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PubMed1977

[Fibrous dysplasia].

Fibrous dysplasia of bone may occur also in the facial skeleton. Main locations are the lateral midface and the mandible. The foci, which are sharply circumscribed in most cases, produce tumour-simulating deformities of single of several facial bones and, in part, disorders of the articulation are bulbar displacements. In contrast to Paget's disease, fibrous dysplasia is a disorder of the younger age groups. Apart from bony changes, Albright's syndrome (which occurs in women only) comprises also irregular, circumscribed café-au-lait patches and signs of somatic and sexual precocity.

Facial Bones↗
PubMed2005

Anchor screw, a valuable technique in facial fractures and cranio-maxillofacial surgery.

INTRODUCTION: Open reduction of displaced and comminuted facial bone fractures involves many difficulties. In these cases, it is very useful to fix a screw to the fragments for immobilization. Once fixed, the screw is seized with a forceps and the fragment can be correctly repositioned and kept in place to perform fixation. MATERIAL: Five cases in which the anchor screw was successfully utilized are reported. CONCLUSION: The technique is easy, efficient, inexpensive and minimally invasive. It enables reduction of comminuted fractures and in quite difficult circumstances.

Adolescent↗
PubMed1977

Reconstitution of craniofacial osseous contour deformities, sequelae of trauma and post resection for tumors, with an alloplastic-autogenous graft.

Our experience using a new technique for reconstructing contour defects of facial bones has been presented. It employs particulate, cancellous bone and an implantable prosthesis accurately fabricated of polyether urethane and polyethylene terephthalate cloth mesh which can be produced in a variety of configurations. A mannequin made of these materials displaying the various parts of the craniofacial complex that have been restored or are currently under investigation is shown in Figure 10. Large cranial vault defects, orbital floors, mandibles including chin augmentation, and nasal bone deformities have been successfully restored in man. Restoration of the pinna of the ear is currently being evaluated in laboratory animals.

Adolescent↗
PubMed1999

Prevalence of dental trauma in 6000 patients with facial injuries: implications for prevention.

OBJECTIVE: In contrast to epidemiologic studies on facial injuries reporting on dental trauma, facial bone fractures with dentoalveolar injuries, or soft tissue injuries individually, the purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation of the impact of sport, work, violence, traffic, household, and play accidents in the relationships among dental trauma, facial trauma, and other concomitant trauma. Finally, preventive considerations are discussed. STUDY DESIGN: Six thousand patients registered at the University Hospital of Innsbruck's Department of Oral and Maxillofacial Surgery during a period of 6 years 4 months were admitted for dental trauma, facial trauma, or both. Records were analyzed for cause of injury, age, gender, monthly distribution, frequency, type of injury, and frequency of dental trauma in relation to facial injuries and concomitant injuries. RESULTS: The incidence of dental injuries with respect to the total number of facial injuries was as follows: 57.8% in play and household accidents, 50.1% in sports accidents, 38.6% in accidents at work, 35.8% in acts of violence, 34.2% in traffic accidents, and 31% in unspecified accidents. The overall incidence revealed was 48.25%. CONCLUSION: Our findings support the fact that in the mosaic of traumatic injuries, the frequencies of tooth trauma and its sequelae are underestimated and that such trauma and sequelae occur without a predictable pattern of intensity and extensiveness. Preventive approaches are the sole way to minimize the number of these injuries. Substantial progress made in treating facial and dental trauma in the last 2 decades only improves functional and esthetic outcomes among the population that has suffered dental injury.

Accident Prevention↗
PubMed2002

[Results of the facial skull bone defects and deformations repair by modern methods for plasty and fixation of bone fragments].

