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At least 811 records · Page 45Linked to original sources
PubMed1986

Maxillofacial fractures sustained in bicycle accidents.

The present report is an analysis of 93 patients (52 male; 41 female) treated in 1981-1983 for maxillofacial fractures sustained in bicycle accidents. These accidents accounted for 7.1% of all facial bone fractures treated during the same period. Most accidents were single vehicle accidents (88%) and took place during the summer months. Of the patients, 65% had mandibular fractures, 35% had midface fractures and 5% had fractures in both the middle and lower thirds of the face. Condylar fractures were by far the most common of the mandibular fractures (67%)--a result which differs from studies concerning the profile of mandibular fractures in general. The majority of the middle third fractures were zygomatic (65%). Multiple injuries were diagnosed in 38% of the cyclists and other head injuries were the most common associated injury. Mean hospitalization of the in-patients (38%) was 4.1 days and the average sick leave was 14 days. The results of the study indicate that the use of protective helmets should be strongly recommended to cyclists, although most commercially available helmets do not protect the whole facial area and especially not the chin.

Accidents↗
PubMed1990

Maxillofacial fractures in the elderly: a comparative study.

Previous maxillofacial trauma research has dealt primarily with facial bone fractures in the general population. Very few studies have specifically addressed maxillofacial fractures in the elderly. We compared 45 elderly (65 years of age or older) and 201 younger adult (16 to 64 years of age) patients admitted to our hospital with maxillofacial fractures. The percentage of patients admitted with nasal bone fractures was much greater in the elderly population, while mandibular fractures were more common in the adult group. Motor vehicle accidents accounted for over half the injuries in both groups, while falls were more prevalent in the elderly. Management of the elderly patient may be complicated by their associated injuries or underlying medical problems, perhaps partially accounting for their longer median length of hospital stay. The elderly are a unique subpopulation of maxillofacial fracture patients and deserve further study regarding their injuries and optimal methods for treatment.

Accidental Falls↗
PubMed1985

Midfacial fractures: importance of angle of impact to horizontal craniofacial buttresses.

The complex nature of midfacial fractures is a result of the interaction of impact forces and inherent resistance of the facial bones to displacement. Analysis of fractures created in cadavers shows that impact forces angled obliquely to the horizontal craniofacial buttresses cause LeFort III fractures with inferior and posterior displacement of the midface. Forces directed head-on to the buttresses cause LeFort II-I fractures with inferior rotation of the midface around the lower ends of the pterygoid plates. It appears that the point of impact is of lesser importance in creating midfacial fractures than is the angle of impact in relation to the horizontal craniofacial buttresses. This may explain why victims of equal impact forces at the same level on the face suffer widely varying injuries.

Biomechanical Phenomena↗
PubMed1994

Method for preparing an exact-size model using helical volume scan computed tomography.

Helical volume scan computed tomography is a recently developed technology by means of which detailed data for most facial bone areas can be accumulated in a very short period, i.e., about 30 seconds, a much shorter time than required with conventional computed tomography. From a clinical standpoint, this is extremely important. In this report we discuss the principles of a method for preparing actual-size models by laser lithographic procedures based on data obtained by helical volume scan computed tomography. With these procedures, it is possible to obtain a good reproduction with high accuracy, on the order of 0.5 mm, not only of the outer morphologic structure of the cranial and maxillofacial bones but also of portions of the inner structure of cavities such as the cranium and paranasal sinuses. The difference between the original and model was under 3 percent, as confirmed by constructing a model of the dry skull with helical volume scan computed tomography. Therefore, production of exact-size models using helical volume scan computed tomography data represents an important technological development, breaking through previous limits imposed by conventional simulations prepared with three-dimensional images using CRT. With the combined use of laser lithographics and helical volume scan computed tomography, operative methods for craniomaxillofacial surgery should improve significantly in the near future.

Adult↗
PubMed1996

Maxillofacial fractures sustained during sports.

