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PubMed1987

Normative studies of the TSEP. The basis of an objective sensory testing procedure in oral and maxillofacial surgery.

Disturbances of oro-facial sensation may frequently complicate dental surgical procedures, including the extraction of impacted third molars and osteotomies, and are often associated with fractures of the facial bones. The development and refinement of an objective measure of this clinical problem is highly desirable, particularly as it is increasingly being raised as a medico-legal issue. Evoked potential techniques have attracted considerable attention as a means of assessing the function and integrity of nervous pathways. An investigation of the trigeminal somatosensory evoked potential (TSEP) has been undertaken, in the hope of providing a safe, simple objective test of oro-facial sensibility that is acceptable to the patient. The 'normal' TSEP response has been standardised in 23 healthy volunteers, and the typical evoked waveform was found to be in line with the findings of other investigators. The TSEP waveform begins with a positive deflection at 20 ms (P20), followed by a negative deflection at 29 ms (N29) and then a second positive deflection at 37 ms (P37). In all cases, standard stimulation and recording procedures were followed. Stimulation of the maxillary or mandibular branches of the trigeminal nerve at the lip or the gingiva was employed. Evoked potentials were recorded at scalp loci overlying the oro-facial representation area of the post-central gyrus. Averaging and display of data was governed by microcomputer. A standardised method for recording trigeminal evoked responses was satisfactorily achieved and it is suggested that the technique may be useful in the clinical assessment of oro-facial sensory loss.

Adult↗
PubMed2002

[Frontal sinus osteomas: neuro-ophthalmological complications].

Osteomas are the most frequent benign tumors of the paranasal sinuses. They often grow in the frontal sinus near the nasofrontal duct. They remain frequently asymptomatic and they tend to be an incidental finding on radiographic studies. Rarely, they extend out of the sinus limits. Two cases with neuro-ophthalmological complications are reported and discussed. A 19-year-old female presented with a progressive left visual impairment and orbital bone deformity. A CT-scan revealed a large calcified mass in both frontal sinuses, with left intraorbital and frontobasal extension. A 21-year-old man suffered from acute frontoethmoidal sinusitis. Radiological exams revealed a right frontal sinus osteoma with bilateral nasofrontal ducts obstruction. The frontal sinus cavities were filled with a large mucocele with intracranial extension. Both patients were successfully treated using frontobasal craniotomy with complete osteoma and mucocele removal and cranio facial bone reconstruction. Neuro-ophthalmological or intrasinusal complications of osteomas lead to radical treatment. CT-scan and MRI analysis for surgical purpose and strategy are emphased.

Adult↗
PubMed1992

[Differential physical growth during the 1st year of life. II. Growth of the head].

The corporal segment that display the major growth velocity before and after born is the head; that is, once a baby is born, it represents the fourth part of the stature, it has the greater corporal circumference, and their development is superior than other corporal segments. However, the growth shape of the craniofacial structures is different; so, the growth gradient of brain, is the responsible of the morphological view described previously; the facial structures follow the general growth curve; moreover, the facial bone that contributes with the growth of brain, describes mixed growth gradients. This complex shape of the head growth, requires the existence of growth standards for these structures. The present paper describes the results of longitudinal research on head growth. We studied 200 children of both sex and ages from 0 to 1 year of extrauterine life. We got 18 growth measures of the head, such as: head circumference, head length and width, minimum frontal diameter; head, total facial, upper facial, and nose height; bizygomatic, bigonial, external bipalpebral, internal bipalpebral and nose widths; length and width of lips and ear. Moreover, we report the final increments and the differences on sexual dimorphism.

Age Factors↗
PubMed1998

[Odontogenic tumors and neoplastic-like changes of the jaw bone. Clinical study and evaluation of treatment results].

