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PubMedDate not supplied

Thalassemias and their dental implications.

Thalassemias constitute a form of anemia that pose clear problems in relation to dental treatment. Dental professionals must be aware of the treatment adaptations required in patients with severe forms of beta-thalassemia. Until medical research is able to afford a definitive solution to these diseases (thereby greatly simplifying the dental management of such patients), effort will continue to center on the improvement of available therapeutic modalities, with the aim of obtaining effective and inexpensive oral chelators and drugs that either individually or in combination allow increases in fetal hemoglobin levels. Undoubtedly, the use of such measures together with serial blood transfusions has made it possible for an ever increasing number of patients with beta-thalassemia to reach adult age, where the provision of integral rather than merely palliative dental treatment must be seriously considered. At present, the clinical orofacial manifestations caused by the erythroid mass expanding the facial bones - resulting in dental malocclusions and protrusions tend to be less intense as a result of early medical treatment. In the future, gene therapy may be expected to allow a normal facial appearance thanks to complete healing of the patient.

Chelating Agents↗
PubMed2003

The application of virtual endoscopy with computed tomography in maxillofacial surgery.

OBJECTIVE: To use virtual endoscopy to obtain detailed three-dimensional images of bone, soft tissue and paranasal sinus damage as well as images of adjacent unaffected areas for optimum surgical planning. METHODS: A spiral CT scanner was used to examine 46 cases of facial bone fractures, maxillary cysts, obstructive sleep apnea syndrome (OSAS) and maxillary bone tumours. Data were input into a navigator workstation to create images similar to those displayed by a fiberoptic endoscope. Various 3-D images were obtained when probe sites were changed. RESULTS: Virtual endoscopy can clearly display the anatomic structure of the paranasal sinuses, nasopharyngeal cavity and upper respiratory tract, revealing damage to the sinus wall caused by a bone tumor or fracture. In addition, the technique can be used to indicate volume changes of the upper respiratory tract in OSAS patients. These results were similar to those obtained through actual operations. CONCLUSIONS: Virtual endoscopy is a new method which produces very clear images. It is reliable to provide detailed information for optimal operative planning.

Adolescent↗
PubMed1979

An analysis of the pattern of facial injuries in a general accident department.

Over a period of one year 20 549 new patients attended an accident and emergency department. Of these patients, 15 555 were victims of accidents, including 875 who had sustained facial injuries. This latter group comprised 609 patients with soft tissue trauma and 266 with skeletal injury. The frequency, aetiology, age and sex distribution of the facial injuries were analysed and compared with other published statistical surveys of facial injury. It is concluded that facial injuries constitute a significant proportion of the work of a civilian accident unit and that any accident service must have adequate facilities for the management of these injuries.

Accidents↗
PubMed1999

Maxillofacial injuries associated with all-terrain vehicles.

PURPOSE: The purpose of this article is to report the pattern and frequency of maxillofacial injuries resulting from all-terrain vehicle (ATV) accidents, to evaluate the mechanisms of injury, to document the length of hospital stay, and to characterize other associated injuries in patients presenting to a level 1 trauma center. PATIENTS AND METHODS: The records of patients admitted to the University of Kentucky Medical Center from July 1, 1995 through August 1996 with an ATV-related injury were reviewed. Patients were included in the study if the events of their injury, demographic data, and the specifics of their perioperative care were sufficiently documented to provide the information pertinent to the investigation. Age, sex, mechanism of injury, facial injuries, associated injuries, and length of stay were the factors considered for the study. RESULTS: Seventy-two patients met the criteria for the study. Fifty-nine (82%) were male, and 13 (18%) were female. Forty patients required operative intervention. Twenty-five (35%) had soft tissue or bony injuries to the maxillofacial region. One mandibular and 13 midface fractures were identified. Twelve of the patients with midface injuries had multiple facial fractures. Orbital floor fractures occurred in seven patients. Two patients required unilateral enucleation of the globe. Ten soft tissue injuries were diagnosed. Extremity fractures (n = 16) and closed head injuries (n = 17) were the most commonly associated injuries. The length of hospital stay for all the subjects identified in the study averaged 4.7 days. ATV rollover and being thrown from a moving ATV were the most common mechanisms of injury. CONCLUSIONS: Head and maxillofacial injuries, particularly midface injuries, are common findings after ATV accidents. Orbital trauma with serious globe injury was a striking feature of this study. Multiple systems injuries should always be anticipated and identified. The public should be alerted to the hazards of imprudent recreational vehicle use.

Accidents↗
PubMed1982

The incidence of hospital-treated facial injuries from vehicles.

