SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The long-term and successful treatment of facial defects with bone-anchored prostheses requires daily cleaning of the prosthesis, any retention elements and surrounding skin. This keeps a potential problem zone around the implant healthy and free of inflammation. Suitable concepts for care and cleaning aids are discussed.
The material properties of cortical bone from the diaphyses of long bones (e.g., the femur and tibia) vary by direction, such that bone is stiffer and stronger along its long axis. This configuration improves the abilities of these structures to resist axial compressive loads coupled with bending. As in long bones, cortical bone from the cranial vault is subject to mechanical loads from various orofacial functions and the contraction of attached muscles. However, experimental studies suggest that the resulting bone strains are at least an order of magnitude smaller than those found in the midshafts of the femur or tibia. The characteristics of the three-dimensional elastic properties of cortical bone are largely unexplored in regions of low bone strain, including the cranial vault, in which little is known regarding cortical structure and function. In the present study we examined variations in the cortical microstructure and material properties of the bone of the human cranial vault, including the parietal, frontal, temporal, and occipital bones. A facial bone, the zygoma, was also included to contrast the properties of the cranial vault with another craniofacial intramembranous bone that experiences larger strains. Cortical specimens from the outer cortical plate of the cranial vault were removed from 15 frozen human crania. We measured cortical thicknesses and densities, and determined the primary direction of stiffness within the bone specimens prior to ultrasonic testing to determine their elastic properties. There were statistically significant differences in elastic properties between bones and, in some cases, sites within bones, which for most variables were clustered by bone or region. In striking contrast to this pattern, elastic moduli in the direction of primary stiffness were larger in cortical regions underlying muscle attachments than in regions without muscle attachments. Few sites in the cranial vault or zygoma showed a consistent orientation of the material axes among individuals, although specimens from many regions had directional differences similar to those in cortical bone from the mandible, femur, or tibia.
Explore the source record for details and available documents.
In order to examine whether or not facial bones are themselves able to regulate their own growth, we devised a new experimental model in which we transplanted the whole head of an infant rat to the body of an isohistogeneic adult rat by means of microvascular anastomoses. The advantage of this model is that the transplanted head has neither scars nor any moving soft tissues that could modify growth around facial bones. Using this model, we conducted a study of the nasomaxillary region that has led us to conclude that facial bones do in fact regulate their own growth. The results also suggested that facial bone sutures play a more active role in the growth process than presently suspected.
Congenital muscular torticollis is caused by idiopathic fibrosis of the sternocleidomastoid muscle that restricts movement and pulls the head toward the involved side. Deformation of the craniofacial skeleton will develop if the restriction is not released and result in aesthetic and functional problems. The purpose of this study was to use three-dimensional computed tomography imaging for qualitative and quantitative evaluation of the craniofacial deformity in a series of patients with uncorrected congenital muscular torticollis, and to assess age as a precipitating factor for severity of the deformity. A total of 14 patients from 1 month to 24 years of age were included. The skull images were rotated into standard orientation and reconfigured for evaluation of the cranium, endocranial base, and facial skeletal structures. The midlines of cranial base and facial bone, angle of midline deviation, width of each hemicranium and hemiface, and the orbital index were defined and measured. The results showed that the cranium and cranial base deformation took place as early as in infant stage, with the most prominent change occurring in the posterior cranial fossa. Facial bone asymmetry started to appear after 5 years of age, at which time the mandibular and occlusal abnormalities were observed. The deformity of the orbits and maxilla occurred at an older age, characterized by the deviation and decreased vertical height on the affected side. The severity of the observed deformities increased with age. The angle of midline deviation was 2.48 +/- 1.68 degrees in the cranial base and 3.26 +/- 3.28 degrees on the facial bone. Both of the midline deviations were significantly correlated with age. Compared with the contralateral side, the width of the ipsilateral posterior hemicranium was longer (54.36 +/- 6.72 mm versus 50.81 +/- 6.55 mm), and the width of the ipsilateral lower hemiface was shorter (35.30 +/- 7.27 mm versus 43.49 +/- 11.34 mm). Both differences were statistically significant. Measurement of the orbital index demonstrated a significantly flatter orbit on the ipsilateral side (89.48 +/- 0.11 versus 92.74 +/- 0.08). This study showed that the cranium and cranial base deformity occurred early in patients with uncorrected torticollis, while the facial bone deformity occurred in childhood stage. The cranial and facial deformity became more severe with age. Early release of the muscle restriction is advised to prevent craniofacial deformation.
Mediastinal emphysema following facial trauma in the absence of neck, chest or abdominal injury is a rare entity. Mediastinal emphysema associated with fractures of the facial bones or odontological surgery has only been reviewed previously in case reports. This article reviews the etiological and pathogenetic mechanisms of subcutaneous facial/cervical emphysema and mediastinal emphysema associated with fractures of the facial bones. Complications and risk factors in treating fractures of the facial bones when mediastinal emphysema is present are discussed with emphasis on anaesthesiological complications.