The purpose of the study was clinical analysis of 164 odontogenic tumours and tumour-like lesions of the jaws treated at the Department of Maxillofacial and Oral Surgery, Jagiellonian University College of Medicine between 1956 and 1996, and to evaluate early late and therapeutic results. Odontogenic tumours have a specific histological structure reflecting various stages of odontogenesis and are located mainly in the jaws, exceptionally in other parts of the skeletal system. Due to their specific structure and location they have been identified and classified by pathologists into a separate group of neoplasms differing from other tumours developing in the oral cavity and facial bones first of all in histogenesis, but also in biology, clinical manifestations and radiological sings. The currently recommended histological classification of odontogenic tumours established by the WHO in 1992 comprises a variety of odontogenic tumours and tumour-like lesions of bones of ectodermal, ecto-mesodermal and mesodermal origin as well as lesions histogenetically not associated with the dental organ, but constituting this group. They include histologically benign tumours, locally malignant and malignant tumours, the latter making up the least numerous group. Due to marked polymorphism histological diagnosis of odontogenic tumours is difficult, therefore co-operation between a clinicist, radiologist and pathologist is especially important. Treatment of choice in patients with odontogenic tumours is surgical operation: in case of benign tumours extirpation and curretage, whereas in case of malignant and locally malignant tumours--segmental resection of the jaws. Removal of extensive tumours is associated with the need of surgical tissue repair and prosthetic rehabilitation, and in young patients surgical treatment must be followed by orthodontic treatment. Clinical analysis included case histories of 164 patients admitted to the Department of Maxillofacial and Oral Surgery (Head: Professor MD S. B. Bartkowski) between 1956 and 1996. Additional control examinations were performed to analyze late results of therapy. The 40-year clinical material comprised 164 odontogenic tumours including 91 (55.5%) in women, and 73 (44.5%) in men. The mean age of the patients was 32.5 years, but about 30% of the patients were below 18. The tumour was most frequently located in the mandible i.e. in 118 (72.0%) patients, and in the maxilla in 44 (26.8%), and in both jaws in 2 (1.2%) patients. Due to tumour recurrence 19 (11.6%) patients were referred to our clinic from other centres, the remaining ones received their first treatment. The most frequent reason for patient referral was deformity of the jaws, maleruption or lack of teeth or their dislocation, and in case of extensive lesions face deformation and bulging of the tumour into the oral cavity. Radiological examination showed noncharacteristic transparencies, round or oval in shape, single- or multiventricular or foci of noncircumscribed bone densities usually in the vicinity of the teeth, frequently dislocated or unerupted. Rarely osteolysis of the roots of teeth or their amputation was found. Histological examination of the 164 tumours revealed (in order of frequency): ameloblastoma--60 (36.6%), central reparative giant cell granuloma--52 (31.7%), cementoma--15 (9.2%), odontoma--13 (7.9%), odontogenic myxoma--12 (7.3%), ameloblastic fibroma--4 (2.4%), calcifying epithelial odontogenic tumour--3 (1.8%), odontogenic fibroma--2 (1.2%), adenomatoid odontogenic tumour--2 (1.2%) and odontoameloblastoma--1 (0.6%). Of the 60 ameloblastomas three tumours were histologically malignant. Of the 164 patients 152 were selected for surgical treatment. Surgical treatment of histologically and clinically benign tumours included tumour extirpation, curettage, excision and/or electrocoagulation, whereas malignant and locally malignant tumours such as ameloblastomas, myxomas, Pindborg's tumours, invasive reparative giant c

Adult↗
PubMed1987

[Symptoms of Recklinghausen's disease in the field of ENT medicine].

Neurofibromatosis (also known as multiple neuroma and Recklinghausen's disease) is caused by a deficient proliferation of the neuroectodermal and mesodermal crest. Therefore, a wide variety of symptoms can be found including cutaneous, neurological, ophthalmological, visceral and osseous changes. Hallmark of this disease are so-called café-au-lait areas of pigmentation, or spots. The ENT specialist is confronted with bilateral acoustic tumours, peripheral nerve tumours, cutaneous tumours, tumours of the larynx and alterations of the facial bones. Eight cases of neurofibromatosis are demonstrated, and recent literature is discussed. Management of patients suffering from neurofibromatosis is mainly palliative and symptomatic. To achieve a good result in treatment there must be an effective cooperation between specialists of different disciplines.

Adolescent↗
PubMedDate not supplied

[Radiodiagnosis of Le Fort type fractures].

Le Fort's fractures of maxillary bones are referred to grave injuries that require an accurate and urgent diagnosis. A total of 70 patients with different variants of such fractures were examined. The x-ray examination included polypositional roentgenography, linear tomography and panoramic sonography with the Sonarc apparatus. The injuries with all signs of Le Fort's fractures of two and even three types predominated, asymmetric injuries were rather frequent. Panoramic sonography with the patient in a modified position helped specify the volume and extension of the injury to the facial bones, but it should be supplemented with linear tomography to detect the injuries of the pterygoid processes of the major bone of the anterior and posterior walls of the maxillary sinuses, of the frontonasal channel opening, of the posterior wall of the frontal sinuses and the anterior cranial fossa structures, the detection of injuries of the pterygoid processes being the key sign in the differential diagnosis of Le Fort fractures.

