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PubMed1996

[Current systematic definition and terminology of the face lifting technique].

OBJECTIVE: A more precise definition of the term "face lifting" appears to be necessary. The development of new techniques and modifications in the last decade has been the main reason for the proliferation of definitions. Nearly every author has his own terminology for describing his procedures. METHODS: Three criteria are helpful in achieving an overview. 1. The selection according to the anatomical areas of the face and the neck which have to be rejuvenated 2. The selection according to procedures, involving resection of soft tissues as opposed to techniques that solely involve soft tissue reposition, modification of facial bones, and combinations of these principles. 3. The selection according to the different layers of soft tissue or to the combination of different layers which are to be lifted. CONCLUSIONS: The terms "face lifting" and "lifting" are used synonymously in international literature. They refer to those surgical procedures which aim a achieve facial rejuvenation and a younger appearance of the neck. Definitions that refer only to a lifting of the facial skin do not correspond to the actual techniques, which often involve the surgical treatment of different soft tissue layers and sometimes facial bone. A classification is possible because some terms are used more often.

Humans↗
PubMed1997

Prostate cancer masquerading as a zygomatic posttraumatic mass.

A zygomatic mass is a rare occurrence. We describe a 52-year-old man with a zygomatic arch mass and a recent history of facial trauma. Findings on a computed tomographic scan of the facial bones were interpreted as callus formation, consistent with fracture of the zygomatic arch. The level of the prostate-specific antigen was increased to 62.3 ng/mL, and a biopsy of a nodular prostate specimen revealed adenocarcinoma (Gleason sum, 3 + 4 = 7). Because the laboratory data, history, and findings on physical examination did not correlate, we suspected a tumor metastatic to the facial bones.

Adenocarcinoma↗
PubMed2002

Biomechanical changes in the head associated with penetrating injuries of the maxilla and mandible: an experimental investigation.

PURPOSE: In this experiment, we studied the craniocerebral injury that occurs due to the transmission of forces when maxillofacial gunshot wounds are sustained by the facial bones and cranium. MATERIALS AND METHODS: Forty fresh pigs' heads were wounded by one of the following methods: steel spheres weighing 1.03 g at an impact velocity of 1,400 m/s, steel spheres weighing 1.03 g at an impact velocity of 800 m/s, M193 military bullets, or M56 military bullets. Pressure waves in the brain, acceleration of the head, and stress changes in the facial bones and cranium at the moment of the impact were recorded by pressure and acceleration transducers and strain gauges and were statistically compared. RESULTS: Some obvious differences between the mechanical values obtained from high-and low-velocity missile wounds were found. A negative relationship between the peak value of the pressure wave in the brain and the distance from the point of impact to the transducer was obtained. The acceleration of the head in the direction of the ballistic path was the strongest in absolute value. There were differences in the stress values between the mandible and the temporal bone. CONCLUSIONS: Acceleration of the head, pressure wave changes in the brain, and injury from bony stress conduction all play important roles in associated craniocerebral damage after maxillofacial firearm wounds.

Acceleration↗
PubMed2003

Analysis of injuries among pilots involved in fatal general aviation airplane accidents.

The purpose of this study was to analyze patterns of injuries sustained by pilots involved in fatal general aviation (GA) airplane accidents. Detailed information on the pattern and nature of injuries was retrieved from the Federal Aviation Administration's autopsy database for pilots involved in fatal GA airplane accidents from 1996 to 1999. A review of 559 autopsies revealed that blunt trauma was the primary cause of death in 86.0% (N=481) of the autopsies. The most commonly occurring bony injuries were fracture of the ribs (72.3%), skull (55.1%), facial bones (49.4%), tibia (37.9%) and pelvis (36.0%). Common organ injuries included laceration of the liver (48.1%), lung (37.6%) heart (35.6%), and spleen (30.1%), and hemorrhage of the brain (33.3%) and lung (32.9%). A fractured larynx was observed in 14.7% of the cases, a finding that has not been reported in literature until now. It was observed that individuals who sustained brain hemorrhage were also more likely to have fractures of the facial bones rather than skull fractures.