This study reviews the epidemiology of patients aged 1-18 years treated for maxillofacial injuries during a 3 year period at a tertiary care centre. Of the 276 patients, 65.5% were aged 1-10 years. Seventy-three per cent of injuries were to the soft tissues and 15% of injuries were fractures. The mandible and zygoma were the most commonly fractured facial bones. In the adolescent group, facial fractures accounted for over half of all injuries. Injuries of 96.8% were classed as minor to moderate. Falls were by far, the commonest cause of injury, but with increasing age, assaults became more common. A surprisingly high incidence of dog bite injuries was noted, particularly in children under 7 years of age.
Facial bone and especially mandibular fractures are injuries in which first aid and management of late complications require dental professionals, and consequently all dentists should be familiar with the modern principles of their treatment. Tooth involvement is common in mandibular and maxillary fractures and can require more treatment than does the jaw fracture. Nonsurgical treatment of bone fractures involves immobilization, which for the facial bones is achieved with maxillomandibular fixation (MMF) using dental fixed arch bars. Hence, associated tooth injuries are difficult or impossible to treat during immobilization, so that some treatment is necessary beforehand (for example, coverage of exposed dental areas, temporary filling of crown fractures, repositioning of luxated teeth, and endodontic treatment if the pulpal vascular supply is lost in the accident). Operative treatment of mandibular and/or maxillary fractures nevertheless involves some disadvantages and risks of complications. Teeth on the line of a mandibular fracture should not be extracted as a first-aid measure unless they impair repositioning of the jaw fragments. MMF can be avoided by means of direct internal fixation, which in principle allows treatment of associated dental injuries.
The incidence of fractures of the jaws and facial bones in children is less frequent than these same fractured bones in adults. The relative low incidence of facial fractures in children can be related to certain growth factors. Details of facial trauma and associated injuries were collected in 50 patients referred from the Medical School in Hannover. The age and sex distribution, anatomical types of fractures, associated nonmaxillofacial trauma and causes of the injuries are described. Fractures of the mandible occur in greater frequency than those of the middle third of the face in children. Emphasis is placed on paediatric mandibular and condylar fractures and their treatment difference from those in adults are noted. Facial bone fractures in children have the potential of deformity due to growth disturbances. Fractures of the facial skeleton are often accompanied by associated injuries, especially fractures of the skull and intracranial injuries. Of primary importance is an early assessment of the patient's general condition and associated injuries.
Ten children with gross deformity of the external ear were observed. In six the facial bones were underdeveloped on the same side as the deformed ear. In all six there was a congenital abnormality of the kidney or upper urinary tract, usually on the same side as the deformed ear. In addition there were usually other associated congenital defects in each case.In the remaining four children the facial bones appeared normal, and pyelography showed no abnormality of the urinary tract. In these four children there were no other associated defects.These observations emphasize the importance of investigating the urinary tract in children with gross deformity of the external ear, especially where there is an associated underdevelopment of the facial bones.
Endothelin-1 (ET-1) was first found as a vasoconstrictor protein excreted by vascular endothelial cells, but recently ET-1 has been considered to have widespread functions that include regulation of osteochondrogenic metabolism. We analyzed sections of head regions in ET-1 knockout mice that are known to have abnormalities in pharyngeal arch-derived tissues and found that there was severe hypoplasia in facial bones. The hypoplasia suggests that the matrix mineralization system of facial bones is disrupted in ET-1-/- homozygous mice. To elucidate whether osteogenic cells in facial bones are the targets for ET-1 and whether expression of bone matrix genes are modulated by ET-1, we examined gene expression of ET-1 receptors, ETA and ETB, and that of the bone matrix proteins, osteonectin (ON) and osteopontin (OP), both in the head regions of ET-1+/- heterozygous and ET-1-/- homozygous mice by means of in situ hybridization. Different patterns of expression between ETA and ETB mRNAs were observed in both groups. In 18.5 days post coitus fetuses, ETA mRNA was most strongly expressed in osteogenic cells along craniofacial bones, but ETB mRNA was most strongly expressed in trunks of trigeminal nerve. This finding suggests that ET-1 may modulate osteogenic cells through ETA receptor but not through ETB receptor. The expression patterns of ETA, OP, and ON mRNAs were distinct between the two groups. In the lower jaw of ET-1+/- heterozygous mice, the ETA, ON, and OP mRNA positive cells were scattered in the inner and outer regions of the thick bone matrix, but in ET-1-/- homozygous mice, cells containing those mRNAs were located close to each other at the surface of thin bone matrix. However, cellular expression of ON and OP mRNAs in osteogenic cells of ET-1-/- homozygous mice was not suppressed as compared with ET-1+/- heterozygous mice. We conclude that ET-1 may regulate proliferation and migration of osteogenic cells in the maxillofacial region, rather than modulating the expression level of ON and OP mRNAs.