PURPOSE: This study investigated the number and type of maxillofacial fractures caused by various athletic activities. PATIENTS AND METHODS: The ninety-eight patients were treated between 1977 and 1993, and the type of sport involved, patient age and sex, cause of accident, site of injury, and mode of treatment were evaluated. RESULTS: Sports-related maxillofacial fractures accounted for 10.4% of all patients with facial bone fractures. The number of different sports was 19, with the incidence of the fractures being most common in rugby and skiing, followed by baseball and soccer. The ratio of males to females was 5.5:1, and most of the patients were between 10 and 29 years of age. Total restriction from sports activity was between 8 and 12 weeks after initial treatment. CONCLUSION: The treatment for sports-related maxillofacial fractures is not different from that for fractures from other causes. However, it is important to establish some standard for deciding the time when it is possible to participate in sports after a fracture.

Adolescent↗
PubMed2004

Air entrapment in the cervicofacial region due to injury.

Air entrapment in the soft tissues of the cervicofacial region is a benign entity occasionally developing after a fracture of the facial bones or ribs. Characteristic clinical findings of air entrapment are the sudden onset of edema and crepitation of the respective region. Possible complications are respiratory obstruction or contamination of the mediastinum. Treatment includes precautionary administration of antibiotics. In regard to the region of injury, air may enter the anterior cranial fossa where it compresses the brain, resulting in pneumocephalus, which may cause meningitis as an imminent complication. After a fracture at the zygomatic or nasal bones, subcutaneous emphysema may result in the middle third of the face. It is also possible for air to penetrate into the retrobulbar fat and damage the eye. In other cases, air traverses the parapharyngeal space and causes pneumomediastinum. Moreover, after a fracture at the mandible, it is possible that air passes through the floor of the mouth and the submandibular area to the deep tissue layers again causing pneumomediastinum. Alternatively, after rib fracture, air could follow an upward course, resulting in subcutaneous emphysema of the thoracocervicofacial region. In this article, patients who suffered from air entrapment were categorized into four groups, and the methods used to diagnosis and treat these patients are presented.

Airway Obstruction↗
PubMedDate not supplied

Wide reconstruction of the anterior cranial base with bipedicled galeopericranial flap.

BACKGROUND: Reconstruction of facial bone fractures complicated by frontal sinus destruction must seal off the cranial cavity from the upper respiratory tract to avoid ascending infections of the intracranial contents. METHODS: We used a bipedicled galeopericranial flap for reconstruction of the extradural and subcutaneous spaces of the frontal region, which were infected with methicillin-resistant Staphylococcus aureus (MRSA) following unsuccessful coverage of the anterior cranial base with an anteriorly based pericranial flap. RESULTS: The patient healed uneventfully without infection. CONCLUSION: Because a bipedicled galeopericranial flap has abundant blood supply, it can be used to cover a wide segment of the anterior cranial base. This is the first report of the application of a bipedicled galeopericranial flap for wide reconstruction of the anterior cranial base.

Abscess↗
PubMed2007

Aging of the midface bony elements: a three-dimensional computed tomographic study.

BACKGROUND: The face loses volume as the soft-tissue structures age. In this study, the authors demonstrate how specific bony aspects of the face change with age in both men and women and what impact this may have on the techniques used in facial cosmetic surgery. METHODS: Facial bone computed tomographic scans were obtained from 60 Caucasian patients (30 women and 30 men). The authors' study population consisted of 10 male and 10 female subjects in each of three age categories. Each computed tomographic scan underwent three-dimensional reconstruction with volume rendering, and the following measurements were obtained: glabellar angle (maximal prominence of glabella to nasofrontal suture), pyriform angle (nasal bone to lateral inferior pyriform aperture), and maxillary angle (superior to inferior maxilla at the articulation of the inferior maxillary wing and alveolar arch). The pyriform aperture area was also obtained. The t test was used to identify any trends between age groups. RESULTS: The glabellar and maxillary angle in both the male and female subjects showed a significant decrease with increasing age. The pyriform angle did not show a significant change between age groups for either sex. There was a significant increase in pyriform aperture area from the young to the middle age group for both sexes. CONCLUSIONS: These results suggest that the bony elements of the midface change dramatically with age and, coupled with soft-tissue changes, lead to the appearance of the aged face.

