1
|
Pitak-Arnnop P, Hirsch J, Stengel D. [Are certain facial fractures indicators for cerebrovascular injuries or intracranial hemorrhage?]. Unfallchirurgie (Heidelb) 2024; 127:407-409. [PMID: 38498156 DOI: 10.1007/s00113-024-01421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Poramate Pitak-Arnnop
- Klinik und Poliklinik für Mund‑, Kiefer- und Plastische Gesichtschirurgie, Medizinische Fakultät, UKGM, Universitätsklinikum Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg (Lahn), Deutschland.
- Klinik für Mund-Kiefer-Gesichtschirurgie und Plastische Operationen, Universitätsklinikum Ruppin-Brandenburg, Medizinische Fakultät, Medizinische Hochschule Brandenburg, Fehrbelliner Str. 38, 16816, Neuruppin, Deutschland.
| | - Julius Hirsch
- Medizinische Fakultät, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg (Lahn), Deutschland
| | - Dirk Stengel
- Ressort Medizin, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117, Berlin, Deutschland
- , Berlin, Deutschland
| |
Collapse
|
2
|
Kong CW, To WWK. Precision of vacuum cup placement and its association with subgaleal hemorrhage and associated morbidity in term neonates. Arch Gynecol Obstet 2024; 309:1411-1419. [PMID: 37017783 DOI: 10.1007/s00404-023-07018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE To evaluate whether the precision of vacuum cup placement is associated with failed vacuum extraction(VE), neonatal subgaleal hemorrhage(SGH) and other VE-related birth trauma. METHODS All women with singleton term cephalic fetuses with attempted VE were recruited over a period of 30 months. Neonates were examined immediately after birth and the position of the chignon documented to decide whether the cup position was flexing median or suboptimal. Vigilant neonatal surveillance was performed to look for VE-related trauma, including subgaleal/subdural hemorrhages, skull fractures, scalp lacerations. CT scans of the brain were ordered liberally as clinically indicated. RESULTS The VE rate was 5.89% in the study period. There were 17(4.9%) failures among 345 attempted VEs. Thirty babies suffered from subgaleal/subdural hemorrhages, skull fractures, scalp lacerations or a combination of these, giving an incidence of VE-related birth trauma of 8.7%. Suboptimal cup positions occurred in 31.6%. Logistic regression analysis showed that failed VE was associated with a non-occipital anterior fetal head position (OR 3.5, 95% CI 1.22-10.2), suboptimal vacuum cup placement (OR 4.13, 95% CI 1.38-12.2) and a longer duration of traction (OR 8.79, 95% CI 2.13-36.2); while, VE-related birth trauma was associated with failed VE (OR 3.93, 95% CI 1.08-14.3) and more pulls (OR 4.07, 95% CI 1.98-8.36). CONCLUSION Suboptimal vacuum cup positions were related to failed VE but not to SGH and other vacuum-related birth trauma. While optimal flexed median cup positions should be most desirable mechanically to effect delivery, such a position does not guarantee prevention of SGH.
Collapse
Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China.
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China
| |
Collapse
|
3
|
McGuckin E, Ho KM, Honeybul S, Stuckey E, Song S. A Prospective Cohort Study Characterizing Incidence of Dural Venous Sinus Thrombosis in Traumatic Brain Injury Patients with Skull Fractures. World Neurosurg 2024; 184:e374-e383. [PMID: 38302002 DOI: 10.1016/j.wneu.2024.01.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Limited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with significant morbidity and mortality. Prospective data accurately characterizing the incidence of DVST in patients with high-risk TBI are sparse but are needed to develop evidence-based TBI management guidelines. METHODS After obtaining institutional approval, 36 adult patients with TBI with skull fractures admitted to an Australian level III adult intensive care unit between April 2022 and January 2023 were prospectively recruited and underwent computed tomography venography or magnetic resonance venography within 72 hours of injury. When available, daily maximum intracranial pressure was recorded. RESULTS Dural venous sinus abnormality was common (36.1%, 95% confidence interval 22.5%-52.4%) and strongly associated with DVST (P = 0.003). The incidence of DVST was 13.9% (95% confidence interval 6.1%-28.7%), which was lower than incidence reported in previous retrospective studies. Of DVSTs confirmed by computed tomography venography, 80% occurred in patients with extensive skull fractures including temporal or parietal bone fractures in conjunction with occipital bone fractures (P = 0.006). However, dural venous sinus abnormality and DVST were not associated with an increase in maximum daily intracranial pressure within the first 7 days after injury. CONCLUSIONS Dural venous sinus abnormality was common in TBI patients with skull fractures requiring intensive care unit admission. DVST was confirmed in more than one third of these patients, especially patients with concomitant temporal or parietal and occipital bone fractures. Computed tomography venography is recommended for this subgroup of TBI patients.