Methods of reconstructive maxillofacial operations bringing about the best functional and esthetic results are analyzed. Surgical methods for repair of maxillofacial bone defects and deformations with the use of transplants and different methods of their fixation depending on the tissues at the site of defect (deformation) in patients with acquired and congenital abnormalities of the facial skull have been developed and are used at Central Institute of Dentistry. Osteosynthesis using titanium constructions and compression-distraction devices is acknowledged as an effective method of bone repair operations on the face. It notably reduces the duration of operation and prevents the relapse of the deformation. Analysis was carried out on extensive clinical data (more than 1000 patients), which allowed an objective evaluation of remote results of plastic repair of bones and helped define the indications and contraindications for such operations.

Contraindications↗
PubMed1996

Symposium "Implantable Materials in Facial Aesthetic and Reconstructive Surgery: Biocompatibility and Clinical Applications". American Society of Maxillofacial Surgeons. Montreal, Quebec, October 6, 1995.

On October 6, 1995, the American Society of Maxillofacial Surgeons sponsored a 1-day symposium entitled "Implantable Materials in Facial Aesthetic and Reconstructive Surgery: Biocompatibility and Clinical Applications." The symposium examined issues relating to the biocompatibility and clinical role of alloplastic materials commonly used for facial bone and soft-tissue replacement and augmentation. It provided a forum for the interaction of basic scientists, clinicians, and manufacturers. Clinical and laboratory data concerning a variety of implantable materials were presented and discussed. The program consisted of three parts. The first session was designed to provide historical and scientific background as well as perspective on legal issues surrounding the use of implantable biomaterials. The second session involved the presentation of clinical data on bone and bone substitutes for augmentation of the facial skeleton. The third session was devoted to clinical reports of bone and bone substitutes used for the reconstruction of cranial vault and cranial base skull defects.

Biocompatible Materials↗
PubMed1985

Single photon emission computerized tomography of the skull.

The diagnostic contribution of single photon emission tomography for detection of bone lesions of the skull was explored in 125 cases and compared with planar imaging. Twenty-one localizations (16% of the total group) were only visualized by scintitomography, these were predominantly lesions of the base of the skull and facial bones. Scintitomography gave a false negative result in only one lesion out of 49 visible on skull radiographs. Together with the revelation of unsuspected bone abnormalities, SPECT generally provides a better visualization of the skull lesions and their extent than does planar imaging. In cases where disease of the facial bones and the base of the skull is suspected, scintitomography is an indispensable adjunct to planar scintigraphy.

Bone Neoplasms↗
PubMed1997

[Craniosynostosis operations in childhood].

Premature osteosynthesis of one or more cranial bones, either intrauterine or within the first postnatal months, is defined as craniosynostosis. The resulting limitation of intracranial space can cause retardation of cranial growth which, in turn, leads to craniostenosis with increasing intracerebral pressure. Complex forms of craniosynostosis with concomitant malformations (i.e. Apert-, Crouzon-, and Pfeiffer syndromes) must be principally distinguished from simple craniosynostosis. This complex cranio-facial dysostosis is a premature osteosynthesis of cranial and facial bones. In general, as far as Germany is concerned, the incidence of cranio-synostosis amounts to 1/1000 births. If they remain untreated, many of these children will suffer from cortex-associated retardation of intelligence. Surgical management, therefore, is initiated at a very early stage, and should be performed in specialised centres. Recommendations for operation vary from an age of 4 to 36 months. However, an age of 6 months or more is the most frequently preferred age for surgical intervention. Severe respiratory disorders, as well as impossibility of enteral intake of nourishment, are considered absolute indications for surgery, independent of the age; elimination of the stigmatisation regarding environmental contacts of the child is another mandatory indication for operation. The goal of early surgery is reconstruction of physiological, cranial, and facial bone structures ("fronto-orbital" or "fronto-facial advancement"). Correction of craniofacial malformation may be associated with--in part--severe complications for the child. From the anaesthesiologist's point of view, this disease demands highly qualified perioperative management, since a variety of idiosyncrasies and risks must be taken into account: These are, for example, venous air embolism, hypothermia, disorders of water and electrolyte equilibrium, and, extremely vital, difficult intubation and substantial blood loss.

Anesthesia, General↗
PubMed1995

The role of autogenous primary rib grafts in treating fractures of the atrophic edentulous mandible.