Accidents, Aviation↗
PubMed1996

[Spiral CT with reduced radiation dosage].

PURPOSE: To examine the clinical use of a reduced dose in high-resolution spiral-CT (HR-SCT) in combination with a multiplanar volume reconstruction technique (MPVR) to decrease image noise. MATERIAL AND METHODS: Facial bones, skull and extremities of 33 patients with different pathological findings were examined with spiral-CT using a slice thickness of 1 mm (pitch 1.7-2.0), a tube amperage of 40 mA and tube voltages of 80 or 120 kV. Additionally, 2-D, 3-D, and MPVR images reconstructions were performed. MPVR takes advantage of displaying planar volumes of variable thickness. RESULTS: Increased image noise was negligible if high contrast structures like bones were examined. However, very small bony structures like the stapes of the middle ear were not seen. Soft tissues could also be imaged by using the MPVR-technique. This technique did reduce image noise while at the same time partial volume averaging was increased. The skin entrance dose per investigation did not exceed 3 mGy, which is based on twelve dose measurements in two patients. CONCLUSION: It is feasible to perform HR-SCT with secondary reconstructions of facial bones, skull and extremities using reduced skin entrance doses by 10 to 20 fold to below 3 mGy. With the exception of imaging very small structures, sufficient image quality can be accomplished in routine examinations without relevant diagnostic compromise.

Arthrography↗
PubMed1991

Maxillofacial trauma in severely injured patients.

A study was made of maxillofacial trauma in seriously injured patients to determine the likely role of oral and maxillofacial surgeons working in the regional trauma centres proposed by the Royal College of Surgeons of England. There were 153 patients, aged 70 years or less, who sustained major trauma (injury severity score 16 or more) and were admitted directly to the accident departments of the Bristol Royal Infirmary or Derriford Hospital, Plymouth during 1989. Maxillofacial injuries occurred in 50 (33%) of these patients with lacerations present in 39, burns in 1 and facial bone fractures in 28 (18%); soft tissue abrasions and contusions were excluded. The aetiology, patterns of injury, surgical treatment and outcome were reviewed. The implications for the provision of maxillofacial surgical services in regional trauma centres is discussed.

Accidents, Traffic↗
PubMed1989

Imaging orofacial tissues by magnetic resonance.

Magnetic resonance imaging was used to study the human orofacial complex. Two imaging methods, a fixed head coil and a surface coil, were used. Images from a database of 31 subjects revealed details of many structures including the masseter, temporal, medial and lateral pterygoid muscles, the teeth, articular condyles, and facial bones. A dentigerous cyst and a maxillary sinus "polyp" were also identified. Our study demonstrates the utility of this imaging modality in the identification and localization of soft tissue lesions. The strengths and weaknesses of the technique and its clinical potential are discussed.

Face↗
PubMed2006

All-terrain vehicle-related maxillofacial trauma in the pediatric population.

PURPOSE: Nearly 40% of all-terrain vehicle (ATV) crash-related fatalities involve pediatric patients, with many of these patients dying from head and neck injuries. West Virginia is in a unique position to examine these injuries because of its high rate of ATV use. This study examines craniofacial ATV-related trauma in children. PATIENTS AND METHODS: We conducted a single-center, retrospective, descriptive study of 26 children presenting with a craniofacial injury(ies) resulting from an ATV crash from January 2001 to December 2004. RESULTS: Twenty-six children (65% boys) with a mean age of 13.1 years presented with craniofacial injuries during the study period. Two patients were helmeted. Mortality was 3.8% (n = 1, head injury related, postinjury day 3). Patients were most often drivers of the ATV (65%), although girls were more likely to be passengers (P = .03). Facial contusions, lacerations, and abrasions were highly prevalent (62%, 69%, 65%, respectively), as were fractures of the facial bones and skull (77%). Thirty-five percent sustained closed head injuries, which were significantly associated with mandible fractures (odds ratio 12.8%; 95% CI, 1.15-143). Mean length of hospital stay was 4.6 +/- 5 days, and 36% required an ICU stay (mean, 5.1 +/- 3 days). Twenty-four percent required ventilator support (mean, 107 +/- 43 hours; range, 48 to 168 hours). Operative intervention was required in 72% of patients (n = 18). CONCLUSION: Maxillofacial injury patterns from ATV-related crashes in children suggest a high percentage of significant facial injuries and closed head injuries. As new ATV legislation that addresses operator use is enacted, a decrease in the number and severity of craniofacial injuries may be seen.