Adult↗
PubMedDate not supplied

Fractures of the supraorbital rim: principles and management.

Dentists may be asked to provide consultations for patients who have sustained trauma to their facial structures. Supraorbital rim fractures, although uncommon, must be recognized and promptly referred to an oral and maxillofacial surgeon or other specialist skilled in the management of facial bone fractures. Supraorbital rim fractures commonly coexist with other craniomaxillofacial injuries, especially with fractures of the anterior table of the frontal sinus. In this article, we review the frequency, management and complications associated with the treatment of supraorbital rim fractures in adults. A series of 5 cases was reviewed; 4 of the 5 patients were male, with a mean age of 21.6 years (range 17-28 years). All injuries involved the supraorbital rim and the anterior table of the frontal sinus and occurred concurrently with other facial injuries. Treatment ranged from conservative observation to open reduction and internal fixation of the fractures. No associated perioperative or postoperative complications occurred. The follow-up ranged from 6 months to 26 years, with satisfactory subjective esthetic outcomes in all cases.

Adolescent↗
PubMed1999

Maxillofacial fractures following airbag deployment.

Maxillofacial fractures and associated lesions following airbag deployment were studied in six patients who suffered frontal or fronto-lateral car crashes. Installation of airbags in motor vehicles has reduced the morbidity and the mortality following motor vehicle accidents, but the appearance of new types of trauma directly related to airbag deployment raise questions about the potential danger of these devices when used improperly. The results of this limited study suggest that airbag injuries can be aggravated if: (1) seat belts are not worn; and (2) if the driver's chest is too close to the steering wheel as can easily happen with small people (in our study, two women). There needs to be a way of disconnecting the system.

Accidents, Traffic↗
PubMed1989

Lymphangioma and cystic hygroma. Correction of facial growth disharmony and obstructive sleep apnea.

Soft tissue tumors and masses of the mouth and face can adversely affect the growth of facial bones. Cystic hygroma and lymphangioma, when massive, can create serious deformities of the maxilla and mandible. These deformities are correctible, surgically, and may be preventable if surgery and orthodontics are coordinated early in life. During and after surgery, airway management is paramount, but paradoxical effects such as obstructive sleep apnea may be observed.

Adolescent↗
PubMed1997

Paget bone disease involving young adults in 3 generations of a Korean family.

Although the etiology of Paget bone disease (PBD) is unknown, increasing evidence implicates a "slow virus" infection of the skeleton, perhaps in genetically predisposed individuals. PBD is rare in Asia. We describe a Korean family with PBD. The propositus noticed bowed limbs at approximately 25 years of age. Radiologic studies made when he was 55 years old revealed essentially panostotic PBD. Serum alkaline phosphatase (ALP) activity and osteocalcin (OC) levels were markedly elevated. An iliac crest specimen showed classic histopathologic changes of PBD. Additionally, palpable swellings were first observed at age 45 years at his occiput, pubic ramus, ileum, and facial bones. They contained numerous multinucleated cells and were originally diagnosed as giant cell tumors. However, we found that, like osteoclasts, these cells expressed considerable tartrate-resistant acid phosphatase activity. These "extraskeletal osteoclastomas" resolved rapidly with dexamethasone treatment. Two daughters, 20- and 24-years-of-age, were discovered by study of his 5 children to have elevated serum ALP activity and OC levels and widespread PBD. Both women, however, are without palpable masses and are asymptomatic. The propositus' father, who died at age 55 years, had similar skeletal deformities beginning at age 20 years, but was not examined. Leukocytopenia was found in the 3 living family members with PBD. There was no evidence for linkage of the PBD to HLA loci. The condition appears to be transmitted as an autosomal dominant trait and is manifest in young adult life. Multicentric extraskeletal osteoclastomas with remarkable sensitivity to dexamethasone treatment appear to be another unusual feature of this family's disorder. In this family, the stimulus for PBD is so great that the PBD is apparent at an early age, affects essentially the entire skeleton, and leads to the formation or extension of osteoclast-like cells into nonosseous tissues (extraskeletal osteoclastomas). This 3-generation kindred in Korea, where PBD is rare, shows a strong clustering of PBD compatible with autosomal dominant inheritance. Leukocytopenia appears to distinguish affected family members, but any role for this abnormality in the pathogenesis of PBD is unclear. Our findings support a heritable diathesis for PBD, perhaps mediated by an immune deficiency.

