PubMed · 8555157
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G R Ogden. 1995. Midfacial trauma.. https://doi.org/10.1016/0266-4356(95)90065-9
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OBJECTIVE: Patients sustaining facial fractures are at risk for accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition is crucial in improving patient survival and recovery. This study examined which simple clinical signs identify facial fracture patients at risk for intracranial hemorrhage before the performance of computed tomography. DESIGN AND METHODS: Retrospective study of 2,195 patients with facial fractures during a period of 7 years. By means of univariate and multivariate analysis clinical features potentially predictive for (a) intracranial hemorrhage and (b) surgery for intracranial hemorrhage were identified. SETTING: Critical care units of anesthesiology and neurology, general traumatology, and oral and maxillofacial surgery in a level I trauma university hospital. RESULTS: Seizures (OR 22.1) and vomiting/nausea (OR 20.2) were the strongest independent predictors of intracranial bleeding in facial fracture patients. For intracranial hemorrhages requiring surgical intervention closed head injuries (OR 9.75) and cranial vault fractures (OR 5.0) were the most significant risk factors. However, among those patients without vomiting/nausea and without seizures and without closed head injury ( n=1,628), 20 patients (1.2%) suffered intracranial hemorrhage, and six (0.37%) of them required surgical intervention. CONCLUSIONS: Simple clinical symptoms, such as seizures, vomiting/nausea, history of a closed head injury or cranial vault fractures are strong predictors for intracranial hemorrhage in facial fracture patients. The early consideration of such important indicators allows us to detect patients at elevated risk of an intracranial hematoma requiring surgical intervention.
Distraction osteogenesis is becoming the treatment of choice for the surgical correction of hypoplasias of the maxillofacial skeleton. The mandible can be elongated by intraoral or extraoral devices. The intraoral devices are smaller, do not leave an external scar and do not cause social inconvenience to the patient. The main disadvantages are less control of vector and the need for a second operation for removal. The most important factors of mandibular distraction are planning of distraction, location of the osteotomy, control of vector of lengthening and type of distraction device. In the maxilla, our experience with three types of maxillary distraction is discussed: 1) the rigid extraoral distraction, 2) the surgically assisted protraction and 3) the intraoral method. In the last years, distraction osteogenesis was applied in the treatment of obstructive sleep apnea. The method has several advantages over other methods, mainly in treatment of young children in order to improve airway and to decannulate tracheostomy. Alveolar distraction osteogenesis poses a new challenge in reconstructing atrophic alveolar bone with no need to harvest bone graft or to use bone substitutes. The advantages and problematic issues of alveolar distraction such as vector control of distraction are described. The intraoral method should always be considered first. However, in severely hypoplastic patients, when three-dimensional correction is necessary, the extraoral device has an advantage over the intraoral device. In the future, the issues to consider will be improvement of osteotomies by endoscopy, development of smaller multidirectional devices, improvement of bone quality by cytokines and growth factors in order to shorten the time of device bearing by the patients.
Extraoral implants are used with increasing frequency, in order to provide retention for facial prostheses. Facial prostheses can replace lost extraoral hard and soft tissues using acrylic or silicone materials. The surgeon, maxillofacial prosthodontist and dental technician are facing particular treatment considerations and practical problems. Some of these are demonstrated and discussed in this article by means of a case-report. A patient received an orbital prosthesis which obtains its retention from implants, placed in the lateral orbital rim.