Accidents, Traffic↗
PubMed1983

Three-dimensional reconstruction of craniofacial deformity using computed tomography.

The computed tomographic studies obtained routinely in the examination of patients with congenital or acquired defects of the skull and facial bones can be utilized as a substrate to provide an accurate three-dimensional representation of osseous abnormalities. The total dose of x-irradiation is reduced as other means of radiological examination are eliminated. Osseous structures are faithfully reproduced. Complete inspection of the reproduced structure can be made from any viewpoint, including internal inspection.

Abnormalities, Multiple↗
PubMed2003

Prognostic factors and outcome for nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal cancer (NPC) is a distinct form of cancer of the upper respiratory or digestive tract in which the epidemiologic features, origin, histopathologic types, treatment, and prognosis are different from those associated with other malignant neoplasms of this anatomical area. Recent publications have demonstrated the advantage of aggressive multimodality treatment for advanced NPC. OBJECTIVES: To evaluate the results of standardized treatment of NPC during 11 years and to identify pertinent factors for clinical outcome. METHODS: Between January 1, 1989, and December 31, 2000, 173 patients with newly diagnosed NPC were treated at Instituto Nacional de Cancer. Clinical records and radiographic studies of the patients were retrospectively reviewed. Documented data of the initial presenting symptoms, head and neck examination, radiotherapy protocols, chemotherapy regimens, and surgical technique were analyzed. To determine important prognostic factors, we correlated survival rates with age, clinical stage, tumor extent, histopathological type, and therapeutic approach. The major end point used for assessment was relapse-free survival. Survival curves were estimated by the Kaplan-Meier product-limit method. Multivariate analysis was performed using the Wilcoxon signed rank and Cox proportional hazards regression tests. RESULTS: Most patients (88.5%) had locoregional advanced disease, mostly (53.4%) of the nonkeratinizing subtype. Forty-seven percent of patients had clinical cervical nodal metastases at first consultation. Gross extension of the primary tumor involving the facial bones and skull base was observed in 39.3% and 20.8%, respectively. Just under 75% of patients were treated with radiotherapy (median dose, 6600 cGy), and 25.4% underwent concomitant chemoradiotherapy with adjuvant chemotherapy (cisplatin plus 5-fluorouracil) (median dose, 6800 cGy). The 5-year disease-specific survival for the 173 patients was 32.3%. The disease-specific survival for the radiotherapy group was 22.5%, compared with 61.4% for the chemoradiotherapy plus adjuvant chemotherapy group (P =.004). Factors associated with adverse outcomes were age older than 40 years at treatment (P =.001), advanced TNM stage (P =.002), skull base invasion (P =.004), and facial bone invasion (P<.001). CONCLUSIONS: Compared with radiotherapy alone, concomitant chemoradiotherapy with adjuvant chemotherapy improved the treatment outcome of patients with NPC treated in our institution. Advanced age, local extension, and stage of the disease adversely affected the prognosis in our patients. Compared with reirradiation, salvage brachytherapy and radical neck dissection for local and regional residual or recurrent NPC were associated with increased rates of locoregional control and survival.

Adolescent↗
PubMedDate not supplied

Early haemorrhage from brachiocephalic trunk as a complication of tracheostomy.