Collapse
Affiliation(s)
- Ellen McGuckin
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - Kwok M Ho
- Department of Intensive Care Medicine, Fiona Stanley Hospital, University of Western Australia & Murdoch University, Perth, Western Australia, Australia
| | - Stephen Honeybul
- Department of Neurosurgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Emma Stuckey
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Swithin Song
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
4
|
Crinnion W, Doke T, Yordanov S, Moffat D, O'Halloran PJ, Mckenna G, Offiah C, Uff C. Radiological prediction of contralateral extradural haematoma following evacuation of traumatic acute subdural haematoma. Br J Neurosurg 2024; 38:367-371. [PMID: 33570450 DOI: 10.1080/02688697.2021.1877612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To identify radiological predictors of contralateral extradural haematoma (CEDH) in patients undergoing evacuation of acute subdural haematoma (ASDH). DESIGN Retrospective case-control study. SUBJECTS Patients requiring evacuation of traumatic ASDH via craniotomy/craniectomy with contralateral skull fracture were analysed in two groups: those who developed CEDH postoperatively and those who did not. MATERIALS AND METHODS Retrospective analysis of severe traumatic brain injury admissions over 24 months (2017-2019) at a major trauma centre. Pre- and post-operative CT scans were reviewed by a Consultant Neuroradiologist for initial fracture haematoma (FH) and specific contralateral skull fracture features (CLFF) comprising: complex petrous fracture, suture diastasis and fractures involving foramen spinosum or middle meningeal groove (MMG). RESULTS 35 patients had ASDH evacuation (age: 11-74); 7 with craniotomy, 28 with craniectomy. 9/35 developed CEDH of whom 7 underwent bilateral craniotomy/craniectomy. 8/9 with CEDH had FH, 6/26 of those without CEDH had FH. All patients with CEDH had CLFF. 6/9 had >1 CLFF. CLFF was identified in 9/26 patients without CEDH and only 3/26 non-CEDH had >1 CLFF. Analysis using univariate logistic regression identified statistically significant factors for the development of CEDH which were: younger age, FH on initial CT, increasing number of CLFF and MMG involvement alone. After multivariate analysis, only younger age and FH were significant. CONCLUSIONS FH and CLFF on CT enable prediction of CEDH in patients undergoing evacuation of traumatic ASDH. These features raise a high index of suspicion for this complication and may expedite investigation and management for CEDH.
Collapse
MESH Headings
- Humans
- Child
- Adolescent
- Young Adult
- Adult
- Middle Aged
- Aged
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Retrospective Studies
- Case-Control Studies
- Craniotomy/adverse effects
- Hematoma, Subdural/surgery
- Skull Fractures/complications
- Skull Fractures/diagnostic imaging
- Skull Fractures/surgery
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Subdural, Intracranial/surgery
- Treatment Outcome
Collapse
Affiliation(s)
- William Crinnion
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Thomas Doke
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Stefan Yordanov
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Daniel Moffat
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | | | - Grainne Mckenna
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Curtis Offiah
- Department of Neuroradiology, The Royal London Hospital, London, UK
| | - Chris Uff
- Department of Neurosurgery, The Royal London Hospital, London, UK
| |
Collapse
|
5
|
Poupore NS, Britt AF, Nguyen SA, White DR. Complications After Pediatric Temporal Bone Fractures by Classification System: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:1009-1019. [PMID: 38168743 DOI: 10.1002/ohn.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To analyze the rates of complications after pediatric temporal bone fractures (TBF) and the utility of the longitudinal, transverse, and mixed versus the otic capsule sparing (OCS) and otic capsule violating (OCV) classification systems in predicting these complications. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS Per PRISMA guidelines, studies of children with TBFs were included. Meta-analyses of proportions were performed. RESULTS A total of 22 studies with 1376 TBFs were included. Children with TBF had higher rates of conductive hearing loss (CHL) than sensorineural hearing loss (SNHL) (31.3% [95% confidence interval [CI] 23.2-40.1] vs 12.9% [95% CI 8.9-17.5]). No differences in both CHL and SNHL were seen between longitudinal and transverse TBFs; however, OCV TBFs had higher rates of SNHL than OCS TBFs (59.3% [95% CI 27.8-87.0] vs 4.9% [95% CI 1.5-10.1]). Of all patients, 9.9% [95% CI 7.2-13.1] experienced facial nerve (FN) paresis/paralysis, and 13.4% [95% CI 5.9-23.2] experienced cerebrospinal fluid otorrhea. Transverse TBFs had higher rates of FN paresis/paralysis than longitudinal (27.7% [95% CI 17.4-40.0] vs 8.6% [95% CI 5.2-12.8]), but rates were similar between OCS and OCV TBFs. CONCLUSION CHL was the most common complication after TBF in children; however, neither classification system was superior in identifying CHL. The traditional system was more effective at identifying FN injuries, and the new system was more robust at identifying SNHL. While these results suggest that both classification systems might have utility in evaluating pediatric TBFs, these analyses were limited by sample size. Future research on outcomes of pediatric TBFs stratified by type of fracture, mainly focusing on long-term outcomes, is needed.