Adult↗
PubMed2003

Etiology and patterns of facial fractures in the United Arab Emirates.

A retrospective study on facial fractures was carried out in the Department of Oral and Maxillofacial Surgery at Tawam Hospital (Al Ain, United Arab Emirates) between January 1, 1998 and December 31, 2001. The study included 144 patients with a mean age of 26.5 years; the most frequently injured patients belonged to the 16- to 20-year-old age group. The male predilection was 83%. Road traffic accident was the most common causative factor (59%), followed by falls (21.5%), accidents where camels were involved (5.5%), work- and sport-related accidents (4.8% and 4.8%, respectively), and assault (4.1%). A total of 53.4% of the patients suffered isolated mandibular fractures, 32.6% had isolated midface fractures, and 13.8% had combined midface and mandibular fractures. Associated injuries were noted in 22.2% of the patients. The number of patients treated increased from 28.3 (1990-1995) to 36 (1998-2001) on an annual average; a reduction in isolated nasal fractures and associated injuries, including facial lacerations, was noted with no change in age or etiology predilection. Sufficient data could not be obtained to determine if the favorable results with the associated injuries were a result of the effect of a compulsory seat belt law introduced on June 1, 1998, but the increasing number of maxillofacial injuries suggests that the seat belt law is ignored in this country.

Accidental Falls↗
PubMed1987

[Olfactory esthesioneuroma. Clinical description and therapeutic results apropos of 45 cases observed at the Gustave Roussy Institute from 1956 to 1986].

Olfactory esthesioneuroma is a rare malignant nerve tumour of the nasal fossa, generally developing from the olfactory epithelium, 45 cases seen at the Gustave-Roussy Institute between 1956 and 1986 are studied. From a clinical standpoint, this tumour usually progresses slowly and essentially locally, but it is important to be aware of the possibility of a rapid progression with diffuse bone metastases. The diagnosis, borne in mind of the presence of any tumor of the upper part of the nasal fossa, is based upon histo-pathological examination. It has benefitted from the use of new indicators. The role of CAT scan in the evaluation of spread is confirmed in the present series. Treatment is based above all on surgical excision followed by radiotherapy (the neurosurgical approach being of a certain value). The prognosis of these malignant tumors is similar to that of adenocarcinomas of the ethmoid and better than that of squamous carcinomas of the facial bone structure. The role of chemotherapy is discussed.

Adolescent↗
PubMed2001

5196 mandible fractures among 4381 active duty army soldiers, 1980 to 1998.

OBJECTIVE: We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries. METHODS: Retrospective analysis of 5196 mandible fractures in 4381 patients extracted from the Total Army Injury and Health Outcomes Database (TAIHOD), a comprehensive database developed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) that links population data to all hospitalizations among active duty army soldiers. The database is based on the ICD-9 CM coding system. RESULTS: We found the following frequencies for specific mandible fracture locations: angle 35.6%, symphysis 20.1%, subcondylar 14.2%, body 12.7%, condylar process 9.1%, ramus 4.5%, alveolar border 2.7%, and coronoid process 1%. The mechanisms of injury were separated into seven categories. Fighting accounts for 36.2%, automobile accidents for 18.6%, athletics for 13.6%, falls for 9.7%, motorcycle accidents for 3.1%, other land transport accidents for 3%, and miscellaneous causes for 15.8%. A few fracture locations appear to be associated with specific mechanisms. Of 82 alveolar border fractures with known mechanisms, 37% resulted from automobile accidents. Of 1094 angle fractures with known mechanisms, 48.6% resulted from fighting. Our data show that the majority of fractures were isolated to one location. Only one fracture was recorded for 70.6%, 29.2% have two fractures recorded, 0.2% have three or more fractures recorded. Associated injuries were common and include facial lacerations 1236 (28.2%), non-mandible facial bone fractures 733 (16.7%), intracranial injury 403(9.2%), internal injuries 229 (5.2%), fractures of the upper limb 295 (6.7%), fractures of the lower extremity 302 (6.9%), and cervical fractures 34 (0.8%). CONCLUSIONS: The mechanism of injury is important in determining the most likely resultant mandible fracture in the case of angle of mandible and alveolar ridge fractures. The clinician should maintain a high level of suspicion for associated injuries that occur more than one fourth of the time and even more frequently in motor vehicle accident victims. Associated intracranial injury is particularly important to rule out. Associated facial fractures, intracranial injury, internal injuries, and extremity injuries are all more common than cervical fractures.