Fractures of the atrophic edentulous mandible are relatively uncommon representing less than 1% of all facial bone fractures seen at The Queen Victoria Hospital, East Grinstead. Only 35 patients have been treated for fractures of the atrophic edentulous mandible at this unit from a total of over 4000 facial bone fractures seen here between 1975 and 1994. All traditional treatment modalities have been utilised with varying degrees of success. A technique is presented whereby all displaced fractures of the atrophic edentulous mandible with a measured bony vertical dimension of less than 10 mm at the fracture site are managed with primary autogenous rib grafting. This reduces the risk for formation of pseudarthrosis and facilitates subsequent prosthetic rehabilitation.

Aged↗
PubMed1999

Surgical management of the facial nerve in craniofacial trauma and long-standing facial paralysis: cadaver study and clinical presentations.

BACKGROUND AND OBJECTIVES: Examination of the extratemporal branches of the facial nerve reveals several branching patterns of the facial nerve, indicating the variability in the course of the nerve. Due to such variance, injury to this nerve often accompanies facial trauma and surgical dissection for the repair of facial bone injuries, and it may result in high morbidity. METHODS AND MATERIALS: A study of 12 fresh cadavers was performed to 1) review the variability in location of the extratemporal branches of the facial nerve, 2) identify the soft tissue injuries in which the facial nerve is at risk, and 3) discuss surgical options for repair. The authors identified the zygomatic and buccal and the extratemporal branches of the facial nerve. Among the five extratemporal branches, there is a significant crossover between all, except the temporal and the mandibular branches. This indicates that dissection should proceed with great caution, since injury to the temporal and marginal mandibular branches is unlikely to resolve spontaneously. The management of injuries within one year and those of longer duration is discussed. RESULTS AND/OR CONCLUSIONS: Two of the 5 major branches of the extratemporal facial nerve have a high morbidity following injury. Repair should be performed within the first 72 hours. Graft, if required, should be placed in 9 to 12 months.

Adolescent↗
PubMed2002

[Multislice helical CT (MSCT) for mid-facial trauma: Optimization of parameters for scanning and reconstruction].

PURPOSE: To determine the optimal scan parameters in multislice helical CT (MSCT) of the facial bone complex for both axial scanning and multiplanar reconstructions. MATERIAL AND METHODS: An anthropomorphic skull phantom was examined with a MSCT. Axial scans were performed with continuously increasing collimations (4 x 1.25 - 4 x 2.5 mm), tube current (20 - 200 mA) and table speeds (3.75 mm/rot. and 7.5 mm/rot.). Multiplanar reconstructions in coronal and parasagittal planes with different reconstruction increment and slice thickness were evaluated in terms of image noise, contour artifacts and visualisation of anatomical structures. RESULTS: The best image quality was obtained with a collimation of 4 x 1.25 mm and a table speed of 3.75 mm/rot. A reconstruction increment of 0.6 mm achieved the best time to image quality relation. With these parameters the bone structures were depicted in an optimal way without artifacts. The tube current could be reduced to 50 mA without significant loss of image quality. The optimized protocol was used for regular routine examinations in patients with facial trauma (n = 66). CONCLUSIONS: Low-dose MSCT using thin collimation, low table speed and small reconstruction increments provides excellent data for both axial images and multiplanar reconstructions in patients with facial trauma. An additional examination in coronal orientation is therefore no longer necessary.

Adult↗
PubMed1990

Gunshot injuries of the soft and bony tissues of the face.

A classification of wounds into penetrating, avulsive and perforating, applied to the face and neck region is given. The results of the management of 60 patients with gunshot injuries treated in Gondar College of Medical Sciences Hospital in 1987-1988 are evaluated. In all cases there was soft tissue damage associated with comminuted fractures of the facial bones. Primary wound healing was possible in 31 patients. Complicated wound repair was needed in 22 cases. Open wound management with secondary suturing was performed in 4; the other 3 casualties died of brain damage. Differences from the treatment of combat wounds in the extremities are pointed out. All salvageable soft tissue of the face and neck region should be preserved, and methods of intraosseous suturing of fractured facial bones, craniofacial suspension, and compression osteosynthesis can be applied.

