Facial gunshot injuries are unusual and complicated clinical entities. Because of the mechanism of injury, early aggressive primary reconstruction might not be ideal. Initial conservative management followed by staged secondary reconstruction could be performed to obtain satisfactory functional and aesthetic results. Reconstruction of the cranio-maxillo-facial deformities requires a multi-disciplinary approach, the same way as for patients with cleft lip/palate deformities. We present a male patient with severe facial gunshot injuries. A team approach revealed maxilla recession, dental malocclusion, a large oronasal fistula over his hard palate, velopharyngeal insufficiency, and a stable psychosocial status. His main concern was facial appearance, which included the nose, lip, and scars. Staged reconstructions were performed, consisting of orthognathic surgery, rhinoplasty, lip-switch flap, and revisions of scars. A satisfactory outcome was obtained. The results indicated the importance of preoperative evaluation and treatment planning for this uncommon problem. (+info)
(10/169) Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders.
PURPOSE: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. METHODS: During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. RESULTS: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. CONCLUSION: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment. (+info)
(11/169) A 16 year study of injuries to professional boxers in the state of Victoria, Australia.
OBJECTIVES: Concerns about the significant injury risks in boxers have been well documented. To inform the continuing debate, updated information about the risk of injury for participants, and suitable means of modifying or preventing these risks, need to be identified. METHODS: Data describing all professional boxing fight outcomes and injuries sustained during competition, from August 1985 to August 2001, were obtained from the Victorian Professional Boxing and Combat Sports Board. RESULTS: A total of 107 injuries were recorded from 427 fight participations, corresponding to an injury rate of 250.6 injuries per 1000 fight participations. The most commonly injured body region was the head/neck/face (89.8%), followed by the upper extremities (7.4%). Specifically, injuries to the eye region (45.8%) and concussion (15.9%) were the most common. About three quarters of all injuries were lacerations/open wounds or superficial. No information was available on the mechanism of injury. CONCLUSIONS: Future research should collect information on the mechanism of injury, as this is crucial for the development and implementation of effective injury prevention strategies. A suggested boxing injury report form is provided to facilitate this. (+info)
(12/169) PREVENTION OF FACIAL TRAUMA IN AUTOMOBILE ACCIDENTS.
Automobiles do not protect passengers from the forces generated in traffic accidents. Although some compensatory protection can be provided by restraining devices, seat belts are not enough and must be supplemented by upper torso restraints. Cars should be designed with a view to better protection of passengers against injury from striking against hard surfaces or protuberances. (+info)
(13/169) BLOWOUT FRACTURES OF THE FLOOR OF THE ORBIT.
Blowout fractures of the orbit, a frequent complication of midfacial trauma, result from an increased intraorbital pressure which "blows out" the weakest area-the floor. Intraorbital fat and muscles herniated into the maxillary sinus, muscles incarcerated in the fracture, and the displaced orbital contents produce diplopia. After incarceration, elevation of the affected eye is impossible.Diagnosis is frequently difficult because initial intraorbital hemorrhage may limit mobility. Tomograms in the Waters' projection may show the fracture but frequently reveal only a cloudy antrum. The muscle traction test described herein is most helpful.The surgical correction aims at bridging the defect with Teflon or stainless-steel mesh or endogenous bone graft placed beneath the periosteum. Entry is gained through the lower lid. If repaired early, there is no functional loss and the repair is cosmetically excellent. (+info)
(14/169) FRACTURES OF FACIAL BONES.
A detailed review was made of 1025 consecutive patients with "face-bone" fractures admitted to four Montreal hospitals over the five-year period 1958-1962, inclusive. In addition a survey was carried out of the other general hospitals in Greater Montreal in order to obtain admission figures for facial-bone fractures and for total hospital cases. In the study group the common causes of face-bone fractures were found to be fights, traffic accidents, falls, and athletic pursuits. Very few of these injuries occurred in industrial settings. A distinctly vulnerable group is made up of males between ages 16 and 35 years. In order of frequency of occurrence these injuries involve the nose, lower jaw, cheekbone, upper jaw, and zygomatic arch. The experience throughout metropolitan Montreal indicated that more persons with face-bone fractures require hospital treatment each year, but the increase is approximately parallel to the upward trend of total hospital admissions. (+info)
(15/169) DERMABRASION FOR TRAUMATIC FACIAL SCARRING.
Deep dermal planing is effective for removal of traumatic facial scarring such as those from jagged cuts in automobile collisions and the like. Severe complications are few. The technique is of utmost importance. (+info)
(16/169) THE TREATMENT OF FRACTURES OF THE MANDIBLE.
One hundred and eleven cases of mandibular fracture in 67 patients who were seen at the San Francisco General Hospital from 1960 to 1962 were reviewed. With the exception of two cases in which displaced fragments interfered with the mandibular range of motion, condylar fractures were successfully treated with closed reduction. Undisplaced fractures of the angle were treated successfully by intermaxillary fixation alone, but the significantly displaced fractures were treated by open reduction and interosseous wire fixation. Fractures of the anterior body and midbody were usually treated with closed reduction if adequate teeth were present for satisfactory intermaxillary fixation. Some fractures of the anterior body, particularly those in the region of the symphysis require open reduction because of the strong pull of the muscles in that area. In this series of patients, clinical infection and non-union were most commonly associated with fractures communicating with teeth. If open reduction is necessary, the results in this series suggest that it should be delayed until the oral tract left by extraction is healed. Prophylactic antibiotics did not appear to be of value in preventing infection or non-union in this small series of patients, although sufficient data were not available for a statistical conclusion. (+info)