Background: Maxillofacial trauma affects young adults more. The injury assessment is difficult to establish in low-income countries because of the imaging means, particularly the scanner, which is poorly available and...Background: Maxillofacial trauma affects young adults more. The injury assessment is difficult to establish in low-income countries because of the imaging means, particularly the scanner, which is poorly available and less financially accessible. The aim of this study is to describe the epidemiological profile and the various tomodensitometric aspects of traumatic lesions of the face in patients received in the Radiology department of Kira Hospital. Patients and methods: This is a descriptive retrospective study involving 104 patients of all ages over a period of 2 years from December 2018 to November 2019 in the medical imaging department of KIRA HOSPITAL. We included in our study any patient having undergone a CT scan of the head and presenting at least one lesion of the facial mass, whether associated with other cranioencephalic lesions. Results: Among the 384 patients received for head trauma, 104 patients (27.1% of cases) presented facial damage. The average age of our patients was 32.02 years with extremes of 8 months and 79 years. In our study, 87 of the patients (83.6%) were male. The road accident was the circumstance in which facial trauma occurred in 79 patients (76% of cases). These injuries were accompanied by at least one bone fracture in 97 patients (93.3%). Patients with fractures of more than 3 facial bones accounted for 40.2% of cases and those with fractures of 2 to 3 bones accounted for 44.6% of cases. The midface was the site of the fracture in 85 patients (87.6% of cases). Orbital wall fractures were noted in 57 patients (58.8% of cases) and the jawbone was the site of a fracture in 50 patients (51.5% of cases). In the vault, the fractures involved the extra-facial frontal bone (36.1% of cases) and temporal bone (18.6% of cases). Cerebral contusion was noted in 41.2% of patients and pneumoencephaly in 15.5% of patients. Extradural hematoma was present in 16 patients and subdural hematoma affected 13 patients. Conclusion: Computed tomography is a diagnostic tool of choice in facial trauma patients. Most of these young patients present with multiple fractures localizing to the mid-level of the face with concomitant involvement of the brain.展开更多
Blindness is a serious complication that can occur after facial trauma and may represent the loss of one of the most useful senses in the human relationship with the world—the sight. This study aims to review the pat...Blindness is a serious complication that can occur after facial trauma and may represent the loss of one of the most useful senses in the human relationship with the world—the sight. This study aims to review the pathophysiology of blindness related to facial trauma in order to identify the mechanisms by which it develops and to recognize the signs and symptoms required to establish proper diagnosis and treatment. Blindness following facial trauma may occur due to mechanisms that involve injury to the eyeball, optic nerve and eyelids. The leading causes of blindness resulting from facial trauma, and which may be altered by medical interference, are related to retrobulbar hemorrhage and traumatic optic neuropathy, which require extremely rapid diagnosis and can be accomplished with the resources available in most trauma-based emergency services. The authors conclude that loss of vision tends to be irreversible in direct eyeball and optic nerve lesions, but can be prevented in retrobulbar hemorrhage and traumatic optic neuropathy. Eyeball and, especially, sight accuracy evaluation should be included in the initial care of trauma patients, so that the lesions that might lead to loss of vision are diagnosed and treated early.展开更多
Background: Globally, much has changed in the imaging modalities available to investigate maxillofacial trauma. Nevertheless, the regional practice patterns are highly influenced by availability, affordability and acc...Background: Globally, much has changed in the imaging modalities available to investigate maxillofacial trauma. Nevertheless, the regional practice patterns are highly influenced by availability, affordability and accessibility of imaging services as well as competence in interpreting radiological images and the practice of defensive medicine. The aim was to assess the use of maxillofacial trauma imaging modalities as well as to document patterns of skeletal injuries at selected government-sponsored health facilities in Kenya. Material and Methods: A cross sectional study, done in three health facilities. Results: There were 137 (81.5%) males and 31 (18.5%) females with a mean of 27.73 ± 9.86 years. Commonest aetiology of trauma was interpersonal violence (80, 47.62%) and road traffic crashes (63, 37.50%). The total number of radiological examinations was 250 with a mean of 1.49 ± 0.99 examinations per patient. Plain film radiographs were more (210, 84%) than computed tomographic scans (39, 15.6%). Dental panoramic technique was the most (104, 61.9%) popular. Most participants experienced isolated fractures to the mandible (99, 58.9%) and midface (28, 16.7%). Conclusion: Dental panoramic radiography remained the imaging of choice for mandibular fractures which had the commonest occurrence. There is a shift from the traditional conventional skull radiography to computed tomography in the diagnosis of midfacial fractures. Judicious utilization and prompt provision of affordable services in dental panoramic and computed tomographic scanning at the study centers and other upcoming health facilities are paramount in ensuring timely diagnosis and management of maxillofacial injuries in Kenya.展开更多
This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. ...This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.展开更多
Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in th...Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in the context of insecurity linked to terrorism. Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2018 to December 31, 2022 in the stomatology and maxillofacial surgery departments of the university hospitals of Ouagadougou. Results: In 5 years, 52 patients were collected, i.e. 10.4 cases per year. The mean age of the patients was 31.46 ± 15.41 years, and the sex ratio was 3. In 67.31% of patients, these injuries were the result of shootings during terrorist attacks. The jugal (36.54%) and chin (32.69%) regions were the most affected. The mandible (36.54%) and zygomatic bones (28.85%) were the most injured bones in these traumas. All patients underwent surgical treatment, and 25% suffered secondary complications. All patients retained at least one sequela. Conclusion: Maxillofacial injuries caused by ballistic trauma are true emergencies that can be life-threatening and functionally disabling. Their management is delicate and the outcome is uncertain, hence, the prevention is important.展开更多
Complex facial trauma requires complex repair and solutions.This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result.Historica...Complex facial trauma requires complex repair and solutions.This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result.Historically,the use of pedicled flaps,and then free tissue transfer,were the primary techniques utilized.Advancements in soft-tissue reconstruction,such as perforator flaps and pre-expanded and prefabricated flaps,allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage.The advent of contemporary technologies,such as virtual surgical planning,stereolithography and customized implants and plates,facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction.When surgical and technological techniques are combined in complementary multistage reconstructions,better reconstructive and aesthetic outcomes are achievable than ever before.In this review,the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience.Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed.A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result.We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.展开更多
Aim: Describe the epidemiological, clinical and therapeutic particularities of craniofacial trauma by encornment. Type of study: This was a retrospective and descriptive study. Material and methods: It took place in t...Aim: Describe the epidemiological, clinical and therapeutic particularities of craniofacial trauma by encornment. Type of study: This was a retrospective and descriptive study. Material and methods: It took place in the surgical emergency departments of Bouaké (Côte d’Ivoire) University Hospital from January 2013 to December 2017, for a period of 5 years. It focused on patients of 0 to 5 years old admitted for craniofacial trauma involving the horn of a bovine. Results: Of the 26 cases of traumatic encornment, 11 were craniofacial location (42%). There were 9 male and 2 female victims. The average age was 10.54 years with extremes of 6 months and 24 years. Patients came from rural areas of Côte d’Ivoire. Bovids were responsible for all causal encornements. The lesions involved the scalp (3 cases) and the face (8 cases). The lesions were cutaneous-musculo skeletal in 7 cases. The surgical treatment included debridement associated to a suture in all cases and associated with maxillo mandibular blockage in 3 cases and duro-cranioplasty in one case. Conclusion: In the local context, facial cranio traumatism by encornement is rare and seems to be essentially infantile, masculine and rural problem.展开更多
文摘Background: Maxillofacial trauma affects young adults more. The injury assessment is difficult to establish in low-income countries because of the imaging means, particularly the scanner, which is poorly available and less financially accessible. The aim of this study is to describe the epidemiological profile and the various tomodensitometric aspects of traumatic lesions of the face in patients received in the Radiology department of Kira Hospital. Patients and methods: This is a descriptive retrospective study involving 104 patients of all ages over a period of 2 years from December 2018 to November 2019 in the medical imaging department of KIRA HOSPITAL. We included in our study any patient having undergone a CT scan of the head and presenting at least one lesion of the facial mass, whether associated with other cranioencephalic lesions. Results: Among the 384 patients received for head trauma, 104 patients (27.1% of cases) presented facial damage. The average age of our patients was 32.02 years with extremes of 8 months and 79 years. In our study, 87 of the patients (83.6%) were male. The road accident was the circumstance in which facial trauma occurred in 79 patients (76% of cases). These injuries were accompanied by at least one bone fracture in 97 patients (93.3%). Patients with fractures of more than 3 facial bones accounted for 40.2% of cases and those with fractures of 2 to 3 bones accounted for 44.6% of cases. The midface was the site of the fracture in 85 patients (87.6% of cases). Orbital wall fractures were noted in 57 patients (58.8% of cases) and the jawbone was the site of a fracture in 50 patients (51.5% of cases). In the vault, the fractures involved the extra-facial frontal bone (36.1% of cases) and temporal bone (18.6% of cases). Cerebral contusion was noted in 41.2% of patients and pneumoencephaly in 15.5% of patients. Extradural hematoma was present in 16 patients and subdural hematoma affected 13 patients. Conclusion: Computed tomography is a diagnostic tool of choice in facial trauma patients. Most of these young patients present with multiple fractures localizing to the mid-level of the face with concomitant involvement of the brain.