A 27-year-old patient suffered injuries to the facial bones and brain contusion in a traffic accident. On the third day after the accident the patient was admitted to an intensive care unit in view of increasing respiratory failure. Tracheostomy was performed for prolonged controlled respiration. On the 6th day after tracheostomy the patient died from a sudden massive hemorrhage from the tracheostomy site. Autopsy findings showed that the direct cause of death was injury to the brachiocephalic trunk communicating with a focus of tissue necrosis in the tracheal wall. The authors stress the early development of this complication and the necessity of the earliest possible commencement of intensive care in cases of injuries to the facial bones.

Adult↗
PubMed1999

Incidence of oral and maxillofacial skiing injuries due to different injury mechanisms.

PURPOSE: This study emphasizes the significance of maxillofacial injuries in skiing accidents, correlating injury mechanisms and patterns, by evaluating a large population of maxillofacial injuries over a 6-year period. PATIENTS AND METHODS: Between 1991 and 1996, of 5,623 patients showing oral and maxillofacial injuries, 1,859 were sports-related. Records of 579 patients with 882 incidents of oral and maxillofacial injury due to skiing were reviewed and analyzed according to age, sex, type of injury, cause of accident, location, and frequency of fractures. Additionally, the five main injury mechanisms were analyzed. RESULTS: The oral and maxillofacial injuries in 10.3% of all trauma patients, or 33% of all sports-related trauma patients, were due to skiing. A total of 310 patients (53.5%) had facial bone fractures, 236 patients (40.8%) suffered from dentoalveolar trauma, and 336 patients (58%) showed soft tissue injuries. Five major causes and mechanisms of injury existed, namely, 263 falls (45%); 135 collisions with other skiers (23%); 70 individuals struck by their own ski equipment (12%); 46 collisions against stationary objects (8%); and 34 lift-track accidents (6%). Sex distribution showed an overall male-to-female ratio of 1.9:1.0, but varied depending on the injury mechanism. The age distribution ranged from 2 to 81 years. CONCLUSION: The results of this study show the high incidence of oral and maxillofacial injuries due to skiing accidents. Depending on the mechanism of injury, different patterns occur. Facial bone fractures are more likely in collisions with other persons, falls, and collisions with stationary objects, whereas dentoalveolar trauma is more common when persons are struck by their own ski equipment, or when accidents on lift-tracks occur.

Accidental Falls↗
PubMed2000

Traumatic dental injuries and Alpine skiing.

The purpose of this study was to determine the occurrence and type of traumatic dental injuries after maxillofacial injuries as a result of Alpine skiing. During an 8-year period (from January 1991 to December 1998) 7600 patients with facial injuries were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria. Of 784 patients with skiing-related facial injuries (524 males, 260 females) 326 (41.6%) sustained injuries to 639 teeth. The age groups predominantly affected were between 7 and 32 years. Luxation injuries occurred in 338 (53%) teeth, fractures accounted for 270 tooth injuries (42%), and only 35 (5%) were lost at the place of the accident. Of skiers with traumatic dental injuries 58% had concomitant soft tissue injuries, while 23.3% had associated facial bone fractures. The most common causes of injury were falls in 42% (329 patients) and collisions with other persons in 24.1% (189 patients). Being hit by one's own sports equipment (11%) was the third most common cause. Collisions with obstacles accounted for 9% and lift accidents for 5.6% of injuries. The probability of suffering dentoalveolar trauma during skiing varied depending on the injury mechanism. There was a 2-fold risk for dentoalveolar trauma when colliding with objects, a 3.5-fold risk when hit by one's own equipment and a 8.5-fold risk during lift accidents. Dental injuries occurred in about 2% of all injured skiers. Dental health professionals should be aware of the high incidence and the distribution of dental trauma and facial injuries caused by skiing.

Accidental Falls↗
PubMed2005

Three-year review of facial fractures at a teaching hospital in northern Iran.

During the three years March 2001-February 2004, 7200 patients with maxillofacial trauma were seen at Poorsina Hospital, of whom 2160 had 4752 fractures of facial bones, 3089 (65%) mainly mandibular and 1663 (35%) mainly midfacial. Road traffic collisions accounted for the injuries in 6552 of the 7200 patients (91%), falls in 396 patients (5.5%), assault in 208 (2.9%) and sport and other causes in 44 (0.6%). The male (n=6646) to female (n=554) ratio was 12:1. During summer, Iranian weekends (Thursdays-Fridays) and the Iranian new year (begins on 21 March), the incidence was much higher than at other times.

