58 selected articles and 63 cases were assessed in total; posttraumatic repeated blowing of nose was proved as most frequent triggering factor among them. Furthermore, the outcomes of review showed that thoracic pain, respiratory distress, and swallowing difficulties were not frequently reported in patients with ME due to facial trauma. Conclusions: Both our experience and the results of systematic literature review indicated that patients with PM due to OMF injuries present mild clinical course. If properly managed, this specific pathologic condition may have no further complications or relative comorbidities. The exact etiology and mechanism of PM in the context of maxillofacial injuries always needs to be identified. Radiographic, laboratory, and endoscopic examinations should be applied to rule out the more serious and frequently diagnosed aerodigestive, thoracic, and abdominal causes of PM.

Injury Patterns in Pediatric Facial Fractures Unique to an Urban Environment

2021 ◽  
Author(s):  
Anthony P. Sclafani ◽  
Matthew Scott Sclafani ◽  
Sallie Long ◽  
Tasher Losenegger ◽  
Daniel Spielman ◽  
...  
Keyword(s):  
Urban Environment ◽  
Older Patients ◽  
High Energy ◽  
Urban Setting ◽  
Cranial Bone ◽  
Csf Leak ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Facial Fractures

AbstractThis study aimed to define better the clinical presentation, fracture patterns, and features predictive of associated injuries and need for surgery in pediatric facial trauma patients in an urban setting. Charts of patients 18 years or younger with International Classification of Disease 9th and 10th revision (ICD-9/ICD-10) codes specific for facial fractures (excluding isolated nasal fractures) at NY-Presbyterian/Weill Cornell Medical Center between 2008 and 2017 were retrospectively reviewed. Of 204 patients, most were referred to the emergency department by a physician's office or self-presented. Children (age 0–6 years) were most likely to have been injured by falls, while more patients 7 to 12 years and 13 to 18 years were injured during sporting activities (p < 0.0001). Roughly half (50.5%) of the patients had a single fracture, and the likelihood of surgery increased with greater numbers of fractures. Older patients with either orbital or mandibular fractures were more likely to undergo surgery than younger ones (p = 0.0048 and p = 0.0053, respectively). Cranial bone fractures, CSF leaks, and intracranial injuries were more common in younger patients (p < 0.0001) than older patients and were more likely after high energy injuries; however, 16.2% of patients sustaining low energy injuries also sustained cranial bone, CSF leak, or intracranial injury. In an urban environment, significant pediatric facial fractures and associated injuries may occur after nonclassic low kinetic energy traumatic events. The age of the patient impacts both the injuries sustained and the treatment rendered. It is essential to maintain a high index of suspicion for associated injuries in all pediatric facial trauma patients.

Preoperative stereolithographic model planning for primary reconstruction in craniomaxillofacial trauma surgery

1998 ◽  
Vol 26 (3) ◽  
pp. 136-139 ◽  
Author(s):  
Christian Kermer ◽  
Andreas Lindner ◽  
Ingrid Friede ◽  
Arne Wagner ◽  
Werner Millesi
Keyword(s):  
Trauma Surgery ◽  
Primary Reconstruction ◽  
Craniomaxillofacial Trauma ◽  
Stereolithographic Model

scholarly journals PROFILE OF PLASTIC SURGERY TRAUMA PATIENTS AT H. ADAM MALIK GENERAL HOSPITAL MEDAN

2019 ◽  
pp. 1-4
Author(s):  
Darwin Firmansyah Siregar ◽  
Frank Bietra Buchari ◽  
Utama Abdi Tarigan ◽  
Aznan Lelo
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Bone Fractures ◽  
Soft Tissue Injuries ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Adult Age ◽  
Common Etiology ◽  
Tissue Injuries ◽  
Age Range

Introduction: According to data from Perhimpunan Dokter Bedah Plastik Rekonstruksi dan Estetik Indonesia (PERAPI), there are only 193 plastic surgeons throughout Indonesia. There is no sufcient data that described pattern of incidence, workload, and role of Plastic Surgery in trauma cases at Indonesian Referral Center Hospital, especially in the Province of North Sumatra. Methods: This research is a descriptive study with a retrospective approach. Sample of this study was medical records of trauma patients who required Plastic Surgery who came to the H. Adam Malik General Hospital Medan Emergency Room (1 January 2016-31 December 2018). This study used total sampling method. Results: This study involved 536 patients and 40.85% included in the adult age range. Men vs women ratio is 3:1 (405 vs 131). Based on type of injury, the most common injury is facial trauma, followed by burns and soft tissue injuries (291, 178 and 66). The most common etiology is trafc accidents (90 cases). Most of facial bone fractures located at mandibular bone (segmental fracture). Inhalation trauma due to burns only occurred in 6 cases (3.24%). Most of soft tissue injuries occurred at lower extremities (upper limbs). Conclusion: Trafc accidents are the most common etiology for trauma in Plastic Surgery. Most of the patients are men and included in the adult age range. Facial trauma is the most common injury in Plastic Surgery. Most facial bone fractures located at mandible (symphysis and parasymphysis). Most of burns injury are re burns. Most soft tissue injuries are located at lower extremities (upper limbs).