Adult↗
PubMedDate not supplied

The benign fibroosseous lesion: its association with paranasal sinus mucoceles and its MR appearance.

Although fibrous dysplasia and ossifying fibroma of the facial bones may, with some difficulty, be distinguishable pathologically, they are inseparable radiographically. Based on a study of 30 patients, there was no good or reliable imaging correlation with the histology and the degree of ossification or the bone(s) involved. Therefore, "benign fibroosseous lesion" has been proposed by several noted bone authorities as the term for these entities. Eleven patients had MRI and the overall signal intensities were low on both T1-weighted and T2-weighted sequences. Areas of high signal intensity on T2-weighted imaging correlated with either cysts within the lesion or the presence of mucocele, especially in the frontoethmoid region. Four such mucoceles are presented. The coexistence of mucoceles and benign fibroosseous lesions may be more common than previously reported. It is both realistic and appropriate for the radiologist to diagnose these entities as benign fibroosseous lesions and leave the final histologic diagnosis to the pathologist who can diagnose most such cases, albeit with some difficulty. Sites of high signal intensity on T2-weighted imaging in the frontoethmoid area should raise the possibility of a coexistent mucocele.

Adolescent↗
PubMed2003

A survey of radiographic prescription in dental implant assessment.

OBJECTIVES: To survey the current radiographic prescriptions in dental implant assessment amongst dentists in Brazil. METHODS: Sixty-nine dentists were interviewed during a dental implant meeting by two calibrated graduate students, using a 19-question questionnaire, considering imaging modality options both for pre-operative implant site assessment and for follow-up, particularly with respect to cost, patient radiation dose, and broad coverage of facial bones and teeth. Epi-Info 6.04 software was used to analyse the database file. RESULTS: Approximately 63.8% of the dentists prescribed only panoramic radiography for dental implant assessment and 28.9% ordered panoramic radiography plus periapical radiography and/or conventional tomography and/or computed tomography (CT). Only 7.2% of the dentists ordered conventional tomography or CT as a single examination, although 10.1% ordered it in combination with other imaging modalities. The main reasons given for prescribing panoramic radiography were broad coverage and cost (86.4%). CONCLUSIONS: This study has shown that most of the dentists in this study prescribe panoramic radiographs in dental implant assessment based on broad coverage and cost. They are not following the American Academy of Oral and Maxillofacial Radiology recommendations regarding cross-sectional imaging.

Anatomy, Cross-Sectional↗
PubMed1995

Facial injury: a review of biomechanical studies and test procedures for facial injury assessment.

A review of biomechanical studies that have attempted to measure fracture tolerances of facial bones has been carried out. The particular bones of interest were the mandible, the zygoma, the maxilla and the nasal bones. Numerical values have been given for the peak force and pressure fracture tolerances for these bones. A study of these values illustrates just how variable the bone strength of various individuals is. A review of various methods that have attempted to measure and quantify the physical effects of a blow to the face has also been carried out. Three major types of test procedure exist, namely frangible elements, peak force and pressure sensing elements and deformable elements. Frangible and deformable elements generally replace the face of a standard test dummy, fracturing and deforming at appropriate impact force levels, respectively. These surrogate face forms are used for two different reasons; either they are used to measure the damage to the human face for some impact scenario or they are simply used to better simulate the response of the whole head to impact by simulating the compliance of the face. Peak force and pressure sensing elements take the form of piezoelectric sensors and pressure-sensitive, colour 'Fuji film'. Both these methods are complicated and really only suitable for research purposes only. Finally, it is recommended that a mathematical model approach be used to establish the principal injury mechanism and support further development of an acceptable face form test.

