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PubMed1992

Maxillofacial injuries following steering wheel contact by drivers using seat belts.

Maxillofacial injuries are common sequelae in road traffic accidents. For the restrained driver, impact against the steering wheel is the most prevalent cause of injury. A sample of drivers restrained by seat belts with facial injury caused by the steering wheel was taken from data at the Accident Research Unit, University of Birmingham, UK. Two hundred and forty facial injuries occurred in 135 drivers, and these are described. Superficial contusion, laceration and nasal fractures predominated. There were 504 injuries at other body regions, and these were often caused by other vehicle components. These were, for 57% of drivers, no more serious than the facial injury caused by steering wheel contact. The role of steering wheel design in maxillofacial trauma is discussed and new solutions briefly reviewed.

Abbreviated Injury Scale↗
PubMed1992

Facial balance in cleft lip and palate. II. Cleft lip and palate and secondary deformities.

The cleft abnormality is the cause of underdevelopment and subsequent loss of function. Primary cleft surgery and surgery to correct the secondary deformities of previous non-functional repair should aim to restore normal anatomy and physiology, with an emphasis on muscle reconstruction of the lip and soft palate if normal facial development is to be encouraged.

Cleft Lip↗
PubMed1995

Skeletal growth after muscular reconstruction for cleft lip, alveolus and palate.

OBJECTIVE: To compare two treatments for unilateral cleft lip and palate. DESIGN: Follow-up study. SETTING: University department, Germany. SUBJECTS: 110 children with unilateral cleft lip and palate, 50 of whom were treated between 1980 and 1988 (group 1) and 60 of whom were treated between 1970 and 1979 (group 2). INTERVENTIONS: Group 1 had no dentofacial treatment before operation. At the age of 3 months they had musculoperiosteal reconstruction with no orthopaedic treatment postoperatively. At the age of 9-12 months they had the velar muscle reconstructed but no orthopaedic treatment to follow. Group 2 had dentofacial treatment before operation. At the age of 6 months they had their lips operated on by Millard's technique. Postoperatively they had dentofacial orthopaedic treatment followed, at the age of 2.5 years, by palatal surgery by the Campbell-Widmaier technique. This was followed by more dentofacial orthopaedic treatment. Main outcome measure--Growth of the midface skeleton. RESULTS: The course of the anterior tooth segment was similar in the two groups, as was the transverse development of the maxilla. Analyses of both dental casts and lateral cephalometric radiographs showed that the skeletal development in group 1 (who had undergone reconstruction of the perioral and perinasal muscles) was better than in group 2 (who had not) despite the fact that group 1 had had no orthopaedic growth stimulation. CONCLUSION: If the primary and secondary growth centres are not joined at the first operation and the midfacial muscles are not reconstructed, even orthopaedic growth stimulation will not compensate for the defect.

Alveolar Process↗
PubMed1990

Cavernous hemangioma of the zygoma: report of cases.

Osseous hemangiomas of the facial bones are rare lesions, with most cases occurring in the maxilla and mandible. Reported cases in the zygoma are sparse. Two cases of zygomatic hemangiomas with widely differing presentations are reported. One case in a neonate required surgery to prevent fatal hemorrhage, and the other in an adult required correction of a cosmetic deformity. Each patient presented with a second congenital anomaly. Therapeutic problems associated with these lesions and their management are discussed.

Female↗
PubMed1992

Pediatric facial injuries associated with all-terrain vehicles.

All-terrain vehicles (ATVs) are becoming increasingly popular recreational devices. Multiple injuries have been associated with ATV accidents. This report reviews pediatric injuries treated at a regional pediatric trauma center, with special attention to facial trauma, as well as the ATV injury data for the United States.

Accidents, Traffic↗
PubMed1994

Biomechanical rationale for surgical-orthodontic expansion of the adult maxilla.