Adult↗
PubMed1986

The Beirut terrorist bombing.

The Beirut terrorist bombing on October 23, 1983, caused 234 immediate deaths and injured at least 112 survivors. Military medical records were available for each casualty; postmortem examination reports were available for each immediate fatality. This represented a unique opportunity to assess type, incidence, treatment, and outcome of neurological injuries suffered in a mass casualty terrorist bombing situation. Three categories of neurological injuries are described: head injuries, spine and spinal cord injuries, and peripheral nerve injuries. The following types and numbers of injuries occurred among the 112 immediate survivors of the explosion: 37 head injuries--28 concussions, 20 scalp lacerations, 13 skull fractures, 6 facial bone fractures, 4 cerebral contusions, 5 dural lacerations, 2 cerebrospinal fluid fistulas, and 2 intracerebral hematomas; 2 spine or spinal cord injuries--1 cervical and 1 thoracolumbar spine fracture associated with neurological deficit; and 9 peripheral nerve injuries--1 facial nerve palsy, 2 brachial plexus palsies, 1 median and 1 radial nerve palsy, and 4 peroneal nerve palsies. Among 234 immediate fatalities, the types and numbers of neurological injuries were: 167 head injuries--93 scalp lacerations, 85 skull fractures, and 24 facial bone fractures; and 22 spine and spinal cord injuries--15 cervical and 7 thoracolumbar fractures. Seven of the 112 immediate survivors died; 4 of these deaths were related to severe head injuries. The treatment and outcome of survivors with neurological injuries is briefly described. One-third of the immediate survivors who suffered either a scalp laceration or a concussion had a concomitant skull fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Blast Injuries↗
PubMed1999

Facial injuries in skiing. A retrospective study of 549 cases.

In the last 2 decades, reports of skiing injuries have shown an increasing number of skiers with severe trauma. This article provides an account of a retrospective study of 549 patients with 1155 facial injuries sustained while skiing who received treatment at the Department of Oral and Maxillofacial Surgery at the University Hospital in Innsbruck, Austria between 1991 and 1996. The study was based on a questionnaire answered by the patients and on case report forms. Most of the patients were male (65.2%) and were aged between 3 and 81 years (average 28.4 years). A simple fall while skiing was the main type of accident (45.9%), followed by collisions with other people (23.5%). Injuries were classified into 1 of 3 groups: (i) lesions of the soft tissue (32.2% of all injuries); (ii) dentoalveolar traumas (24.3%); and (iii) fractures of facial bones (43.5%). Lacerations and haematomas were the most frequent lesions in patients with injuries to the soft tissues. The group of patients with dentoalveolar trauma mainly presented with fractures of tooth crowns. Fractures involving the mandible and the zygomatic bone were predominant in patients in the third group. Concomitant injuries mainly included injuries to the brain and skull fractures. Treatment was ambulatory, or by admission and surgery. We did not observe an increase in the number of skiing accidents causing facial injury in the last 5 years. Facial injuries represented 4% of all skiing injuries, a lower proportion than in other sports.

Accidental Falls↗
PubMed1989

Computed tomography of bones and joints.

