Pearls of plastics in ENT practice that Conceals & Camouflages the Camber, Contour & Cosmesis in Facial Trauma

Facial trauma can involve soft tissue injuries such as burns, lacerations, bruises and even fractures of the facial bones such as nasal fractures and fractures of the jaw as well as injury to the eye. Symptoms are specific to the type of injury that can be either signs of inflammation or changes in facial definition. Facial injuries have the potential to cause temporary deviations in facial delineation to permanent disfigurement of facial structures.

BRAIN DEATH DIAGNOSIS IN SEVERE TRAUMATIC BRAIN INJURY (TBI)

Проведено клинико-неврологическое и инструментальное исследование смерти мозга у 23 пациентов с тяжелой черепно-мозговой травмой за 2020 год. Результаты исследования показали, что летальность в первые 72 часа была в 14 случаях - 60,9%. Досуточная летальность составила 9 случаев - 39,1 %. Пациенты трудоспособного возраста составили 83%. В большинстве случаев клиническая картина смерти мозга осложнялась наличием травм лица, спонтанными или индуцированными автоматизмами, ушибом легких при сочетанной травме. В данной статье описаны виды клинических исследований, используемых в диагностике смерти мозга, в сложных случаях дополнительных подтверждающих тестов. Research has been done of 23 patients with а severe traumatic brain injury (TBI) in 2020. Outcomes of our research have indicated mortality in the first 72 hours was in 14 cases - 60,9%.And the first day lethality was 9 cases - 39,1%. The significant quantity of working age patients amounts to 83%. Generally, brain death in any patient with catastrophic brain injury and a bedside exam consistent with brain death complicated by facial injuries, spontaneous or induced automatism, lungs contusion with concomitant injury. The article describes types of clinical examination, used in the definition of brain death. In complicated cases, supplementary confirm tests.

William Warwick James OBE FRCS MCh FDS FLS (1874 to 1965)

William Warwick James was one of the most inspiring and outstanding dental surgeons of his time, a key researcher in dentistry and zoology and a pioneer in maxillofacial surgery. Most maxillofacial departments hold sets of his dental elevators. He wrote a major wartime work with Benjamin Fickling on the treatment of jaw and facial injuries.

Falls From Height, Facial Injuries and Fatalities: An Institutional Review

Study Design Retrospective cohort review. Objective To investigate the relationship between falls from height and facial injuries. Methods This is a retrospective cohort study, conducted over a 7-year period, of the medical records of all patients who presented to hospital for a maxillofacial injury following a fall from height. Fall heights were classified as low falls (1–3 m), high falls (3–10 m) and very high falls (≥10 m). Results A total of 111 patients with 218 facial bone fractures were identified (78 men, 33 women and mean age 50.3 years). High falls were the most common (n = 58, 52.3%). Multiple fractures were identified in 51 (46.0%) patients. Orbital and middle third fractures were the most prevalent. Nasal, mandible, bilateral and fractures involving more than one facial third, increased as fall height increased, as did the requirement for operative fixation. The majority of patients had an associated injury (n = 100, 90.1%) and overall mortality was 6.3%. Conclusions Falls from height are prevalent and there is a trend towards increased severity of facial injury, surgical intervention and associated morbidity as fall height increases. Falls from height are a significant public health concern and an important facet of maxillofacial trauma to recognise, as is the requirement for an interdisciplinary approach as they present to hospital.

Dog bite of the orofacial region- Case series and update

Animal bites are a significant cause of morbidity and mortality across the globe and when involving the orofacial region, they commonly present to dental surgeons. Literature on their initial management provides a plethora of conflicting views and results and it is necessary to be up to date with the latest modalities of management of such facial injuries to give best functional and surgical outcomes to the patients. Antibiotics and anti-tetanus and anti-rabies vaccinations and immunoglobulins should be judiciously administered along with appropriate wound management.