Collapse
Affiliation(s)
- Nicolas S Poupore
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Annie F Britt
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Medical University of South Carolina School of Medicine, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R White
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
6
|
Shukla AD, G S, Chakravarthy K, Kaushal A, Udeshi HM. Epidemiology of maxillofacial injuries during monsoon and non-monsoon season in India: a data-based retrospective study from a tertiary care dental teaching hospital. F1000Res 2024; 12:1377. [PMID: 38585231 PMCID: PMC10997983 DOI: 10.12688/f1000research.134532.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/09/2024] Open
Abstract
Background Maxillofacial Injury (MFI) is a major public health concern that is multifactorial in etiology-road traffic accidents (RTAs), falls and violence. RTAs are the major cause of maxillofacial injuries (MFIs) in countries like India. Recent studies have shown that maxillofacial fractures (MFF) constitute a significant proportion of facial injuries seen in hospitals (56.5%). The incidence of maxillofacial fractures can vary depending on several factors, including age, gender, and environmental factors. Of particular concern is the impact of seasonal variations, such as the monsoon season, which lead to high incidence of maxillofacial fractures due to hazardous conditions. Methods A retrospective review of medical records was done in a tertiary-care dental teaching hospital was done. Results Data of 200 subjects including 154 males (77%) and 46 females (23%) with a mean age of 35.38 ± 16.541 years; age range: 1 - 80 years was analyzed. A total of 200 MFI's were recorded between 2021 and 2022. Soft tissue injuries were reported in 37.5% of the cases in non-monsoon season and 42.3% of the cases during the monsoon season. Dentoalveolar fractures were reported in 6.2% of the cases during the non-monsoon seasons and 7.7% during the monsoon season. In this study, mandible was the most fractured bone (n=104,52%) followed by zygomatic complex (n=50, 25%). The frequently observed pattern among mandibular fracture was condyle 8.3% during the non-monsoon season and 2.9% during the monsoon season). Conclusions The results of the study indicate that mandibular fractures are most commonly seen in maxillofacial fractures, followed by fractures of the zygomatic complex. The study also reveals a higher incidence of soft tissue injuries and dentoalveolar fractures during the monsoon season. Further research is warranted to explore the factors that contribute to the seasonal variation in maxillofacial fractures for effective interventions to reduce their occurrence.
Collapse
Affiliation(s)
- Anand Deep Shukla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Srikanth G
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kalyan Chakravarthy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ayusha Kaushal
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Hariti M Udeshi
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| |
Collapse
|
7
|
Sharma RK, Vivek N, Yang SF, Stephan SJ, Patel PN. Time-to-operation delays and in-hospital complications in operative facial trauma: A national analysis. Am J Otolaryngol 2024; 45:104148. [PMID: 38101139 DOI: 10.1016/j.amjoto.2023.104148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Management of facial fractures is variable. Understanding how time to operative management impacts outcomes can help standardize practice. METHODS Retrospective analysis of the ACS Trauma Quality Improvement Program (TQIP) database between 2016 and 2019. Adult patients with operative facial fractures were isolated by ICD-10 procedure codes, and further stratified by fracture location, including the mandible, orbit, maxilla, zygoma, and frontal bone. Multivariable logistic regression was conducted to predict in-hospital complications (both surgical and systemic complications) adjusting for time-to-operation, comorbidities, fracture location, AIS, and demographics. RESULTS 1678 patients with operative facial fractures were identified. The median time-to-operation was 2 days (IQR 1.0-2.0 days). Most patients only had one operative fracture (95 %) and orbital fracture was the most common (44 %). The overall complication rate was higher for those operated after 2 days compared to those operated between 1 and 2 days and within 24 h (2.8 % vs 0.6 % vs 0.7 %; p < 0.001). Patients who were operated on after 48 h exhibited an increased risk of any complication (OR 4.72, 95 % CI 1.49-16.6, p = 0.010) on multivariable models. CONCLUSION Delays in the management of facial fractures are associated with more in-hospital complications. However, the incidence of short-term postoperative complications remains low. Injury characteristics are the primary predictor of delays in operation, however Hispanic patients independently experienced delays in care.