Accidents, Traffic↗
PubMed2005

Three-dimensional osteotomy planning in maxillofacial surgery including soft tissue prediction.

Preoperative planning of complex osteotomies in craniomaxillofacial surgery, in conjunction with a surgeon's expertise, is essential for achieving an optimal result. However, the soft tissue changes that accompany facial bone movements cannot yet be accurately predicted. Bony tissue, because of its greater density, can be better predicted, but it alone does not account for the final aesthetic result. A new approach using not only three-dimensional (3-D) surface models of the patient's anatomy, but also a corresponding volumetric model, is discussed. This 3-D planning software was used in the treatment of 15 patients and was found to provide a good correlation between simulation and postoperative outcome.

Adipose Tissue↗
PubMed2003

[A case of giant frontal sinus osteoma].

Osteomas are the most frequent bone tumors of the facial bones, the most involving the frontal sinus and thus leading to symptoms of frontal sinusitis or associated complications. A twenty-one-year-old male patient presented with a growing swelling on the right side of the forehead. Examination revealed a slight facial asymmetry, a laterally shifted right orbital bulb, and disturbed vision. Cranial and orbital computed tomography showed a dense bony mass in the medial wall of the right orbit. The mass was excised totally following a bicoronal incision. The frontal and ethmoid sinuses were filled with fat tissue. Postoperatively, his vision improved to normal after two months and no complications or recurrences were detected in the sixth month.

Adult↗
PubMedDate not supplied

[Facial injuries. Classification].

The present paper was intended as an introduction to the symposium organized in Paris on 4 October 1990 by the Royal Belgian Society for Surgery under the heading "Eurosurgery 90". The anatomical and functional properties of the facial bones and soft tissues were recalled. The face is the support of the main social functions of Man. The classification makes a distinction between fractures of the middle third and of the mandible. Among the formers, classical fractures of Le Fort I, II and III, are now less frequent than asymmetrical or complex fractures with multiple soft tissue lacerations. The main types of mandibular fractures are described. Part of these may show important displacements, due to the insertion of strong muscles. The aims of treatment are defined and to-day technology briefly described. Tendency is to shorten the duration of intermaxillary fixation thanks to the more recent procedures of internal fixation.

Facial Bones↗
PubMed1993

Management of windshield facial injuries.

Between Jan. 1986 and Dec. 1990, 99 patients with automobile windshield facial injuries were hospitalized in Kaohsiung Medical College hospital. All patients were injured by old type windshields in car accidents. Seventy-three patients (74%) were male and twenty-six (26%) were female. Ages ranged from 6 to 62 years (mean age 31 years). Fifty-seven patients (58%) were car drivers and forty-two (42%) were front seat passengers. All patients had typical multiple U-shaped lacerations on the face. The major injury sites were localized to the upper one third of the face. The wounds were repaired immediately after careful debridement. A total of 21 facial bone fractures were noted. All were open fractures with large, deep avulsion wounds. Displaced and comminuted fractures received reduction and fixation before wound closure. Three patients had cranial bone fracture with no displacement. Brain edema and subarachnoid hemorrhage were found by brain CT scan in two and one patients respectively. They were treated conservatively. In one patient with frontal sinus fracture the glass pieces penetrated into the brain. The foreign bodies were removed from the brain and frontal sinus. Eyeball rupture was found in 16 patients, including two patients in whom both eyes were involved. Eight eyeballs needed immediate evisceration and ten eyeballs received reparation. Blindness occurred in all these patients. Of the 99 patients in this study, 15% sustained additional injury. Most were wounds on the extremities. Because serious injuries can be caused by the old type of windshields, it should be abandoned. Driving with the seat belt fastened is the best way to insure safety.

Accidents, Traffic↗