OBJECTIVE: To develop a biomechanical rationale for surgical-orthodontic correction of transverse maxillary deficiencies in adults by clarifying the internal stress responses to rapid palatal expansion in a photoelastic model. MATERIALS AND METHODS: A three-dimensional photoelastic analog of an adult human skull was constructed by fabricating the individual facial bones from a photoelastic material and fixing them along their anatomic sutural areas. After determining the force-activation characteristics of a Hyrax expansion appliance in a straining frame, the appliance was applied to the analog and incrementally activated. The stresses developing at the different craniofacial areas were visualized and photographed in the field of a circular polariscope. Sequential cuts were performed to simulate midpalatal, zygomatic buttress, and pterygomaxillary osteotomies, and the alterations in the internal stress responses were recorded after each individual cut. RESULTS: The force-activation characteristics of the Hyrax appliance are in the orthopedic range (500 g). The magnitude and distribution of the stresses induced by appliance activation differed notably between the simulated osteotomies. Analysis of fringe patterns showed that the midpalatal and pterygomaxillary articulations were the primary anatomic sites of resistance to expansion forces. The patterns of distribution and the increase in the magnitude of the stresses at superior sutural location were particularly pronounced after the pterygomaxillary cuts. The forces produced by the Hyrax appliance had deep anatomic effects, with internal stresses also manifesting at regions distant from the site of force application. CONCLUSIONS: Based on photoelastic observation, it may be concluded that complete midpalatal and pterygomaxillary osteotomies are essential for predictable skeletal expansion in adults. Exclusive use of bilateral zygomatic buttress osteotomies appears to be inadequate. The expansion forces exerted by the Hyrax appliance are orthopedic in nature and produce deep anatomic effects. Clinicians should be aware that the craniofacial stresses produced by appliance activation may be experienced by the patient as pain or discomfort.

Adult↗
PubMed1985

Morphologic asymmetries of the face: a review.

It has been suggested that asymmetries in the morphological properties of the face contribute to or produce asymmetries in facial emotional expression. Over 50 years of research on hard tissue, soft tissue, and facial surface asymmetries is reviewed here. Generally, it appears that if consistent asymmetry characterizes facial morphology, it is extremely small in magnitude or characterizes regions yet to be examined. In contrast, marked homology and asymmetry in regional size and area has been noted often. At present, it does not appear that asymmetry in facial morphology is associated with facial expressive asymmetry, with the latter more likely to be an outcome of functional brain asymmetry.

Adolescent↗
PubMed1985

Parameningeal rhabdomyosarcoma (including the orbit): results of orbital irradiation.

Twenty-three patients with parameningeal (including orbital rhabdomyosarcoma (RMS)) were treated at Memorial Sloan-Kettering Cancer Center (MSKCC) between July 1971 and January 1983. Twenty were children with a mean age of 6 and 3 were adults. In 6 patients, the primary tumor was from the orbit, whereas the remaining 17 had other parameningeal primary sites. The tumors were in a very progressive local stage, with extensive destruction of the facial bones in 19 patients. Eight patients were treated with T2 chemotherapy protocol and 15 received T6. Seven patients received 5,000 to 7,200 rad delivered to the primary tumor in 11-16 weeks, 15 patients received between 4,500 to 5,000 rad in 4-7 weeks, and 1 patient received 3,000 rad in 3 weeks for residual microscopic disease following surgery. Two patients were treated with radiation to the whole brain; no patients received radiation of the whole central nervous axis (CNA). Fifteen of the 23 patients (65%) are alive and well with a medical follow-up time of 5 years. Two patients died of therapeutic complications and six died of tumor spread. In five patients, involvement of the central nervous system (CNS) was the cause of death. The prognosis of orbital RMS with parameningeal involvement is no better than in other tumors of parameningeal sites. In those patients who had impaired vision because of optic nerve damage prior to treatment, the vision did not improve following treatment. There was no impaired vision seen due to radiation damage of eye structures except in the lens.

