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Sudden onset of velopharyngeal insufficiency in Klippel-Feil syndrome.

A 17-year-old girl with Klippel-Feil vertebral anomalies presented with sudden onset of VPI and hoarseness after a minor neck torsion injury. Her symptoms were felt to be due to compression of the brain stem by the odontoid process (through basilar invagination). The VPI and hoarseness responded to conservative management with oral steroids.

Adolescent↗

Oro-maxillofacial skeletal deformities resulting from burn scar contractures of the face and neck.

The deforming forces of the scar contracture associated with burns of the head and neck region involve primarily the skin and secondarily the facial musculoskeletal structures. A case of severe face and neck burn accompanied by extreme facial skeletal deformity is reported. Best results are obtained in patients treated properly and promptly by a team including plastic and maxillofacial surgeons as well as orthodontists.

Adult↗

[Surgical treatment of non-gunshot wounds of the soft tissues of the face and neck].

The primary surgical treatment of injured soft tissues of the maxillofacial area is performed with special reference to anatomo-physiological features of the injured area, mechanism and character of the trauma. Complete closure of all wound surfaces is a necessary condition of the primary surgical treatment of wounds of the face with elements of primary plasty when necessary. It gives the best functional and esthetic results and a more valuable preparation of the injured area for the following reconstructive operations.

Drainage↗

[The possibility for the early diagnosis of suppurative-inflammatory wound complications of the maxillofacial area and neck by using an acoustic skin analyzer].

The acoustic method was used for early diagnosis of pyo-inflammatory complications of wounds of the maxillofacial area and neck. Acoustic skin analyzer was used. The velocities of acoustic wave propagation (Vx, Vy) were notably increased in the pyo-inflammatory focus in comparison with perifocal tissues and with the symmetrical contralateral side. The difference in the absolute values of velocities was about 45-65 m/s. No acoustic anisotropy was observed in the focus of inflammation. Hence, the acoustic method can be used as a method for early diagnosis of pyo-inflammatory complications and for monitoring the wound status in the course of wound process.

Abscess↗

A variant of incaprettamento (ritual ligature strangulation) in East Timor.

Incaprettamento is a ritualized form of ligature strangulation often associated with the Italian Mafia. The hallmarks include ligature strangulation and binding of the body in a highly stereotyped fashion. The bindings include tying the wrists and ankles together, with the body in the prone position (similar to "hogtying"), and an additional ligature encircling the neck and attached to the bindings of the extremities. The binding of the body may be performed after death is inflicted by ligature strangulation, or it may be associated with self-strangulation, as shown by the arrangement of ligatures and the position of the body. A case with great similarities to incaprettamento, in which the body was exhumed from a grave in East Timor, is described in detail. However, in addition to prone-position binding and a hyoid fracture, chopping wounds of a knee and blunt trauma to the posterior torso were found. The implication of these wounds is discussed in relation to incaprettamento.

Ankle Injuries↗

[Mechanisms of injuries of cut and stab wounds of the neck].

The following paper presents a fundamental overview of the relationship between the manner in which cut or stab wound of the neck is inflicted and the resulting injury. The dependence of the type and shape of the weapon is discussed as well as the direction of the thrust. In addition, the main differences between cut and stab injuries and the differences between suicide and murder are pointed out.

Carotid Artery Injuries↗

[The use of superficial cervical artery island skin flaps in the repair of the maxillofacial and cervical scar].