Collapse
Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America.
| | - Niketna Vivek
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Shiayin F Yang
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Scott J Stephan
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Priyesh N Patel
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| |
Collapse
|
8
|
Fujiwara G, Okada Y, Shiomi N, Sakakibara T, Yamaki T, Hashimoto N. Derivation of Coagulation Phenotypes and the Association with Prognosis in Traumatic Brain Injury: A Cluster Analysis of Nationwide Multicenter Study. Neurocrit Care 2024; 40:292-302. [PMID: 36977962 DOI: 10.1007/s12028-023-01712-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The pathogenesis and pathophysiology of traumatic coagulopathy during traumatic brain injury is not well understood, and the appropriate treatment strategy for this condition has not been established. This study aimed to evaluate the coagulation phenotypes and their effect on prognosis in patients with isolated traumatic brain injury. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Japan Neurotrauma Data Bank. Adults with isolated traumatic brain injury (head abbreviated injury scale > 2; abbreviated injury scale of any other trauma < 3) who were registered in the Japan Neurotrauma Data Bank were included in this study. The primary outcome was the association of coagulation phenotypes with in-hospital mortality. Coagulation phenotypes were derived using k-means clustering with coagulation markers, including prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FBG), and D-dimer (DD) on arrival at the hospital. Multivariable logistic regression analyses were conducted to calculate the adjusted odds ratios of coagulation phenotypes with their 95% confidence intervals (CIs) for in-hospital mortality. RESULTS In total, 556 patients were enrolled and five coagulation phenotypes were identified. The median (interquartile range) score for the Glasgow Coma Scale was 6 (4-9). Cluster A (n = 129) had the closest to normal coagulation values; cluster B (n = 323) had a mild high DD phenotype; cluster C (n = 30) had a prolonged PT-INR phenotype with a higher frequency of antithrombotic medication in elderly patients than in younger patients; cluster D (n = 45) had a low amount of FBG, high DD, and prolonged APTT phenotype with a high incidence of skull fracture; and cluster E (n = 29) had a low amount of FBG and extremely high DD phenotype with high energy trauma and a high incidence of skull fracture. In the multivariable logistic regression analysis, the association of clusters B, C, D, and E with in-hospital mortality yielded the corresponding adjusted odds ratios of 2.17 (95% CI 1.22-3.86), 2.61 (95% CI 1.01-6.72), 10.0 (95% CI 4.00-25.2), and 24.1 (95% CI 7.12-81.3), respectively, relative to cluster A. CONCLUSIONS This multicenter, observational study identified five different coagulation phenotypes of traumatic brain injury and showed associations of these phenotypes with in-hospital mortality.
Collapse
Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc, 2-4-1, Ohashi, Ritto, Shiga, Japan.
| | - Yohei Okada
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan
| | - Naoto Shiomi
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Ritto, Shiga, Japan
| | | | - Tarumi Yamaki
- Department of Neurosurgery, Kyoto Kujo Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
9
|
Ryan S, Hewes H, Fenton SF, Russell K, Hansen K, Brockmeyer DL, Robison J. Ten-Year Analysis of Complications Related to Simple Basilar Skull Fractures in Children Presenting to a Trauma Center. Pediatr Emerg Care 2024; 40:137-140. [PMID: 37212784 DOI: 10.1097/pec.0000000000002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Head trauma is a common presenting complaint among children requiring urgent medical attention, accounting for more than 600,000 emergency department (ED) visits annually, 4% to 30% of which identify skull fractures among the patient's injuries. Previous literature shows that children with basilar skull fractures (BSFs) are usually admitted for observation. We studied whether children with an isolated BSF have complications precluding them from safe discharge home from the ED. METHODS We performed a retrospective review of ED patients aged 0 to 18 years given a simple BSF diagnosis (defined by nondisplaced fracture, with normal neurologic examination, Glasgow Coma Score of 15, no intracranial hemorrhage, no pneumocephalus) during a 10-year period to identify complications associated with their injury. Complications were defined as death, vascular injury, delayed intracranial hemorrhage, sinus thrombosis, or meningitis. We also considered hospital length of stay (LOS) longer than 24 hours or any return visit within 3 weeks of the original injury. RESULTS Of the 174 patients included in the analysis, there were no deaths, cases of meningitis, vascular injury, nor delayed bleeding events. Thirty (17.2%) patients required a hospital LOS longer than 24 hours and 9 (5.2%) returned to the hospital within 3 weeks of discharge. Of those with LOS longer than 24 hours, 22 (12.6%) patients needed subspecialty consultation or intravenous fluids, 3 (1.7%) had cerebrospinal fluid leak, and 2 (1.2%) had a concern for facial nerve abnormality. On the return visits, only 1 (0.6%) patient required readmission for intravenous fluids because of nausea and vomiting. CONCLUSIONS Our findings suggest that patients with uncomplicated BSFs can be safely discharged from the ED if the patient has reliable follow-up, is tolerating oral fluids, has no evidence of cerebrospinal fluid leak, and has been evaluated by appropriate subspecialists before discharge.
