Fractures facial

IVIaxillofacial Assess for fractures and soft-tissue injury. Management may be delayed until the patient is safely stabilized. Place a gastric tube orally in patients with suspected or confirmed facial fractures. Reassessment is necessary as facial fractures may not be identified early during the primary and secondary surveys. 

Facial and neck injuries may predispose the victim to airway and ventilatory difficulty. Airway compromise may result if the patient with facial fractures remains in a supine position due to lack of bony support. Progressive airway obstruction may also result from hemorrhage from penetrating neck wounds. Bleeding into the trachea, bronchus, and lungs will all compromise the victim s airway and ventilatory status. An artificial airway should be placed to maintain airway patency until intubation is required (American College of Sur-... 

Kokoska M S, Citardi MJ (2000) Computer-aided surgical reduction of facial fractures. Fac Plast Surg 16 169-179 Lekholm U, Zarb GA (2003) Patient selection and preparation. Osseointegration Clin Dentistry 199-209 Levin DN, Pelizzari C, Chen G, Chen C, Cooper M (1998) Retrospective geometric correlation of MR, CT and PET images. Radiology 817-823... 

Rodt T, Battling SO, Zajaczek JE, Vafa MA, KapapaT, Majdani 0, Krauss JK, Zumkeller M, Matties H, Becker H, Kaminsky J (2006) Evaluation of surface and volume rendering in 3D-CT of facial fractures. Dentomaxillofac Radiol 35 227-231... 

Facial fractures are a common consequence of direct trauma, for example in a traffic accident. The complex anatomy of the facial structures requires super-position-free, detailed imaging. Therefore, helical CT in general is considered the standard imaging modality of facial fractures for characterization and classification. CT in at least two orthogonal planes, axial and coronal, is the standard examination to make a reliable and precise diagnosis for treatment planning (Philipp et al. 2003 Rosenthal et al. 2000). Narrow-collimation (0.6 mm-1.2 mm) axial acquisition yields a volume that allows creation of 2D and 3D reconstructions with very high spatial resolution (Fig. 25.6). Sections can be obtained in any plane. 

Clinical trials of absorbable fixation methods showed that absorbable fixation methods can provide satisfactory fixation for craniofacial procedures (3,5,6,7). Eppley et al.(3) found that polymer fixation hardware was no longer palpable and there was radiographic evidence of facial fracture healing in 28% (7 out of 25) of the patients that received Lactosorb implants 9-12 months after surgery. Because only 25-40% of the polymer plates blend was left in this study, a very similar clinical result would be expected at 9-12 months. 

The polymerization of p ra-dioxanone as well as that of methyl and dimethyl homologues were described by Doddi et al. [183]. Poly(ptira-dioxanone) is primarily used as the absorbable suture material PDS (manufactured by Ethicon Inc.) because of its good tensile properties with respect to PGA and its ability to form monofilaments [28]. PDS material has been investigated for arterial regeneration in rabbit [184] and for internal suspension and fixation of facial fractures clinically [185], for cerclage of the eyeball [186], for closure of abdominal wounds [187] and for orbital floor reconstruction [188] as well as for use in pediatric cardiovascular operations [189] and in orthopeadic surgery [190]. 

Head Examine scalp and head for injury and fractures. Assess vision and pupils. Hemorrhage, penetrating injury, lens dislocation, and ocular entrapment may occur. Contacts should be removed at this time. Facial and periorbital edema will progressively impair eye exams. Completion of an initial eye exam is essential. 

Chronic ingestion and/or inhalation of phosphorus may result in osteomyelitis and bone necrosis. Signs and symptoms of this condition include bone inflammation, spontaneous bone fractures, anemia, and weight loss. A typical example of this condition is phossy jaw . This condition is caused by the absorption of phosphorus fumes through teeth cavities. Once absorbed, phosphorus attacks and destroys the bones of the mandible and maxilla. The extent of facial bone loss can be so severe that the bone necrosis may extend from the maxilla to the eye orbits. Phossy jaw is an irreversible and usually fatal condition. 

Ear Hemotympanum Vesicles Basilar skull fracture Facial weakness due to zoster-associated Vllth nerve palsy... 

Trichorrhexis nodosa (Figure 1-49) occurs more often in facial hair than scalp hair and produces bulbous-type nodes appearing as irregular thickenings along the hair shaft. These nodes are actually partial fractures, which under stress crack more completely forming broomlike breaks illustrated by Figure 1-50. 

Synthetic materials based on hydroxyapatite are used as implants in ear, nose and throat surgery, facial and cranial rebuilding and in fracture healing. Dental uses include crowns, tooth capping, dentures and tooth implants [27,28,33]. 

Oi5 = the number of intracranial hemorrhage, extraclavicular fracture, spinal injury, nerve injury (other than facial and brachial plexus), and other birth trauma. 

Fig. 2. Scanning electron micrographs of fracture surfaces of PC/glass bead composites, (a) Excellent interfacial adhesion obtained with y -aminopropylsilane (b) poor inte-facial adhesion obtained with silicone oil...

Fractures of the mandible head or neck carry a particular risk of cosmetic deformity and abnormal bite if not corrected into acceptable anatomical position. 3D CT is used, as in other examples of facial trauma, to display the spatial distribution of the fragments and their relation to the joint (Salvolini 2002). Mai-alignment of the mandibular condyle is particularly important to demonstrate or exclude, as are those fractures classed as unfavourable for stabilisation because of opposing muscle pull these fractures require operative fixation. Post operative imaging maybe helpful to confirm satisfactory positioning, or placement of bone grafts, and healing (Ray et al. 1993). 

Mackie RM (1987) Links between exposure to ultraviolet radiation and skin cancer. J R Coll Physicians Lond 21 91 Maitra RS, Johnson DL (1997) Stress fractures clinical history and physical examination. Clin Sports Med 16 259-274 Malanin G, Kalimo K (1985) Facial dermatitis from epoxy resin in a helmet. Contact Dermatitis 12 220-237... 

Cyanoacrylates were shown to form a strong durable bond between bones in vitro. Tensile adhesive strength betw een smooth bovine cortical bone specimens bonded together with the isobutyl monomer and tested after one day storage in water was approximately 6.5 mPa (Brauer et al, 1979). The monomer was used, without evidence of histotoxicity, to repair osteochondral fractures (Harper and Ralston, 1983) and recently to improve meniscal repairs (Koukabis et al, 1995). Butylcyanoacrylate was also used in facial bone surgery for frontal bone reconstitution (Avery and Ord, 1982). 

CT is the method of choice in clinically suspected fractures of the temporal bone. Fracture lines, fragment dislocation, and potential complications (inclusion of the facial nerve canal, carotid canal, and roof of the tympanic cavity) can be unequivocally detected. In routine work, the traditional differentiation into longitudinal, transverse (Fig. 11.3), and mixed fractures is used despite newer classifications. As a result, the damage to the... 

In one case, facial eczema occurred after titanium dental implantation, with complete remission after removal [84 ]. In another case, drug rash with eosinophilia and systemic symptoms (DRESS) occurred in a previously healthy 19-year-old man after insertion of a titanium bioprosthesis for a spinal fracture [85 ]. 

In summary, the data fi om this study including push-out strength retention and hydrolysis of the polymer systems demonstrates that the current absorbable plate and rivet/pin fixation system is biocompatible, has sufficient in-vitro strength retention, and is as effective as metal plates and screws for providing stable support for osteotomized bone fractures in cranio-facial fixation. 

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