Nasal and Naso-orbito-ethmoid Fractures

2021 ◽  
Author(s):  
Sherise Epstein ◽  
Russell E. Ettinger
Keyword(s):  
Trauma Patients ◽  
Craniofacial Trauma ◽  
Nasal Fractures ◽  
Craniofacial Fractures

AbstractCraniofacial fractures are common among trauma patients. Nasal fractures are the most common craniofacial fracture. Understanding how to evaluate and manage craniofacial fractures is important for the craniofacial trauma consultant. This manuscript describes the appropriate workup and management of nasal and naso-orbito-ethmoid fractures.

scholarly journals Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

2021 ◽  
Vol 18 (21) ◽  
pp. 11051
Author(s):  
Fang-Yu Hsu ◽  
Shih-Hsuan Mao ◽  
Andy Deng-Chi Chuang ◽  
Yon-Cheong Wong ◽  
Chih-Hao Chen
Keyword(s):  
Motor Vehicle ◽  
Early Recognition ◽  
Arterial Embolization ◽  
Maxillary Artery ◽  
Trauma Patients ◽  
Shock Index ◽  
Packed Red Blood Cells ◽  
Vehicle Accidents ◽  
Life Threatening ◽  
Craniofacial Trauma

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

scholarly journals Etiology and treatment in craniofacial fractures

2017 ◽  
Vol 23 (3) ◽  
pp. 158-162
Author(s):  
D. L. Mihail ◽  
G. I. Comșa
Keyword(s):  
Life Quality ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Secondary Complications ◽  
Surgical Interventions ◽  
Anatomy And Physiology ◽  
Car Accidents ◽  
Complex Biological Process ◽  
Level Increase ◽  
Craniofacial Trauma

Abstract Introduction. Facial trauma remains an important pathology in present days because of its effects. Facial deformities and functional alteration affect patient’s life quality and his society reinsertion. First evaluation has to be thorough to avoid any secondary complications .This type of pathology involves a pluridisciplinary approach: ENT, OMF, neurosurgeon,plastic surgeon,intensive care doctor. Healing implies complex biological process .A healed bone is capable to perform normal duties without titanium plates help. Osteosynthesis allows a faster and correct recovery. Doctors need to possess profound knowledge with regard to anatomy and physiology and to be acquainted with the reconstructive methods used in craniofacial surgery. Material and methods. This study evaluates craniofacial trauma patients who suffered different types of surgical interventions at the ENT Clinic and OMF Department of Constanta County Hospital since January the 1st 2013 until June the 1st 2017. Results. The group involves 133 cases, both genders and all ages. These 2 elements play an important role in this pathology because of the fact that the vast majority of patients are young active males. The sex ratio in the study is 7:1. In most of cases, craniofacial traumas appear after aggressions and car accidents. The nose and mandibular are fractured in a higher percentage in comparison to other parts of facial structures. Discussions. Important and sensitive structures located at this level increase the risk of possible important and definitive damages.

scholarly journals Etiology and treatment in craniofacial fractures

2017 ◽  
Vol 23 (3) ◽  
Author(s):  
D. L. Mihail ◽  
G. I. Comșa
Keyword(s):  
Life Quality ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Secondary Complications ◽  
Surgical Interventions ◽  
Anatomy And Physiology ◽  
Car Accidents ◽  
Complex Biological Process ◽  
Level Increase ◽  
Craniofacial Trauma

AbstractIntroduction. Facial trauma remains an important pathology in present days because of its effects. Facial deformities and functional alteration affect patient’s life quality and his society reinsertion. First evaluation has to be thorough to avoid any secondary complications .This type of pathology involves a pluridisciplinary approach: ENT, OMF, neurosurgeon,plastic surgeon,intensive care doctor. Healing implies complex biological process .A healed bone is capable to perform normal duties without titanium plates help. Osteosynthesis allows a faster and correct recovery. Doctors need to possess profound knowledge with regard to anatomy and physiology and to be acquainted with the reconstructive methods used in craniofacial surgery. Material and methods. This study evaluates craniofacial trauma patients who suffered different types of surgical interventions at the ENT Clinic and OMF Department of Constanta County Hospital since January the 1st 2013 until June the 1st 2017. Results. The group involves 133 cases, both genders and all ages. These 2 elements play an important role in this pathology because of the fact that the vast majority of patients are young active males. The sex ratio in the study is 7:1. In most of cases, craniofacial traumas appear after aggressions and car accidents. The nose and mandibular are fractured in a higher percentage in comparison to other parts of facial structures. Discussions. Important and sensitive structures located at this level increase the risk of possible important and definitive damages.

scholarly journals Helmet Wear and Craniofacial Trauma Burden: A Plea for Regulations Mandating Protective Helmet Wear

2017 ◽  
Vol 10 (3) ◽  
pp. 197-203 ◽  
Author(s):  
Jamison Anne Harvey ◽  
Waleed Gibreel ◽  
Ali Charafeddine ◽  
Basel Sharaf
Keyword(s):  
Hospital Admission ◽  
Injury Severity ◽  
Bone Fractures ◽  
Specific Pattern ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Skull Fractures ◽  
Helmet Use ◽  
Craniofacial Trauma ◽  
Motorcycle Accidents