Collapse
Affiliation(s)
- Sydney Ryan
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Hilary Hewes
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Stephen F Fenton
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Katie Russell
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Kris Hansen
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Douglas L Brockmeyer
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Jeff Robison
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| |
Collapse
|
10
|
Beucler N, Rambolarimanana T. How I do it: single-staged emergency neurosurgical management of frontal penetrating craniocerebral injury with depressed skull fracture. Acta Neurochir (Wien) 2024; 166:47. [PMID: 38286923 DOI: 10.1007/s00701-024-05941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 01/31/2024]
Abstract
CONTEXT Penetrating craniocerebral injury associated with depressed skull fracture is an infrequent yet timely neurosurgical emergency. Such injury frequently occurs in the frontal region during traffic accident or stone throw in the civilian setting. As military neurosurgeons, we present our experience in the surgical debridement and reconstruction of this peculiar type of traumatic brain injury. METHODS The patient lies supine, the head in neutral position heal by a Mayfield head clamp. The first step is the debridement of the frontal wound. Then, the depressed skull fracture is operated on using a tailored coronal approach through Merkel dissection plane, in order to keep a free pericranial flap. The bone flap is cut around the depressed skull fracture. Neuronavigation allows to locate the frontal sinus depending on whether it has been breached and thus requires cranialization. Brain and dura mater debridement and plasty are performed. Cranioplasty is performed using either native bone fragments fixed with bone plates or tailored titanium plate if they are too damaged. CONCLUSION Performing wounded skin closure first and then a tailored coronal approach with free pericranial flap and a craniotomy encompassing the depressed skull fracture allows to treat frontal penetrating craniocerebral injury in an easy-to-reproduce manner.
Collapse
Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, 83800, Toulon Cedex 9, France.
- Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75230, Paris Cedex 5, France.
| | - Tonifaniry Rambolarimanana
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, 83800, Toulon Cedex 9, France
| |
Collapse
|
11
|
Lin JAJ, Li PH, Liao CH, Hsieh CH, Kuo YC, Hsu TA, Chu YY, Fu CY. Evaluation of Concomitant Facial Fracture in Traumatic Brain Injury Patients-Simplification and External Validation of a Prediction Model. Ann Plast Surg 2024; 92:S27-S32. [PMID: 38285992 DOI: 10.1097/sap.0000000000003774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Patients with traumatic brain injuries (TBIs) often experience concurrent facial bone fractures. In 2021, a prediction model with 10 variables was published and precisely predicted concomitant facial fractures in TBI patients. Herein, external validation and simplification of this model was performed. METHODS Traumatic brain injury patients treated at a major referral trauma center were retrospectively reviewed for 1 year. The original prediction model (published in 2021), which was developed from a rural level II trauma center, was applied for external validation. A new and simplified model from our level I trauma center was developed and backwardly validated by rural level II trauma center data. RESULTS In total, 313 TBI patients were enrolled; 101 (32.3%) had concomitant facial fractures. When the previous prediction model was applied to the validation cohort, it achieved acceptable discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.713 and good precision, with a Brier score of 0.083. A new and simplified model with 6 variables (age, tooth rupture, epistaxis, facial lesion, eye injury, and intracranial hemorrhage) was created with excellent discrimination (AUC = 0.836) and good precision (Brier score of 0.055). The backward validation of this new model also showed excellent discrimination in the cohort used to develop the original model (AUC = 0.875). CONCLUSION The original model provides an acceptable and reproducible prediction of concomitant facial fractures among TBI patients. A simplified model with fewer variables and the same accuracy could be applied in the emergency department and at higher- and lower-level trauma centers.
Collapse
Affiliation(s)
| | - Pei-Hua Li
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ying Chu
- From the Department of Plastic and Reconstructive Surgery
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
12
|
Sansone G, Megevand P, Vulliémoz S, Corbetta M, Picard F, Seeck M. Long-term outcome of alcohol withdrawal seizures. Eur J Neurol 2024; 31:e16075. [PMID: 37823698 DOI: 10.1111/ene.16075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/18/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Alcohol withdrawal seizures (AWS) are a well-known complication of chronic alcohol abuse, but there is currently little knowledge of their long-term relapse rate and prognosis. The aims of this study were to identify risk factors for AWS recurrence and to study the overall outcome of patients after AWS. METHODS In this retrospective single-center study, we included patients who were admitted to the Emergency Department after an AWS between January 1, 2013 and August 10, 2021 and for whom an electroencephalogram (EEG) was requested. AWS relapses up until April 29, 2022 were researched. We compared history, treatment with benzodiazepines or antiseizure medications (ASMs), laboratory, EEG and computed tomography findings between patients with AWS relapse (r-AWS) and patients with no AWS relapse (nr-AWS). RESULTS A total of 199 patients were enrolled (mean age 53 ± 12 years; 78.9% men). AWS relapses occurred in 11% of patients, after a median time of 470.5 days. Brain computed tomography (n = 182) showed pathological findings in 35.7%. Risk factors for relapses were history of previous AWS (p = 0.013), skull fractures (p = 0.004) at the index AWS, and possibly epileptiform EEG abnormalities (p = 0.07). Benzodiazepines or other ASMs, taken before or after the index event, did not differ between the r-AWS and the nr-AWS group. The mortality rate was 2.9%/year of follow-up, which was 13 times higher compared to the general population. Risk factors for death were history of AWS (p < 0.001) and encephalopathic EEG (p = 0.043). CONCLUSIONS Delayed AWS relapses occur in 11% of patients and are associated with risk factors (previous AWS >24 h apart, skull fractures, and pathological EEG findings) that also increase the epilepsy risk, that is, predisposition for seizures, if not treated. Future prospective studies are mandatory to determine appropriate long-term diagnostic and therapeutic strategies, in order to reduce the risk of relapse and mortality associated with AWS.