scholarly journals Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Amin Kheiran ◽  
Purnajyoti Banerjee ◽  
Philip Stott
Keyword(s):  
Phase 1 ◽  
Operative Procedure ◽  
Trauma Surgery ◽  
National Standards ◽  
Junior Doctors ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Phase 2 ◽  
Consent Forms ◽  
Surgical Trainees

Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P=0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient’s copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

scholarly journals Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma

2016 ◽  
Vol 9 (1) ◽  
pp. 076-081 ◽  
Author(s):  
Helen Moses ◽  
David Powers ◽  
Jarrod Keeler ◽  
Detlev Erdmann ◽  
Jeff Marcus ◽  
...  
Keyword(s):  
Surgical Management ◽  
Opportunity Cost ◽  
Financial Burden ◽  
Operative Management ◽  
Facial Trauma ◽  
Facial Fractures ◽  
Potential Threat ◽  
Significant Difference ◽  
Craniomaxillofacial Trauma ◽  
And Shifts

The provision of trauma care is a financial burden, continually associated with low reimbursement, and shifts the economic burden to major trauma centers and providers. Meanwhile, the volume of craniomaxillofacial (CMF) trauma and the number of surgically managed facial fractures are unchanged. Past financial analyses of cost and reimbursement for facial trauma are limited to mandibular and midface injuries, consistently revealing low reimbursement. The incurred financial burden also coincides with the changing landscape of health insurance. The goal of this study is to determine the opportunity cost of operative management of facial trauma at our institution. From our CMF database of greater than 3,000 facial fractures, the physician charges, collections, and relative value units (RVUs) for CMF trauma per year from 2007 to 2013 were compared with a general plastic surgery and otolaryngology population undergoing operative management during this same period. Collection rates were analyzed to assess if a significant difference exists between reimbursement for CMF and non-CMF cases. Results revealed a significant difference between the professional collection rate for operative CMF trauma and that for other operative procedures (17.25 vs. 29.61%, respectively; p < 0.0001). The average number of RVUs billed per provider for CMF trauma declines significantly, from greater than 700 RVUs to 300 over the study period, despite a stable volume. Surgical management of CMF trauma generates an unfavorable financial environment. The large opportunity cost associated with offering this service is a potential threat to the sustainability of providing care for this population.

The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees

2018 ◽  
Vol 164 (5) ◽  
pp. 360-361 ◽  
Author(s):  
Douglas Hammond ◽  
J Breeze ◽  
D Evriviades
Keyword(s):  
Surgical Training ◽  
Major Trauma ◽  
Complex Trauma ◽  
Trauma Surgery ◽  
Queen Elizabeth Hospital ◽  
Trauma Patients ◽  
Multidisciplinary Management ◽  
Leadership Experience ◽  
The Uk ◽  
The Military

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees.

Community Service as Patientsʼ Tutor to Avoid Delirium

2019 ◽  
Vol 158 (06) ◽  
pp. 625-629 ◽  
Author(s):  
Axel Prokop ◽  
Karl Michael Reinauer ◽  
Manfred Koebler ◽  
Erna Schwerb ◽  
Lisa Keller ◽  
...  
Keyword(s):  
Trauma Surgery ◽  
Significant Risk ◽  
Read Aloud ◽  
Trauma Patients ◽  
Team Meetings ◽  
Reduced Frequency ◽  
Insurance Costs ◽  
German School ◽  
Elderly Inpatients ◽  
Patients At Risk

Abstract Background Today, nearly two thirds of inpatients in trauma surgery hospitals are over 70 years old and at significant risk for comorbidities. These patients frequently suffer delirium. Delirium occurs in 15 – 30% of these trauma patients and increases the risk of mortality in up to 15 – 25% of cases. Conversation, attention, and activity significantly reduce this risk. Objectives Thus, the Centre for Geriatric Traumatology and the District Seniors Council have initiated a new project of a visiting service, to prevent delirium and anxiety conditions in elderly inpatients. Volunteers from the welfare program offer daily care for selected patients. Methods They care for and interact with the patients for approximately one hour per day. They accompany the patients in the hospital and during mobilization, explain, read aloud, converse, or simply listen, and thus provide calm, support, and company. The attendants are volunteers who have been previously trained by the clinic, who regularly attend team meetings and draw up reports from each admission. All patients and relatives are informed prior to these visits and are notified with an accompanying letter. There are structured visiting plans for each week. Results From July 17 to May 19, 4031 patients in our clinic and in three other hospitals have been accompanied in the program. None of the patients suffered delirium. The patients and attendants found the care very good and personally satisfying. Evaluations of the volunteers for the success of their work, using the German school-grading system, was an average 1.3. Noticeable was the markedly reduced frequency of patient calls to nursing, who were thus relieved. Travel expenses and insurance costs for the volunteers were reimbursed. Conclusion In times of skilled labour shortages, patient support provided by volunteer patient attendants enables innovative care for patients at risk for delirium. The assistance of the attendants alone reduced the workload on the nursing staff.

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