Adolescent↗
PubMed1977

Direct coronal computerized tomography.

The computerized tomographic examination is routinely performed in the axial plane. However, with several available CT units images in the coronal plane are easily obtained. These images are especially useful in the diagnosis of diseases of the facial bones, sinuses, orbits and parasellar area. This paper describes one year's clinical experience with direct coronal computerized tomography.

Aged↗
PubMed1995

Superimposition and reconstruction in forensic facial identification: a survey.

Forensic facial reconstruction, is the reproduction of the lost or unknown facial features of an individual, for the purposes of recognition and identification. It is generally accepted that facial reconstruction can be divided into four categories: (1) replacing and repositioning damaged or distorted soft tissues onto a skull; (2) the use of photographic transparencies and drawings in an identikit-type system; (3) the technique of graphic, photographic or video superimposition; (4) plastic or three-dimensional reconstruction of a face over a skull, using modelling clay. This paper sets out to review work done on both superimposition and plastic reconstruction, however, the authors believe that only the latter category can correctly be termed facial reconstruction. The survey is divided according to work done through anthropological evaluation of the skull, clinical examination and dissection of the soft tissues, as well as methods of measuring soft tissue thicknesses using tissue puncture, ultrasound, cephalometric radiography and magnetic resonance imaging. In addition, a method of the combined use of ultrasound and radiography to collect a wider range of facial soft tissue depths and a method of producing skull and face profiles are outlined.

Anthropometry↗
PubMed1989

Clinical relevance of step-by-step mandibular advancement in the treatment of mandibular retrusion using the Fränkel appliance.

The effect of the Fränkel appliance was evaluated in patients with mandibular retrusion who were monitored during an active treatment phase of approximately 14 months in the early mixed dentition. The sample treated with the Fränkel appliance consisted of 120 subjects. In 60, the initial construction bite was taken with the incisors in an end-to-end relationship (Fränkel group A). In 60 patients (Fränkel group B), mandibular position was advanced sequentially in small steps. Fifty untreated subjects of approximately the same age and with almost identical characteristics of skeletal Class II malocclusion served as a comparison group. Permanent teeth were not extracted during the period studied in any of the subjects. For statistical analysis of the difference between the variables used in this study, analysis of variance and the t test were used. The results of this study indicate that the distances between pogonion and condylion or articulare increased in both Fränkel groups A and B significantly more than in the untreated sample. However, the anteroposterior position of pogonion relative to the maxillary landmarks remained unchanged in Fränkel group A. The increase in the distance between pogonion and articulare or condylion primarily resulted from a positional change of pogonion inferiorly, which was accompanied by a significant increase of the mandibular plane angle and the gonial angle. In contrast, pogonion moved anteriorly in Fränkel group B significantly more than in the untreated group, that is, the sagittal discrepancy between maxilla and mandible significantly improved in Fränkel group B, whereas it remained unchanged in Fränkel group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Activator Appliances↗
PubMed2004

Control of massive bleeding from facial gunshot wound with a compact elastic adhesive compression dressing.

The issue of immediate control of acute external traumatic hemorrhage is poorly dealt with in the medical literature. A compact unit incorporating the desired components capable of applying significant compression over diverse body areas has been suggested in the past but not formally demonstrated effective in practice. In this report we describe the treatment of a young man presenting with a very large, complex, profusely bleeding facial gunshot wound. The calvarium remained intact. The upper airway was diverted and secured by performing a cricothyroidotomy. A transparent elastic adhesive dressing was then applied by covering the anterior aspect of the face by a contact pad followed by sequential wrapping of the roll covering all structures between the forehead and the neck. This procedure successfully controlled the hemorrhage and maintained the victim's condition hemodynamically stable until definitive surgical intervention at the level 1 medical center. We attribute the survival of this victim to the innovative dressing technique and excellent cooperation between the trauma team and hospital staff. This case demonstrates the contribution of elastic adhesive compression dressing towards saving the lives of those inflicted by severely challenging bleeding wounds. We suggest this technique be considered by Emergency personnel working in the prehospital arena in selected cases.