Collapse
Affiliation(s)
- Giulio Sansone
- Department of Clinical Neurosciences, University Hospital of Geneva & Faculty of Medicine, Geneva, Switzerland
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Pierre Megevand
- Department of Clinical Neurosciences, University Hospital of Geneva & Faculty of Medicine, Geneva, Switzerland
| | - Serge Vulliémoz
- Department of Clinical Neurosciences, University Hospital of Geneva & Faculty of Medicine, Geneva, Switzerland
| | - Maurizio Corbetta
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Venetian Institute of Molecular Medicine (VIMM), Fondazione Biomedica, Padova, Italy
| | - Fabienne Picard
- Department of Clinical Neurosciences, University Hospital of Geneva & Faculty of Medicine, Geneva, Switzerland
| | - Margitta Seeck
- Department of Clinical Neurosciences, University Hospital of Geneva & Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
13
|
Chandrasekhar SS. Caring for the Patient with Otolaryngologic Trauma Is a Complex Matter. Otolaryngol Clin North Am 2023; 56:xv-xvii. [PMID: 37659860 DOI: 10.1016/j.otc.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
In an Austrian study of 14,654 patients with 35,129 injuries treated at a single Department of Cranio-Maxillofacial and Oral Surgery over a 15-year period, the following was seen.1 Older people were more prone to soft tissue lesions with a rising risk of 2.1% per year older, equal in men and women. Younger patients were at higher risk of dentoalveolar trauma with an increase of 4.4% per year younger, and this was 19.6% higher for women. The risk of sustaining facial bone fractures increased each year by 4.6% and was 66.4% times higher in men. A total of 2550 patients (17.4%) suffered 3834 concomitant injuries of other body parts.
Collapse
Affiliation(s)
- Sujana S Chandrasekhar
- Consulting Editor, Otolaryngologic Clinics of North America, President, American Otological Society, Past President, American Academy of Otolaryngology-Head and Neck Surgery, Partner, ENT & Allergy Associates, LLP, Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra-Northwell, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 18 East 48th Street, 2nd Floor, New York, NY 10017, USA.
| |
Collapse
|
14
|
Vahidi N, Kwak P, Sismanis D, Schuman T, Hawkins D, Lee TS. Management of Complications and Secondary Deformity After Fractures of the Midface, Orbit, and Upper Third of the Maxillofacial Skeleton. Otolaryngol Clin North Am 2023; 56:1151-1167. [PMID: 37442663 DOI: 10.1016/j.otc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Craniomaxillofacial trauma is a challenging entity to manage effectively and often necessitates serial evaluation and treatment. A multidisciplinary team is best served to evaluate and treat these complex injury patterns with the use of necessary adjuncts, such as neuronavigation, intraoperative imaging, custom implant use, and virtual surgical planning. Complications of facial trauma can present at a spectrum of time points and manifest in a variety of manners and as such patients should be observed closely and longitudinally. Although not all complications and secondary deformities can be avoided, this article highlights some common pitfalls and our unique management strategies.
Collapse
Affiliation(s)
- Nima Vahidi
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Peter Kwak
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Dimitrios Sismanis
- Oculoplastic Surgery, Virginia Oculofacial Surgeons, 1630 WIlkes Ridges Parkway Suite 102, Richmond, VA 23233, USA
| | - Theodore Schuman
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA
| | - Daniel Hawkins
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, School of Dentistry, Dental Building 1, 521 North 11th Street, Richmond, VA 23298-0566, USA
| | - Thomas S Lee
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, West Hospital, 12th Floor, South Wing, Suite 313, Clinic Box 980146, Academic Box 980237, Richmond, VA 23298-0146, USA.