Adolescent↗
PubMed1979

[How to prevent the various neuralgic complaints after operation of maxillary sinus? (author's transl)].

In order to avoid multiple neuralgic complaints after operations of maxillary sinus the following advice for cautions operative procedures is as follows: 1. A vertical incision in the mucosa of the fossa canine behind the eye-tooth instead of the usual horizontal section. 2. A small dorsolateral fenestration in a part of less nervous ramification in the facial bone layer of the antrum of High-more. 3. The limitation of resection of the mucous membrane in pathological areas of the sinus. 450 operations of the maxillary sinus were done in this way, which resulted in a lower rate of postoperative neuralgic complaints. Another advantage was the minimized intraoperative bleeding and the absence of postoperative swelling and haematoma formation of the cheek.

Facial Neuralgia↗
PubMed1996

Painless osteoid osteoma of the rib in an adult. A case report and a review of the literature.

BACKGROUND: An asymptomatic rib lesion was discovered by means of a bone scan obtained during the clinical evaluation of an adult man with biopsy proven prostate adenocarcinoma. Clinically and radiologically considered to be a metastatic focus, on resection it proved to be an osteoid osteoma (OO). METHODS: A review of the English medical literature on OO was conducted with emphasis on the occurrence in older patients, costal location, and the absence of pain. RESULTS: OO in patients older than age 50 years is rare (1% - 2% of cases). Only 18 cases of painless OO were found. Of these, 8 (44%) occurred in the phalanges, and 3 (17%) in the cranial-facial bones, both uncommon sites for OO; only 7 (39%) arose in the long bones, the most common site for conventional OO. A disproportionate number of these patients (44%) were younger than age five years, a rarity for OO. Fourteen reported examples of costal OO were found, all of which were associated with pain. The possible mechanisms involved in the production of pain, including analysis of the effect of its site of origin and the presence of nerve fibers, is reviewed. CONCLUSIONS: Costal OO is distinguished from osteoblastoma and from what has been described as painless fibro-osseous lesion of the rib. The infrequency of metastases as a cause of solitary rib lesion is emphasized.

Adolescent↗
PubMed1992

Ewing's sarcoma: primary involvement of the zygoma undergoing resection and immediate reconstruction.

Because the occurrence of primary Ewing's sarcoma in the facial bones is unusual, it may pose diagnostic and therapeutic problems. Lack of clinical suspicion along with atypical radiographic features may lead to a delayed diagnosis. Furthermore, because of the limited number of cases, precise treatment guidelines are lacking. In our patient, whom we believe to be the first reported with primary Ewing's sarcoma originating in the zygoma, the tumor was successfully managed surgically. A combination of craniofacial and microsurgical principles made surgical resection and immediate reconstruction possible in an area not generally thought to be amenable to surgery; moreover, we thus avoided the potential deleterious effects of radiation in the facial region in a growing child.

Child↗
PubMed2005

Quality of life and facial trauma: psychological and body image effects.

This study evaluated the social and psychologic impact of facial trauma on previously healthy individuals. Inclusion criteria for the study included 18- to 45-year-old individuals who had a facial laceration of 3 cm or greater and/or a fractured facial bone requiring operative intervention within 6 months to 2 years prior to participation in the study. Retrospective analysis of patients at Yale New Haven Hospital Emergency Department was done between May 1997 and December 1998. When compared with a control population, the study group showed a statistically significant lower satisfaction with life, more negative perception of body image, higher incidence of posttraumatic stress disorder, higher incidence of alcoholism, and an increase in depression. Also, among the study group there was a significantly higher incidence of posttrauma unemployment, marital problems, binge drinking, jail, and lower attractiveness scores. In conclusion, in this preliminary study, it appears that the result of facial scarring/trauma includes a significantly decreased satisfaction with life, an altered perception of body image, a higher incidence of posttraumatic stress disorder, a higher incidence of alcoholism, and increased posttrauma jail, unemployment, binge drinking, and marital problems. Thus, it appears that there is significant negative social and functional impact related to facial trauma and scarring.

Adolescent↗