Adhesiveness↗
PubMed2005

Submento-submandibular intubation: is the subperiosteal passage essential? Experience in 107 consecutive cases.

Adequate treatment of panfacial injuries often requires tracheostomy or alternating intubation through the nose and the mouth to keep the field free during the operation. Altemir's submental technique is an attractive option in these patients. We used the method with a slight modification in 107 operations in our unit to treat panfacial injuries. We had a low rate of complications and no increased operative time.

Dissection↗
PubMed2004

Fibro-osseous lesions of the face and jaws.

Maxillofacial fibro-osseous lesions (FOL) consists of lesions that differ, with the exception of fibrous dysplasia, to those found in the rest of the skeleton. FOLs of the face and jaws are cemento-osseous [corrected] dysplasia, fibrous dysplasia and cemento-ossifying fibroma. Radiology is central to their diagnosis because the pathology for all FOLs is similar, although they range widely in behaviour, from dysplasia, hamartoma to benign neoplasia with occasional recurrence. Furthermore, once diagnosed the management of each is different. For cemento-ossifying dysplasia, this may mean doing nothing, simply because no treatment is generally appropriate. Almost all cemento-osseous [corrected] fibromas should be treated surgically, whereas cases of fibrous dysplasia are treated according to their clinical presentation, ranging from review and follow-up to surgery necessary to save the patient's sight or reduce deformity. The most important and frequent features of the FOLs differential diagnosis is discussed with assistance of a flow-chart.

Cementoma↗
PubMed2005

Comparison of two computer-assisted surgery techniques to guide a mandibular distraction osteogenesis procedure. Technical note.

The accuracy of distracted facial bone displacement depends on the preoperative clinical assessment, surgical planning and technique. The aim of this study was to evaluate two different techniques to guide the mandibular distraction surgical procedure using an intraoral device. This study was performed on a fresh cadavre. 3D reconstructions from a computed tomographic (CT) acquisition were used for the two techniques. The first technique comprised a customised stereolithographic template and the second technique used a computer-assisted surgery (CAS) unit to guide the osteotomy and the positioning and screwing of the distractor device. Both methods were planned and compared with the same 3D software. The authors discuss the feasibility and reliability of the two techniques. The accuracy of the two techniques appears to be comparable for clinical applications, although the rapid prototyping template technique appears to be more satisfactory.

Cadaver↗
PubMed2005

Blindness and visual impairment from severe midface trauma in Nigerians.

Reports have shown that severe midface trauma causes blindness and visual impairment but information from sub-Saharan Africa is sparse. A retrospective analysis was carried out of patients who sustained trauma to the midface and subsequently lost vision in one or both eyes. There were 25 males and 7 females whose ages ranged from 5 to 65 years (mean +/- SD, 33 +/- 13.3 years). All patients presented between 1 h and 7 days of sustaining injury (mean +/- SD, 1.9 +/- 1.9 days). Road traffic accidents (37.5%) and gunshot injuries (34.4%) were the commonest causes. Of the 32 patients identified with loss of vision, half sustained fractures of the zygomatic complex while a total of 54 soft-tissue and bony injuries were recorded. The majority of patients (68.8%) had a ruptured globe, followed by vitreoretinal haemorrhage and traumatic optic neuropathy in 18.7% and 12.5%, respectively. Visual acuity ranged from 6/60 to 'no light perception'. Surgical exploration, enucleation, evisceration or exenteration was the treatment method used for those with ruptured globes. About 10.8% of patients with severe midface trauma also sustained loss of vision in one eye. Loss of vision associated with severe midface trauma is most likely to occur with road traffic accidents and gunshot injuries. High impact from such incidents often causes extensive damage to the eyeball resulting in immediate and irreversible blindness.

Accidents, Traffic↗