The monograph sums up the problem of CT diagnosis of bones and joints making use of predominantly the authors' own experience based on CT tests of more than 45,000 patients examined at the Department of Radiology, Charles University Medical Faculty of Hygiene teaching hospital in Prague in the years 1980-1988. Specific scans of the skeleton were made in 4,500 patients, mostly for suspicion or closer assessment of neoplasms (43.5%), the radicular lumbosacral syndrome (34.5%), and injuries (12%). The opening chapters sum up basic facts about the principle of computed tomography, the apparatus in use, the evaluation of CT images, CT radiation doses, and the patients' preparation for CT scanning. The use of contrast media is discussed with regard to the possible hazards involved and to the need to hear allergological opinion first. For spinal canal visualization non-ionogenic contrast media are used exclusively. The management of side reactions to contrast medium application is also reviewed. Indications for bone and joint computed tomography now comprise a whole series of traumatological, orthopaedic, oncological, rheumatological, neurological and rehabilitation conditions, each of which is discussed in detail in a separate chapter. CT anatomical studies offer the advantage of being applicable even in patients examined for other than bone or articular diseases. The option of simultaneous soft tissue assessment represents another advantage. The authors describe different anatomical structures in terms of CT images, some of them complete with dimensional and density values. The chapter on anomalies and developmental variants stresses the relevance of computed tomography for precise characteristics of clefts of the spinal column and facial bones and for the diagnosis of anomalies and dysplasias of the spinal column and the chest. A rare case of cephalothoracopagus is demonstrated. As for traumatology, computed tomography is found useful in diagnosing fractures of the orbit and facial bones in general, the atlas, axis and pelvis and in tracing vertebral fragments displaced into the spinal canal. Computed tomography occupies a monopoly position in the diagnosis of post-injury haematomas of intracranial but also thoracic, pelvic and abdominal localization. There is a wealth of illustrations to document a wide range of traumatic conditions. The chapter on degenerative diseases is focused mainly on computed tomography in the lumbosacral radicular syndrome, one of the most frequent and also most effective indications for CT. Protrusion and herniation of the intervertebral disk and sequestra in the spinal canal are all absolute indications for CT scanning where surgical treatment is contemplated.(ABSTRACT TRUNCATED AT 400 WORDS)

Arthrography↗
PubMed1994

Pathological fractures of the mandible: a diagnostic and treatment dilemma.

Pathological fractures of the facial bones are relatively rare. Four pathological mandibular fractures are presented and the difficulty in diagnosing the underlying cause and the dilemma of treatment choice are discussed with a review of the literature. The authors found the incidence of pathological fractures of the facial bones in their series was 0.47%. Biopsy followed by rigid internal fixation, preferably with an AO reconstruction plate bridging the area of pathology after its removal, permits normal function and allows good and undisturbed healing which will inevitably be prolonged in such cases.

Abscess↗
PubMed1989

MR imaging of muscles of mastication.

High-field MR imaging was used to study structural and physiologic alterations involving the muscles of mastication in 46 patients. Muscular abnormalities were often detected incidentally in conjunction with lesions of the CNS, cranial nerves, facial bones, and/or temporomandibular joint (TMJ). Specific pathologic alterations observed included anomalies of musculoskeletal development, muscle hypertrophy, atrophy (disuse and denervation), inflammatory disorders, injuries (including contusions, tears, and muscle rupture), posttraumatic musculoskeletal deformities, and reflex sympathetic dystrophy. Atrophy, fatty replacement, fibrosis, and contracture of selected muscles of mastication may accompany internal derangement of the TMJ in the absence of traumatic deformity. We conclude that MR is a highly accurate imaging method for detecting masticatory muscle disease. Nontraumatic anatomic and physiologic abnormalities of the muscles of mastication are uncommon disorders. Demonstrable muscle alterations frequently accompany fracture dislocations of the mandibular condyle neck and related facial bones onto which masticatory muscles attach.

Adolescent↗
PubMed1996

Primary Ewing's sarcoma of the maxilla, a rare and curable localization: report of two new cases, successfully treated by radiotherapy and systemic chemotherapy.

Primary maxillary localization of Ewing's sarcoma is unusual. Involvement of facial bones is characterized by clinical and radiological features distinct from those commonly observed in other sites. Because of the above peculiarities a delay in diagnosis and thus in starting treatment is very probable in such cases. We report here two new cases of Ewing's sarcoma localized to facial bones, successfully treated by local high dosage radiotherapy and systemic chemotherapy. Our experience suggests that, especially for particular sites not suitable to radical surgery, radiation therapy can represent an effective tool to achieve local control of the tumor.

Adult↗