| |
Collapse
|
15
|
Kao WK, Ho T. The Management of Posttraumatic Nasal Deformities. Facial Plast Surg 2023; 39:630-637. [PMID: 37567568 DOI: 10.1055/a-2152-8670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Nasal bone fractures are the most common fractures of the facial skeleton and are often accompanied by bony, cartilaginous, and soft tissue injuries. These injuries are often complex, and when untreated or inadequately treated, can lead to posttraumatic nasal deformity. The most common deformities are the crooked nose and the saddle nose. Both deformities may result in significant cosmetic and functional concerns. The treatment of these deformities can be complex, requiring careful evaluation of the nose and thoughtful planning to correct the cosmetic deformity and restore functional integrity. The rhinoplasty surgeon will benefit from having a large repertoire of techniques to achieve these repairs. In this article, we discuss the options and concepts for the management of nasal bone fractures as well as complicated posttraumatic nasal deformity. Level of evidence is not available.
Collapse
Affiliation(s)
- W Katherine Kao
- Department of Otolaryngology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Tang Ho
- Department of Otolaryngology, University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
16
|
Kidani T, Ozaki T, Nakajima S, Kanemura Y, Izutsu N, Kawamoto S, Taki K, Murakami K, Nishizawa N, Kobayashi K, Fujimi Y, Fujinaka T. Predictors of Middle Meningeal Artery-Related Vascular Diseases Associated with Blunt Head Trauma. World Neurosurg 2023; 180:e667-e675. [PMID: 37813338 DOI: 10.1016/j.wneu.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Traumatic middle meningeal artery (MMA)-middle meningeal vein (MMV) fistula (MMA-MMV fistula) and MMA pseudoaneurysm are the 2 main MMA-related vascular diseases occurring after blunt head trauma. These are rare but known causes of delayed intracranial hemorrhage. This study investigated predictors that may aid in the diagnosis of these diseases. METHODS In our department, screening digital subtraction angiography (DSA) is performed for patients with blunt head trauma accompanied by intracranial hemorrhage and skull or facial bone fracture. This study included 87 patients who underwent screening DSA without craniotomy from January 2019 to June 2023. The patients' clinical characteristics were retrospectively collected from the database. Statistical analysis was performed to examine the associations of various evaluation items with MMA-related vascular diseases. RESULTS The first DSA examination revealed 34 MMA-MMV fistulas and 1 MMA pseudoaneurysm. The second follow-up DSA examination revealed 13 MMA-MMV fistulas and four MMA pseudoaneurysms. Temporal/parietal bone fracture (odds ratio, 5.33; P = 0.0005; 95% confidence interval, 1.95-14.60) was significantly associated with MMA-related vascular diseases. Endovascular treatments were performed in 9 patients. All procedures were successfully completed without complications; no delayed bleeding was observed. CONCLUSIONS Temporal/parietal bone fracture in patients with blunt head trauma is a likely predictor of MMA-related vascular diseases. When initial head computed tomography reveals this pathology, we recommend careful imaging follow-up (e.g., DSA) and treatment as needed, while considering the possibility of MMA-related vascular diseases.
Collapse
Affiliation(s)
- Tomoki Kidani
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Tomohiko Ozaki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Shin Nakajima
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan; Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Nobuyuki Izutsu
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Saki Kawamoto
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Kowashi Taki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Keijiro Murakami
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Naoki Nishizawa
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Koji Kobayashi
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Yosuke Fujimi
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| |
Collapse
|
17
|
Zohrevandi B, Rad EH, Kouchakinejad-Eramsadati L, Imani G, Pourheravi I, Khodadadi-Hassankiadeh N. Epidemiology of head injuries in pedestrian-motor vehicle accidents. Sci Rep 2023; 13:20249. [PMID: 37985796 PMCID: PMC10662169 DOI: 10.1038/s41598-023-47476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023] Open
Abstract
Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most common cause of death of pedestrians is head injuries, there is a lack of knowledge on the epidemiology and characteristics of head injury in terms of the Glasgow Outcome Scale to be used for prevention. However, this study aimed to determine the epidemiology of pedestrian-motor vehicle accidents, the characteristics of head injury, and differences in the Glasgow Outcome Scale in terms of gender. In this retrospective analytical study, the data of 917 eligible injured pedestrians were obtained from the two databases of the Trauma System and the Hospital Information System. The data were analyzed using SPSS software (Version 21). The mean age of all 917 injured pedestrians was 47.55 ± 19.47 years. Most of the injured pedestrians (42.10%) were in the age range of 41-69 years and 81.31% were male. Moreover, 83.07% did not have any acute lesions on the CT scan. The most common brain lesion was brain contusion (n = 33, 3.60%), subarachnoid hemorrhage (n = 33, 3.60%), and skull fracture (n = 29, 3.16%). Among all concurrent injuries, lower extremity/pelvic injuries were observed in 216 patients (23.56%). Outpatient treatment (n = 782, 85.27%), airway control/endotracheal intubation (n = 57, 6.22%), and resuscitation (n = 35, 3.82%) were the most applied treatments respectively. There were significant differences in the Glasgow Outcome Scale between men and women (P- value = 0. 012). The high rate of mortalities, disability, head injuries, contusion, subarachnoid hemorrhage, and skull fractures in pedestrians involved in MVAs emphasizes the need for developing and implementing prevention strategies including appropriate management and risk reduction. Male pedestrians were at higher risk of motor vehicle accidents and worse Glasgow Outcome Scale. The presented data identified the main types of pedestrian injuries and suggested the importance of adopting appropriate preventive strategies to achieve the most effective interventions for creating a safer community.