OBJECTIVE: To investigate the method of harvesting of superficial cervical artery island skin flap, and its clinical application in the repair of the maxillofacial and cervical scars. METHODS: The origin, course, branches and distribution of the superficial cervical artery were studied in 10 adult cadavers. The superficial cervical artery could be divided into three segments: i.e. the segment before entering the trapezius muscle, the segment in the trapezius muscle, and the segment emerging from the trapezius muscle. Fourteen patients with maxillofacial and cervical scar contracture were enrolled in the study. The postburn scars were removed, and the wounds were covered by superficial cervical artery island skin flaps. The survival of the flap after the operation and the recovery of the neck movements were observed. RESULTS: The length of superficial cervical artery before entering the trapezius muscle was 5.1 +/- 0.4 cm, while that inside the trapezius muscle was 2.1 +/- 0.5 cm, and that after emerging from the trapezius muscle was 4.7 +/- 0.7 cm, respectively. The internal perforating branch was located 7.3 +/- 0.6 cm beside the seventh cervical vertebrae, and 3.9 +/- 0.7 cm above the spine of scapula. The flap was from 16 cm x 7 cm to 35 cm x 12 cm in size. All the flaps survived, except one with partial necrosis in the distal part (3.0 cm x 1.5 cm) of the flap. Follow-up observation for 4 months to 3 years showed satisfactory results. CONCLUSION: Superficial cervical artery island skin flap is simple in the flap preparation, and there is no necessity to cut the pedicle, thus it is particularly suitable for the reconstruction of severe postburn maxillofacial and cervical contracture.

Adolescent↗

Traumatic arteriovenous fistula: experience with 202 patients.

Experience with the management of 202 patients with 210 traumatic arteriovenous fistulas is reported. Penetrating trauma accounted for 98 per cent of injuries caused mainly by stabs (63 per cent) and missile wounds (26 per cent). Seven of 15 patients with shotgun wounds had multiple lesions. Over half of all fistulas occurred in the cervico-mediastinal vessels; abdominal and thoracic vessels were infrequently involved. The upper limbs were involved in 22 per cent and the lower limbs in 20 per cent. Some 133 patients were diagnosed and treated within 1 week of injury; 69 presented 1 week to 12 years later. Machinery murmur was noted in 61 per cent of the early presenters, but was an almost universal finding in those presenting late. Only three patients had cardiac failure and all had underlying cardiomyopathy. Active overt haemorrhage was not common. Arterial continuity was restored in 80 per cent of cases, usually by autogenous reconstruction. Venous injury was usually treated by ligation or lateral suture. Patients treated within 1 week of injury had a lower rate of perioperative mortality and morbidity than those treated late, due mainly to technical difficulties in controlling the vessels caused by fibrosis and massive venous dilatation. If a policy of selective exploration of penetrating trauma is to be followed, careful assessment for arteriovenous fistula must be made and the patient evaluated at regular intervals for several months. Shotgun injuries require routine angiography at the time of presentation. The earlier treatment is instituted, the better the results.

Abdominal Injuries↗

[Therapeutic principles and priorities of polytrauma in general surgery (author's transl)].

The absolutely prior task in patients with multiple injuries is to maintain the cardiac and pulmonary functions. Furthermore a quick decision is needed regarding additional life-saving operations. Apart from a careful clinical investigation simple diagnostic procedures are necessary (chest x-ray, peritoneal lavage). The life of the injured person is endangered through hemorrhages. The most effective therapy is to recognize and to stop these bleedings. The surgical repair of intestinal ruptures, injuries to the pancreas, ruptures of the diaphragm and other problems can be postponed. The same applies to most of the thoracic injuries, except to the tension pneumothorax. Mediastinal injuries require the use of the heart-lung-machine, if the heart and the big vessels are involved. The extent of an operation and the intraoperative procedure are determined by the injury.

Abdominal Injuries↗

[Traumatic vertebral artery dissection in an 8 year old boy].

Dissections of extracranial brain supplying arteries are a common cause of ischemic strokes in young patients. Accidents are often accountable for that. We report the case of an 8 year old boy with traumatic vertebral dissection after he was bumped while playing football. He developed an ischemia on both sides of the thalamus which was caused by a bilateral system of the vertebral artery. He showed motor eye and progressive neuropsychological deficits. The CT and MRI scan confirmed the diagnosis. The symptoms ameliorated under anticoagulation treatment with intravenous heparin. At the end of the hospital stay, neuropsychological deficits persisted. Doppler ultrasound showed recanalization of the vertebral artery. Further treatment consisted of anticoagulation with marcumar for 6 months.

Anticoagulants↗