文摘Blindness is a serious complication that can occur after facial trauma and may represent the loss of one of the most useful senses in the human relationship with the world—the sight. This study aims to review the pathophysiology of blindness related to facial trauma in order to identify the mechanisms by which it develops and to recognize the signs and symptoms required to establish proper diagnosis and treatment. Blindness following facial trauma may occur due to mechanisms that involve injury to the eyeball, optic nerve and eyelids. The leading causes of blindness resulting from facial trauma, and which may be altered by medical interference, are related to retrobulbar hemorrhage and traumatic optic neuropathy, which require extremely rapid diagnosis and can be accomplished with the resources available in most trauma-based emergency services. The authors conclude that loss of vision tends to be irreversible in direct eyeball and optic nerve lesions, but can be prevented in retrobulbar hemorrhage and traumatic optic neuropathy. Eyeball and, especially, sight accuracy evaluation should be included in the initial care of trauma patients, so that the lesions that might lead to loss of vision are diagnosed and treated early.
文摘Background: Globally, much has changed in the imaging modalities available to investigate maxillofacial trauma. Nevertheless, the regional practice patterns are highly influenced by availability, affordability and accessibility of imaging services as well as competence in interpreting radiological images and the practice of defensive medicine. The aim was to assess the use of maxillofacial trauma imaging modalities as well as to document patterns of skeletal injuries at selected government-sponsored health facilities in Kenya. Material and Methods: A cross sectional study, done in three health facilities. Results: There were 137 (81.5%) males and 31 (18.5%) females with a mean of 27.73 ± 9.86 years. Commonest aetiology of trauma was interpersonal violence (80, 47.62%) and road traffic crashes (63, 37.50%). The total number of radiological examinations was 250 with a mean of 1.49 ± 0.99 examinations per patient. Plain film radiographs were more (210, 84%) than computed tomographic scans (39, 15.6%). Dental panoramic technique was the most (104, 61.9%) popular. Most participants experienced isolated fractures to the mandible (99, 58.9%) and midface (28, 16.7%). Conclusion: Dental panoramic radiography remained the imaging of choice for mandibular fractures which had the commonest occurrence. There is a shift from the traditional conventional skull radiography to computed tomography in the diagnosis of midfacial fractures. Judicious utilization and prompt provision of affordable services in dental panoramic and computed tomographic scanning at the study centers and other upcoming health facilities are paramount in ensuring timely diagnosis and management of maxillofacial injuries in Kenya.
文摘This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.
文摘Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in the context of insecurity linked to terrorism. Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2018 to December 31, 2022 in the stomatology and maxillofacial surgery departments of the university hospitals of Ouagadougou. Results: In 5 years, 52 patients were collected, i.e. 10.4 cases per year. The mean age of the patients was 31.46 ± 15.41 years, and the sex ratio was 3. In 67.31% of patients, these injuries were the result of shootings during terrorist attacks. The jugal (36.54%) and chin (32.69%) regions were the most affected. The mandible (36.54%) and zygomatic bones (28.85%) were the most injured bones in these traumas. All patients underwent surgical treatment, and 25% suffered secondary complications. All patients retained at least one sequela. Conclusion: Maxillofacial injuries caused by ballistic trauma are true emergencies that can be life-threatening and functionally disabling. Their management is delicate and the outcome is uncertain, hence, the prevention is important.
文摘Complex facial trauma requires complex repair and solutions.This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result.Historically,the use of pedicled flaps,and then free tissue transfer,were the primary techniques utilized.Advancements in soft-tissue reconstruction,such as perforator flaps and pre-expanded and prefabricated flaps,allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage.The advent of contemporary technologies,such as virtual surgical planning,stereolithography and customized implants and plates,facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction.When surgical and technological techniques are combined in complementary multistage reconstructions,better reconstructive and aesthetic outcomes are achievable than ever before.In this review,the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience.Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed.A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result.We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.
文摘Aim: Describe the epidemiological, clinical and therapeutic particularities of craniofacial trauma by encornment. Type of study: This was a retrospective and descriptive study. Material and methods: It took place in the surgical emergency departments of Bouaké (Côte d’Ivoire) University Hospital from January 2013 to December 2017, for a period of 5 years. It focused on patients of 0 to 5 years old admitted for craniofacial trauma involving the horn of a bovine. Results: Of the 26 cases of traumatic encornment, 11 were craniofacial location (42%). There were 9 male and 2 female victims. The average age was 10.54 years with extremes of 6 months and 24 years. Patients came from rural areas of Côte d’Ivoire. Bovids were responsible for all causal encornements. The lesions involved the scalp (3 cases) and the face (8 cases). The lesions were cutaneous-musculo skeletal in 7 cases. The surgical treatment included debridement associated to a suture in all cases and associated with maxillo mandibular blockage in 3 cases and duro-cranioplasty in one case. Conclusion: In the local context, facial cranio traumatism by encornement is rare and seems to be essentially infantile, masculine and rural problem.