The annual incidence rate of facial injuries from vehicle crashes, 278 per 100,000 residents, was determined from a population-based study involving all Dane County, Wisconsin, hospitals with emergency departments. Applying this figure to the U.S. population yields an estimated 625,000 hospital-treated facial injuries from vehicles occurring in the United States each year. Vehicle crashes were the source of a substantial proportion of facial injuries from all causes, and were found to be the single leading cause of the most severe facial lacerations and facial fractures. The majority of injuries were sustained by drivers and other vehicle occupants, and others by bicyclists, motorcyclists, and pedestrians struck by vehicle. Vehicle occupants' faces were most commonly injured by steering wheels and windshields. Technologies which are thought to protect occupants include airbags and nonlacerating windshields, but neither is available in vehicles currently manufactured for sale in the United States.

Accident Prevention↗
PubMed1985

Facial injuries associated with cervical fractures: recognition, patterns, and management.

Publications in both the orthopedic and maxillofacial literature have noted the association of cervical spine and facial injuries. However, because the incidence of spinal injury is low, we found no study which documented the relationship between maxillofacial and cervical spine injuries. The present study reviewed 982 cervical spine injuries in two major trauma centers, finding a 19.3% incidence of facial injury. Fourteen per cent of patients had soft-tissue injuries and 8.6%, facial fractures. Important relationships were noted between fractures of the mandible and upper cervical spine, and soft-tissue injuries of the upper face and fractures of the lower cervical spine. Methods of care adapted to the combined injuries are described. The study concludes that examination of the face for soft-tissue and bony injuries may give important clues on the direction and intensity of the force injuring the cervical spine.

Adolescent↗
PubMed1979

Review of 1,000 major facial fractures and associated injuries.

The records of 1,020 major facial fractures were reviewed, and it was found that the occurrence of life-threatening associated injuries was highly predictable on the basis of the pattern of facial fractures and the circumstances of the injury. Certain groups of patients have a high probability of associated serious injuries of the central nervous system, the trunk, or the extremities. Probably these patients should be primarily under the care of a surgeon who is capable of the diagnosis and emergency therapy of these associated injuries, as well as the facial injuries, so that appropriate priorities can be established and put in effect.

Abdominal Injuries↗
PubMed1997

Air bags alone compared with the combination of mechanical restraints and air bags: implications for the emergency evaluation of crash victims.

BACKGROUND: Air bags (ABs) may be perceived by the public and physicians as protection for thoracoabdominal injuries. This study compares injury patterns when air bags are used alone with injury patterns when air bags plus mechanical restraints (MRs) are used. METHODS: Patients treated over a 4-year period with emergency medical services-documented AB deployment alone (n = 16) or AB plus MR (n = 22) were identified by trauma registry query. Medical records were reviewed and injuries recorded. RESULTS: Air bag-alone users had more severe overall (injury severity score > or = 15:9 vs 5), chest (abbreviated injury score [AIS] > or = 3:5 vs 1), and abdominal injuries (AIS > or = 3:6 vs 0). They required more tube thoracostomies (5 vs 0) and laparotomies (6 vs 0), longer hospitalizations (11.9 +/- 3.2 vs 5.3 +/- 1.4 days), and more intensive care unit admissions (8 vs 1). Craniofacial injuries (AIS > or = 3:6 vs 6) and fractures were similar. More victims using air bags alone required impatient rehabilitation and some patients died (6 vs 1). CONCLUSIONS: Crash victims using air bags alone (vs AB plus MR) had increased injury severity, hospitalizations, thoracoabdominal procedures, and rehabilitation. Physicians must be aware of the incomplete protection by air bags alone.

Abbreviated Injury Scale↗
PubMed2005

Retrospective study of 1251 maxillofacial fractures in children and adolescents.

BACKGROUND: Fractures of the facial skeleton are relatively uncommon in children and adolescents, and only a few reports review a significant number of patients. The authors performed a retrospective study to analyze the different characteristics of such fractures in the pediatric population of Portugal. METHODS: The authors reviewed the clinical records of a series of 912 patients 18 years of age or younger with facial fractures treated by the Departments of Plastic, Reconstructive, and Aesthetic Surgery and of Maxillofacial Surgery, São João Hospital, in Porto, Portugal, between the years 1993 and 2002. The following parameters were evaluated: age; sex; cause of accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications. RESULTS: A total of 1251 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (47.8 percent). Motor vehicle accident was the most common cause of injury (53.3 percent of patients). Mandibular fracture was the most common type of fracture (48.8 percent). Associated injuries occurred in 558 patients (64.5 percent). CONCLUSIONS: Pediatric facial fractures are usually associated with severe trauma. The number of fractures caused by automobile accidents has decreased (p < 0.05). The incidence of this type of fracture is high in Portugal.

Accidental Falls↗
PubMed1979

A method for refixation of the multifractured respiratory cranium.

So-called Tantalum-Visors are used to refixate the multifractured facial skeleton, torn off the base of the skull by trauma, in a three dimensional way to avoid dishface and pseudotelorismus. These visors are kept in storage: a small model--glabella visor, and a large one--zygomatic visor. Of both types, a bigger one is for the head of a male, a smaller for a female and still smaller for youth, because it is impossible to make an individual mold immediately following an accident.

Animals↗