A STUDY OF PROFILE OF MULTIDETECTOR COMPUTED TOMOGRAPHY IN MAXILLO-FACIAL INJURIES IN A TERTIARY CARE CENTER

Maxillofacial injuries account for a large group of patients in the emergency department in tertiary care hospital, presenting as an isolated injury or a part of poly trauma. Road trafc accidents are the commonest cause of maxillofacial injuries. Such injuries are clinically important as they cause facial disgurement and thus imposing emotional, morbidity and cosmetic dependence. To observe these fractures and decide appropriate management lines, there is a need for imaging aid. The main purpose of imaging guidance is to nd and characterize the fractures and associated injuries. Aim:Study of prole of multi detector computed tomography in maxillo-facial injury in a tertiary care centre. Materials and methods: The cases coming to the emergency department and then forwarded to department of Radiology, MGM medical college and hospital, Aurangabad for CT scan formed the source of the data and were studied in detail. Detailed history of the cases was taken. Written and informed consent were taken for undergoing CT scan examination. Patients were scanned using 16 slice Toshiba acquilion machine. The data was tabulated and observed and conclusions were made. Results: Total 175 number of patient were included in the study and CT scan for maxillo-facial injuries were conducted. Diagnosis of the maxillofacial injuries were done and the fractures were classied according to age, gender, location and its subsets. According to our study 21-30 years of age group was the most common age group to be involved in maxillo-facial injuries. Frequency of maxillo-facial injuries was found to be more in male than female. Maxillo facial injuries occurred mostly due to road trafc accidents. Orbit was seen as the most common bone to be fractured followed by fracture of maxilla bone. Orbital wall fracture happen to be overall most common bone affected amongst all the other facial bones.

Dog bite of the orofacial region- Case series and update

Animal bites are a significant cause of morbidity and mortality across the globe and when involving the orofacial region, they commonly present to dental surgeons. Literature on their initial management provides a plethora of conflicting views and results and it is necessary to be up to date with the latest modalities of management of such facial injuries to give best functional and surgical outcomes to the patients. Antibiotics and anti-tetanus and anti-rabies vaccinations and immunoglobulins should be judiciously administered along with appropriate wound management.

1239 Postoperative Complication Rate of Facial Injury Repairs Treated by Maxillofacial On-Call Team: Surgical Audit

Introduction A significant aspect of Oral and Maxillofacial Surgery workload relates to trauma, particularly soft-tissue injuries. Contingent on the aetiology of injury, facial wounds require debridement and rapid closure to reduce risk of infection and degree of scarring. The aim was to identify possible risks and frequency of postoperative complications, including problems identified by patients following treatment of facial injuries by the Maxillofacial on-call team. Method Data was retrospectively collected from patients who sustained soft-tissue facial injuries treated by the Maxillofacial team and provided with follow-up appointments from January to August 2020. Computerised clinical notes were accessed to determine patient demographics, mechanism and site of injury, location and time of repair, operator grade and postoperative complications (if any). Results 153 patients required debridement and suturing of a facial injury under local or general anaesthetic. Among these, the male to female ratio was 65:35. 47% of facial injuries resulted from mechanical fall. Lips were found to be the most common site (31%) of injury. Postoperative complication rate was 8% within the 8-month period, with reports of infection, wound dehiscence and haematoma requiring further treatment. 58% of complications resulted from treatment carried out between 5pm-5am with a sole operator (DCT/SHO). 83% of complications followed treatment carried out within the Emergency Department rather than Maxillofacial clinical setting. Conclusion Following facial injury repair, just less than 8% of patients experienced complications, which required corrective treatment. Although facial injuries require immediate care, careful planning and performing treatment in a specialised setup may improve perioperative care, thus clinical outcomes.

782 Evaluation of Ketamine Sedation as An Alternative to General Anaesthetic for The Management of Paediatric Soft Tissue Facial Injuries During the Covid-19 Pandemic

Introduction Standard surgical practice of paediatric soft tissue facial injuries requires general anaesthetic (GA) if treatment with local anaesthetic is not tolerated. However, the Covid-19 pandemic has increased the risk of hospital admission for GA to patients and pre-operative Covid-19 testing can delay surgical treatment. In response, a service was established to facilitate short surgical procedures by the Oral and Maxillofacial surgical (OMFS) team with ketamine sedation (KS) at a tertiary level paediatric emergency department. Evaluation of this service demonstrates that KS is a suitable alternative to GA with reduced waiting times, low complications and equivalent surgical outcomes. Method 20 patients treated under KS from May- September 2020 were identified and compared to a control group of 20 patients treated under GA during the same time period. Data including patient demographics, surgical treatment and the KS/GA procedure was collected from the medical records and was analysed using Microsoft excel. Results The KS patients had shorter waits for treatment with 85% of patients waiting 1 day or less, compared with 55% for the GA group. Using the local KS protocol 1 or 2 doses of ketamine was sufficient in 79% of cases and adverse effects were minimal with 21% of KS patients suffering mild nausea and vomiting. Conclusions KS is an acceptable alternative to GA for the management of paediatric soft tissue injuries. KS reduces inpatient admission for GA which is of increased importance during the Covid-19 pandemic. Other OMFS units would benefit from access to a similar service.