Biomechanical Phenomena↗
PubMed1993

Use of Medpor porous polyethylene implants in 140 patients with facial fractures.

Use of alloplastic materials in facial bone reconstruction is still controversial. Medpor porous polyethylene is a relatively new implant material that is well suited for this purpose and has a number of advantages over other alloplasts. It is a pure polyethylene with a unique manufacturing process and pore size. Technically, it is easy to work with; it can be carved, contoured, adapted, and fixated to obtain a precise three-dimensional construct. Physically, it is a pure, biocompatible, strong substance that does not resorb or degenerate. It demonstrates long-term stability, high tensile strength, resistance to stress and fatigue, and a virtual lack of surrounding soft-tissue reaction. Rapid tissue ingrowth occurs into the pores. Extensive vascular ingrowth creates the potential to transport cellular products that fight infection deep into the implant. The implant was used in 140 patients from June 1988 to August 1991 to treat acute orbitozygomatic injuries (71), acute Le Fort injuries (24), delayed orbitozygomatic injuries (33), and delayed onlay augmentation (12). In this series, there was 1 instance of implant infection requiring removal, and no implant migration, or exposure.

Adult↗
PubMed2004

Hydroxyurea in the treatment of major beta-thalassemia and importance of genetic screening.

Efforts have been undertaken to find an alternative approach to packed red cell transfusion (PRCT) in major beta-thalassemia. Augmentation of fetal hemoglobin (HbF) by hydroxyurea (HU) has been reported to be less effective in this condition as compared to sickle cell anemia due to molecular heterogeneity of the former disease. HU efficacy and its relation to Xmn1 polymorphism and IVSII-1 mutation was evaluated in major beta-thalassemics. Forty-five patients, M/F ratio 0.8, aged 6-33 years, received oral HU, 20 mg/kg per day, 4 days per week and daily1 mg folic acid. Thirty-six patients were PRCT dependent (group A) and nine independent (group B). The aim was to stabilize or increase pre-PRCT Hb over 10.0+/-0.5 g/dl and to reduce the need or cease the PRCT in group A and to increase Hb level and curb the ineffective erythropoesis, e.g., splenomegaly, facial bone deformity, in group B. HU was administered for at least 6 months (mean: 9 months) and discontinued in case of response failure. Screening for Xmn1 polymorphism and IVSII-1 mutation was carried out in most patients. In group A, 25 patients have become PRCT independent for a period of 2.5-7.3 years (mean: 4 years). The mean Hb, pre-HU 10.0 and post-HU 10.7 g/dl (range: 8.8-13.7 g/dl), mean serum ferritin pre- and post-HU was1877 and 525 ng/ml. The PRCT requirement was reduced in one patient, and ten patients did not respond. In group B HU has been given over 3.3 years (range: 2.8-4.8 years), Hb increased from 9.3 to 10.4/dl, and there was no tangible progression of ineffective erythropoesis. Responders in both groups expressed more comfort with this regimen. Xmn1 and IVSII-1 (homo- and/or heterozygosis) are relevant markers in most responding patients. Molecular determination of genetic markers in early childhood will help to identify candidates for pharmacological HbF switching by HU.

Adolescent↗
PubMed1997

Fine-needle aspiration cytology in tumors and tumor-like conditions of the oral and maxillofacial region: diagnostic reliability and limitations.