The authors described the application of facial bone scintigraphy in 6 patients with acute and 47 patients with chronic sinusitis, 4 patients with cyst of maxillary sinus, 4 patients with sinus maxillary neoplasm and 4 patients with pyocele of frontal sinus. Facial bone scintigraphy was performed by gamma-camera Siemens Gammasonics ZLC-750 after intravenous administration of 15 mCi of 99mTcMDP in anteroposterior projection. The index of accumulation of the tracer (JAT) in maxillary sinus region was counted separately in men and in women in the reference group. In patients with purulent sinusitis marked JAT was predominated. Correlation between JAT and symptoms and rhinological signs has been shown in patients with chronic purulent sinusitis. In patients with sinus maxillary neoplasm high JAT was predominated.
Injuries to the facial bones, orbits and adjacent soft tissue structures are common. Despite the increasing safety precautions in modern cars, facial injury is very often caused by motor vehicle accidents. Severe trauma to the face is a strong indication for radiological investigation. In the patient with maxillo-facial trauma, the radiological exploration of should answer two major questions: do the fractures involve areas that may alter the physiologic function of the sinuses, mouth, nasal vault or orbit?, and will the fracture result in any cosmetically detectable abnormality? The goal of the radiological work-up is to define the number and exact location of the fractures, to determine if there is any depression, elevation, or distraction of the fracture fragments, and to assess concomitant soft tissue complications. In this article, we review the role of clinical evaluation, plain X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). Imaging findings are correlated with anatomic and physiopathologic considerations. We present a practical classification system of facial trauma, with emphasis on trauma of the paranasal sinuses and facial bones (nasal and tripod fractures, Le Fort fractures) and orbits (foreign bodies, soft tissue and orbital wall injuries such as blow-in and blow-out-, lateral wall- and apical fractures). A third part focuses on trauma of the mandible and the temporomandibular joints.
The deformities of craniofacial bones in brachycephaly (n = 2) and plagiocephaly (n = 2) were compared using three-dimensional skull replicas. In brachycephaly the bilateral deformities of the cranial base were similar to the unilateral deformities on the affected side in plagiocephaly. Shortening of the anterior-middle cranial fossas and expansion of the middle cranial fossas suggest downward and anterior displacement of both temporomandibular (TM) joints resulting in the underdevelopment of the middle-inferior facial bones, though this is less conspicuous in brachycephaly for three reasons. The most important one is that the patients have an imposing facial morphology characterised by high, protruding facial bones, as found on the affected side in plagiocephaly. Secondly, the frontal bones are flattened and positioned posteriorly in the anteroposterior direction, which also helps to mask the underdevelopment of the middle-inferior facial bones. Finally, as bony deformities are symmetrical in brachycephaly, they are not as obvious as they would be if they were unilateral.
In spite of curiosity, facial fractures, particularly mandibular fractures, in the pediatric age group embrace only a modest proportion of facial fractures that occur within the general population. Several large series report an overall incidence of approximately 1% of all facial bone fractures. A considerable volume of literature has been generated describing the pattern of injury and treatment modalities for pediatric facial bone fractures. At our institution, which is an extremely busy university-based regional trauma center, we have witnessed a persistent escalation in the number of patients requiring repair of their facial bone fractures. During the period of January 1989 through January 1990, we treated a total of 204 patients for repair of mandible fractures. An analysis of the records of this group revealed only 3 patients who were younger than 4 years of age and 2 additional patients younger than 8 years. There were another 10 patients 17 years and younger, for a total incidence of 0.08%. Additionally, we found that within this seemingly small group, there was a surprisingly high incidence of severe, associated injuries.
The popularity of bicycling is reflected in the number of cycling-related oral and maxillofacial injuries. Five hundred and sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, between 1991 and 1996, accounting for 31% of all sports-related accidents and 48.4% of all traffic accidents. A review of the patient records revealed more severe injury profiles in sixty mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma and 23% soft tissue injuries, compared to 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures and 14% soft tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% LeFort I, II and III fractures. Condyle fractures were more common in bicyclists, with 18.8% compared to 10.8% in mountainbikers. Reduction of facial injuries due to cycling-related accidents needs appropriate design of helmets with faceguards and compulsory helmet use for all cyclists, and particularly mountainbikers.
Explore the source record for details and available documents.
BACKGROUND: Bicyclists and mountainbikers are prone to facial trauma. In the current study, we present a large series of cycling-related sports trauma to the face in an effort to identify the injury pattern among mountainbikers compared with bicyclists. METHODS: The medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1991, through October 31, 1996. All admissions with injuries caused by cycling-related sports were reviewed, analyzed, and compared according to age and sex distributions, causes of accidents, injury types, frequency, and localization of fractures and associated injuries. The injury types were divided into three categories: fractures, dentoalveolar trauma, and soft-tissue injuries. RESULTS: Five hundred sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, during the study period, accounting for 31% of all sports-related or 48.4% of all traffic collisions, respectively. The review of the patient records revealed especially more severe injury profiles in 60 mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma, and 23% soft-tissue injuries, compared with 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures, and 14% soft-tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% Le Fort I, II, and III fractures. Condyle fractures were more common in bicyclists, with 18.8% opposing 10.8% in mountainbikers. CONCLUSION: Appropriate design of helmets with faceguards will reduce the incidence of facial injuries caused by cycling-related accidents and incentives are needed for making helmet use compulsory for all cyclists, particularly for mountainbikers.