Helmet wear offers protection in various ways against craniomaxillofacial and brain trauma. The specific pattern and overall burden of craniofacial trauma among helmeted and unhelmeted patients has not been well defined. This is a retrospective review of trauma patients involved in documented helmet-associated injuries that presented to the Mayo Clinic Emergency Department in Rochester, Minnesota, and completed initial trauma evaluation between 1999 and 2015. A total of 417 patients (50% unhelmeted, 82% male) were identified. The median age at injury was 22.9 years (interquartile range [IQR]: 15.2–44.2]) and median follow-up was 26 months ([IQR: 2.2–64.8]). The majority of injuries involved motorcycle accidents (57.6%), bicycles (30.2%), and other modes of injury (12.7%). The mean Glasgow Coma Score (GSC) at the time of presentation was 14.2 (SD ± 2.4) and mean injury severity score (ISS) was 10.2 (SD ± 7.5). Motorcycle accidents had a higher mean ISS compared with other modes of injury ( p = 0.048). Unhelmeted patients were more likely to sustain scalp lacerations ( p < 0.0001), facial bone fractures ( p = 0.01), scalp hematomas ( p = 0.041), skull fractures ( p = 0.017), and are more likely to require hospital admission ( p = 0.0003). Unhelmeted patients’ hospital length of stay was on average 2 days longer than helmeted patients’ stay ( p = 0.0721). Unhelmeted patients were more likely to require out-of-home placement than helmeted patients. Among trauma patients, helmet use was associated with less scalp lacerations and hematomas, facial bones fractures, skull fractures, and need for hospital admission. Adoption of legislation and regulations mandating protective helmet use in all states are strongly encouraged to minimize the burden of craniofacial injuries among unhelmeted patients.

Study on Utilizing Rapid Prototyping Technology to Build Oral and Maxillofacial Models

2014 ◽  
Vol 939 ◽  
pp. 570-576
Author(s):  
Yih Lin Cheng ◽  
Wei Shiun Lu
Keyword(s):  
Image Processing ◽  
Rapid Prototyping ◽  
High Accuracy ◽  
Slice Thickness ◽  
Trauma Patients ◽  
Average Deviation ◽  
Standard Procedures ◽  
Dental Impression ◽  
Craniofacial Trauma ◽  
Rp Technique

Traditional dental impression approach is not applicable to most of the oral and craniofacial trauma patients. Without a physical model, it is not easy to evaluate a patients fracture and occlusion, limiting the treatment process. Especially, the accuracy of the maxillofacial model for occlusion evaluation needs to meet strict clinical demands. Therefore, in this research, we attempted to use computed tomography (CT), without damaging the oral and craniofacial tissues of patients, together with image processing and Rapid Prototyping (RP) technique to obtain physical oral and maxillofacial models with high accuracy. Initially, a set of procedures of generating maxillofacial model was developed. CT images were segmented and converted to a CAD file by a commercial medical image processing software. RP technique was used to fabricate maxillofacial model. After comparison, the deviations were greater than clinical demands of less than 1 mm. After analyzing the sources of errors, issues of CT slice thickness, images threshold selection and editing, and RP fabrication were investigated to improve the accuracy. As a result, updated standard procedures were suggested to obtain RP maxillofacial models with higher accuracy. The improved average deviation can be reduced to 0.22 mm. The biological RP models with high accuracy generated in this research can be used to improve success rate and safety in a surgery, to reduce complications after the surgery, and to decrease the time and cost of treatment.

Successful Transarterial Guglielmi Detachable Coil Embolization of Posttraumatic Posterior Communicating Artery-Cavernous Sinus Fistula: Technical Note

Neurosurgery ◽  
2003 ◽  
Vol 52 (2) ◽  
pp. 458-461 ◽  
Author(s):  
Kyle D. Weaver ◽  
Matthew G. Ewend ◽  
Sten Solander
Keyword(s):  
Cavernous Sinus ◽  
Coil Embolization ◽  
Technical Note ◽  
Posterior Communicating Artery ◽  
Detachable Coil ◽  
Vertebrobasilar System ◽  
Guglielmi Detachable Coil ◽  
Craniofacial Trauma ◽  
Flow Through ◽  
Craniofacial Fractures

Abstract OBJECTIVE Carotid-cavernous fistulae are uncommon but well-documented sequelae of craniofacial trauma. A rare subset may arise from the posterior communicating artery instead of from the carotid artery proper. The presentation is similar to that of carotid-cavernous fistulae, with ocular pain, chemosis, and proptosis being the common symptoms. The first successful transarterial coil embolization of this type of lesion is described. METHODS A 42-year-old man presented with severe craniocerebral injury, including multiple craniofacial fractures, after an industrial accident. He required emergent craniotomy for an open depressed cranial fracture and epidural hematoma. Six weeks after presentation, the patient began to exhibit progressive chemosis and proptosis. Magnetic resonance imaging revealed findings consistent with a carotid-cavernous fistula. RESULTS Angiography revealed a fistula between the posterior communicating artery and the cavernous sinus. The origin of the fistula in the posterior communicating artery was successfully obliterated with Guglielmi detachable coiling. Subsequent studies demonstrated no flow through the fistula and good opacification of the ipsilateral posterior cerebral artery by the vertebrobasilar system. CONCLUSION Posterior communicating artery-cavernous fistulae are a rare sequel of trauma. They may be treated successfully with the use of transarterial coil embolization.

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