Facial Trauma
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal in Plastic Surgery for Trauma, 2022
In facial trauma there are several ways in which the airway may be affected:Obstruction – Foreign body (teeth, dentures), soft tissue fragmentsHaemorrhage – Oropharyngeal or nasopharyngealSoft tissue swellingFacial fractures – Posteriorly displaced maxillary fractures, posterior displacement of the tongue due to mandibular fracturesAssociated laryngeal trauma
Demographics of Facial Injuries
Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez in Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Major causes of facial trauma include assault, motor vehicle collisions (MVCs), falls, sports injuries, occupational injuries, and gunshot wounds (GSWs) to the face. The relative prevalence of injury type varies by geography and practice setting. Falls and sports injuries are more likely to result in soft tissue–only trauma or relatively minor fracture patterns (such as isolated nasal bone fractures), which are more commonly treated in smaller emergency departments or in an ambulatory setting. Assaults, MVCs, and GSWs are more commonly treated in large, urban, level 1 trauma centers and more commonly result in more severe injuries. Demographic studies of facial trauma are almost exclusively performed in large urban level 1 trauma centers, so the literature is biased accordingly.
Dermal fillers
Michael Parker, Charlie James in Fundamentals for Cosmetic Practice, 2022
Augmenting the cheeks is a common procedure in both younger patients wanting more defined cheekbones as well as older patients aiming to replace lost volume. Administration of cheek fillers is different in principle to the majority of dermal filler injections as it is performed at a 90° angle to the skin, much like botulinum toxin injections. The needle used is often longer and of a large calibre than used for other soft tissue augmentation to enable the introduction of a viscous filler just above the periosteum. Be careful in any patient who has had previous facial trauma or surgery as this will distort the bony anatomy of the maxilla and zygoma and result in aberrant muscular, vascular or neural anatomy. Should you have a patient with a history of craniofacial trauma or surgery it is inadvisable to proceed with treatment unless you are certain you will not inadvertently cause any harm.
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
Basal (or basilar) skull fractures involve bones in the base of the skull, which accounts for 7% to 15.8% of all skull fractures in non-penetrating head traumas [1]. The majority of these are secondary to motor vehicle accidents or other high-velocity impact forces, including gunshot wounds [2]. These fractures are often present with facial trauma and can be associated with cerebral contusion, hematoma formation, and dural laceration. Cerebrospinal fluid (CSF) leaks, also known as CSF fistulas, may form if the space between the meningeal tear and the outside environment is continuous. Eighty per cent of CSF leaks are due to trauma, while the rest are iatrogenic or spontaneous [3]. CSF leaks after a head injury have been estimated to be 10% to 30% in basal skull fractures [4]. However, a recent study suggested that it may be lower as 4% [5]. The location of basal skull fractures can be categorized into three fossae: anterior, middle, and posterior cranial fossa. In this article, we specifically discuss fractures of the anterior (or frontobasal) cranial fossa, which occurs in 4% of head injuries [6].
Management of pediatric orbital wall fractures
Published in Expert Review of Ophthalmology, 2019
Imaging should be performed when there is a history of facial trauma combined with clinical evidence of a fracture on examination, including limited extraocular motility or positive forced ductions, decreased visual acuity, severe pain, inadequate exam, proptosis, enophthalmos, extrusion of intraocular contents on examination, or oculocardiac reflex [4,30,31]. The gold standard imaging workup for suspected orbital floor fracture consists of a high-resolution head computed tomography (CT) scan or a dedicated orbital CT scan (with multiplanar reconstruction preferred). CT provides excellent bone imaging and has been found to be highly sensitive for orbital floor fractures in adults (sensitivity: 96%; specificity: 71%) [45]. However, the particular limitations of CT in the pediatric population include the effects of high-dose radiation on the developing lens as well as its relative weakness for imaging soft tissue. Furthermore, in the pediatric population, CT has been found to significantly underestimate extraocular muscle and soft tissue entrapment [4,9,38]. The concordance rate between radiologic and intraoperative entrapment has been reported to be only 50% in children versus 87% in adults [9].
Experiences from Two Ways of Integrating Pre- and Post-course Multiple-choice Assessment Questions in Educational Events for Surgeons
Published in Journal of European CME, 2021
Monica Ghidinelli, Michael Cunningham, Isobel C. Monotti, Nishma Hindocha, Alain Rickli, Iain McVicar, Mark Glyde
A retrospective analysis was performed on anonymised data from 21 small animal fracture events in English (2018–2019) and from 66 facial trauma courses in English or Spanish (2017–2019). Standard psychometric tests (difficulty index, discrimination index, non-functioning distractors, Cronbach’s alpha coefficient) were performed using the Lertap 5 software (Curtin University, Perth, Western Australia) on a dataset including only participants who had completed both the pre- and post-event assessments (a total of 422 participants from small animal fracture courses and 723 participants from facial trauma courses). Differences between pre-test and post-test scores were investigated using paired t-tests. In addition, responses from faculty were analysed and compared to participants using unpaired t-tests. Data from both courses were compared and analysed and conclusions were drawn regarding what worked well and what best practices could be identified.
Related Knowledge Centers
- Burn
- Bruise
- Bone Fracture
- Injury
- Face
- Soft Tissue Injury
- Wound
- Facial Skeleton
- Nasal Fracture
- Eye Injury