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Facial Trauma
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Facial trauma comes under the care of Plastics, Maxillofacial, Ear Nose and Throat (ENT) and ophthalmic surgeons. The way in which the different aspects of facial trauma are divided up depends on what specialties are represented at your unit. In larger hospitals, there is often a designated Maxillofacial team who take all facial trauma, in smaller hospitals it is more common for facial trauma to come to Plastics. Find out the local policy from your colleagues. It is common for ENT to manage septal haematomas, nasal fractures and sometimes pinna haematomas.
Upper Airway Obstruction and Tracheostomy
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The usual route of intubation is via the mouth. This can be assisted by video-laryngoscopic devices.6 The relative contraindications include cervical spine fractures, severe facial trauma and laryngeal trauma. In cases of cervical spine fracture, great care must be taken to avoid neck extension that may precipitate or worsen spinal cord injury. Facial trauma is usually associated with increased difficulty visualizing the larynx due to oedema, mucosal laceration and bleeding, trismus and bony instability. Great care is needed where there is laryngeal trauma, as the act of intubation may worsen the existing damage.
Pediatric facial trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Ryan M. Dickey, Katarzyna Kania, Larry H. Hollier
Characteristics of pediatric facial injury vary based on age, geography, and social factors. In the Unites States, motor vehicle collision (MVC) is the most common mechanism for facial fracture in children of all ages [5–7]. Unrestrained pediatric patients experience double the risk of facial fracture from MVCs [7]. Laws mandating child safety seats have undoubtedly decreased the incidence of facial trauma from MVC. The second most common mechanism of facial fracture varies with age [7]. Among children less than 6 years of age, falls are more common, giving way to sports-related injuries around age 12 as children gain increased motor skills [2].
A novel treatment of pediatric bilateral condylar fractures with lateral dislocation of the temporomandibular joint (TMJ) using transfacial pinning
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Kerry A. Morrison, Roberto L. Flores
Pediatric facial trauma management remains a therapeutic challenge within plastic and reconstructive surgery. Notably, nearly 50 percent of pediatric facial fractures involve the mandible with the majority comprising condylar fractures, often with a concomitant symphyseal fracture [1–7]. Fractures of the condyle are more common in children than in adults because the highly vascularized pediatric condyle and thin neck are poorly resistant to impact forces [8,9]. In the adult patient population, the morbidity of condylar-symphyseal facial fractures is well known [10]. Indeed, combined condylar-symphyseal fractures in adults can lead to widening of the lower face, malocclusion, and limited oral excursion [11]. Although these challenges affect similarly affected children, the pediatric condyles are integral to mandibular growth, raising concern for surgical manipulation [12]. Furthermore, the presence of tooth buds may limit or preclude the ability to apply rigid fixation to the mandible [7,13]. However, the pediatric condyle’s inherent ability to remodel surpasses that of the adult, a characteristic which can be potentially leveraged during condylar fracture repair [14–16].
Cerebrospinal fluid leak management in anterior basal skull fractures secondary to head trauma
Published in Neurological Research, 2022
Jian-Cheng Liao, Buqing Liang, Xiang-Yu Wang, Jason H. Huang
Classic clinical signs supporting the diagnosis of anterior fossa skull fractures include periorbital ecchymoses (raccoon eyes), epistaxis, CSF rhinorrhea, and cranial nerve palsies. It is important to note that these signs often appear several hours post-injury. The clinical diagnosis of CSF leaks is typically fairly obvious if clear fluid emanates from the nasal passage; however, confirmatory tests should be performed for verification. Facial trauma often coexists with injury to the cervical spine, cranial nerves, and internal carotid artery. In a study of 4,786 patients with craniofacial injuries, approximately 10% had a concomitant cervical spine fracture with a 2% dislocation rate [2]. The study reported that the upper face was associated with injuries to the mid to lower cervical spine and cranium, while mandible and midface injuries were associated with fractures of the upper cervical spine and basilar skull. The most commonly injured cranial nerve (CN) in frontobasal fractures is CN I, with resultant anosmia. Other CN dysfunctions can occur in 5% with variable recovery. Carotid artery injury occurs in approximately 2% in the setting of skull base fracture [8].
Characteristics of emergency room visits in patients with facial injuries in mainland China during the 60-day level I emergency response to COVID-19
Published in International Journal of Injury Control and Safety Promotion, 2021
Yi Zhang, Ying Liu, Tingliang Wang, Jiasheng Dong, Hua Xu
Following institutional review board approval, a retrospective review was conducted on the basis of data on facial trauma presented at the emergency department (ED) of XXX Hospital, a tertiary oral and maxillofacial trauma referral centre covering the city, from 24 January 2020 to 23 March 2020 and the same period in the previous two years. Patient data on baseline demographic characteristics such as age, gender, and time and date of visit were collected from health information system according to the preliminary checklist. For patients in 2020, a detailed telephone survey was conducted one week after the injury regarding the location and mechanism of the injury. The independent samples t-test and analyses of variance were applied to verify differences in populations for continuous variables. The chi-square test was used to calculate differences for categorical variables. Both analyses were followed by a post-hoc analysis with Bonferroni correction of p < 0.05 for detecting significance.