BACKGROUND: Fine-needle aspiration cytology (FNAC) is a well established diagnostic technique. The purpose of the current study was to evaluate its diagnostic accuracy, sensitivity, and specificity in tumors and tumor-like conditions in the oral and maxillofacial region. METHODS: The results of 1022 cases of FNAC performed over a 7-year period (1990-1996) were retrospectively reviewed and analyzed. The material was collected from 228 major salivary glands, 67 perioral soft tissues and facial bones, 139 tumors of the oral cavity, 18 paranasal tumors, 41 oropharyngeal lesions, and 21 nasopharyngeal lesions, whereas 508 cases represented cervical lymph nodes. RESULTS: In 804 cases FNAC established or documented the initial diagnosis whereas in 198 cases it confirmed suspected recurrences. Definitive histologic diagnosis was established in 809 of the 1022 cases after surgical treatment and the histologic diagnoses were compared with preoperative FNAC results. In 20 cases the cytologic material was considered unsatisfactory and therefore the cytologic diagnosis was impossible to establish. In 12 of these cases diagnosis was made based on histologic examination after surgery. Malignancy was found in three of the latter cases. In the total number of 1022 cases there were 18 false-negative and 2 false-positive cytologic results. In another 19 cases a difference in the histologic type of the lesion was found. The diagnostic accuracy of the method was 98.2% with a sensitivity of 96.2% and a specificity of 99.4%. CONCLUSIONS: Four major causes of error were identified: material adequacy criteria, sampling technique, cytologic interpretation, and limitations of the procedure. FNAC proved to be a safe, accurate, inexpensive, and patient-friendly in the effort to establish preoperative diagnosis in tumors and tumor-like conditions of the oral and maxillofacial region. The authors have proposed modification in the mathematic computation of diagnostic accuracy, adding the parameter of nonconcordance with histologic typing of FNAC.

Adult↗
PubMed1991

The characteristics of midfacial fractures and the association with ocular injury: a prospective study.

Ocular injuries commonly occur in patients with facial fractures. This prospective study was set up to determine the incidence of ocular injuries, as assessed by an ophthalmologist, in patients who had sustained midfacial fractures. Over a 2-year period, a study of 363 patients who had sustained midfacial trauma sufficient to lead to a facial bone fracture (438 fractures) was undertaken and patients received a comprehensive examination by an ophthalmologist and an orthoptist within 1 week of injury. The characteristics of the eye injuries sustained were related to the aetiology of the fracture, the type of fracture, and the sex and age of each patient. Ninety percent of patients sustained ocular injuries of various severities. Sixty three percent of patients sustained only minor or transient ocular injuries, 16% suffered moderately severe ocular injury and 12% experienced severe eye injuries. Road traffic accident was associated with the highest incidence of severe ocular disorder (9/45 = 20%) whilst assaults had the second highest incidence at 11% (20/181). One third of all patients with comminuted malar fracture suffered a severe ocular disorder (9/27) whilst blow-out fracture came second at 16.7% (6/36). Fifty six patients (15.4%) had a decrease in their visual acuity and 9 patients (2.5%) had significant traumatic optic neuropathy. Decrease in visual acuity was the main clinical finding accompanying the majority of significant eye injuries. When ocular injuries were related to aetiology, it was apparent that road traffic accidents and assaults associated with alcohol abuse showed the highest incidence of major ocular dysfunction. It is suggested that all patients sustaining midfacial fracture associated with a significant decrease in visual acuity either pre- or postoperatively should have an early ophthalmological review.

Accidental Falls↗
PubMed1978

Unusual bone involvement in congenital syphilis mimicking the battered child syndrome.

Congenital syphilis is re-emerging in modern society. The pediatric radiologist may contribute to its early diagnosis. A case of unusual bone involvement with fracture of the olecranon and facial bone lesions is described; the condition had to be differentiated from the "battered child syndrome". The problem of congenital syphilis as an infectious disease versus bone dystrophy is also discussed.

Battered Child Syndrome↗
PubMed1989

Aneurysmal bone cyst of the zygomatic bone.

Aneurysmal bone cysts are a rare finding in the facial bones and jaws. Only one previous case of this entity affecting the malar bone could be found in the literature. Ultrasound and isotope scan features of this entity are described.

Bone Cysts↗