Collapse
Affiliation(s)
- Behzad Zohrevandi
- Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Ghazaleh Imani
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Iman Pourheravi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | |
Collapse
|
18
|
Alshalah ME, Enezei HH, Aldaghir OM, Khalil AA, Aldelaimi TN, Al-Ani RM. Direct or Indirect Surgical Approach of Zygomatic Complex Fracture: A Comparative Study. J Craniofac Surg 2023; 34:2433-2436. [PMID: 37646342 DOI: 10.1097/scs.0000000000009712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/29/2023] [Indexed: 09/01/2023] Open
Abstract
Zygoma is considered the main support of the midface. Zygoma is frequently fractured owing to its prominent site on the face. Treatment of zygomaticomaxillary complex fractures can be performed through either conservative or surgical measures (closed or open reduction). The study was a cross-sectional retrospective observational investigation done at 4 hospitals in Ramadi and Baghdad cities, Iraq. This investigation covered a duration of 6 years (2016-2021). We reviewed the medical records of patients with ZCFs. The participants were divided into 2 groups according to the approach used for their management (direct versus indirect approach). Data regarding the demographic and clinical characteristics were recorded for each subject. Of 265 patients with ZCFs, 209 (78.9%) were males. The highest age group affected was 18 to 40 years (51.7%). The majority of the ZCFs were caused by road traffic accidents (31.7%). Most of the cases belong to single fractures (72.1%). Cheek flattening (73.6%) was the commonest sign of the ZCFs. The majority of the fractures were treated by direct approach, 65.4% of the isolated fractures and 62.2% for multiple fractures. Excellent patient satisfaction was seen in the majority of the cases. There were no statistically significant differences between the 2 approaches regarding the abovementioned variables ( P -value > 0.05). The majority of the cases were with excellent patient satisfaction (n = 149) while only 7 patients with poor satisfaction. The age groups below 18 years and 18 to 40 years were associated with excellent patient satisfaction than good and poor satisfaction. All (n = 7) of the cases with poor satisfaction belong to the age group above 40 years. The majority of male (n = 113) and female (n = 36) patients were with excellent satisfaction, while all patients with poor results were males (n = 7). There were statistically significant differences between the results of the patient satisfaction and age group and complications ( P -value < 0.05). The ophthalmic complications were the most complications seen after ZCF surgical treatment (2.56%). Direct and indirect approaches can be used safely in the treatment of ZCFs owing to excellent patient satisfaction in the majority of the cases and a low complication rate. This study aims to evaluate the demographic and clinical characteristics and to compare different surgical procedures to treat patients with zygomaticomaxillary complex fractures in a country overwhelmed by violence.
Collapse
Affiliation(s)
- Muamer E Alshalah
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Al Kunooz University College, Basrah
| | - Hamid H Enezei
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Ramadi
| | - Osamah M Aldaghir
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Al-Muthanna University, Muthanna
| | - Afrah A Khalil
- Department of Oral Diagnosis, College of Dentistry, University of Anbar
| | - Tahrir N Aldelaimi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Ramadi
| | - Raid M Al-Ani
- Department of Surgery/Otolaryngology, College of Medicine, University of Anbar, Ramadi, Iraq
| |
Collapse
|
19
|
Sandhaus H, Boakye EA, Johnson M. Incidence of facial fractures in association with facial laceration from dog bites in the pediatric patient. Int J Pediatr Otorhinolaryngol 2023; 172:111639. [PMID: 37478789 DOI: 10.1016/j.ijporl.2023.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Dog bite injuries occur in approximately 102 of every 100,000 population. Pediatric facial injuries due to dog bites are more common than in the adult largely due to height difference and ease of access for the dog to the head and neck region. Although majority are soft tissue injuries, pediatric facial fractures from dog bites are estimated at approximately 5%, with the true incidence unknown. We hypothesize that depth and facial subsite of laceration can indicate likelihood of facial fracture presence in pediatric patients with dog bite injuries. METHODS This single-institution retrospective study included 162 patients 18 years or younger (n = 162) who had an ICD-9 code of E906.0 or ICD-10 code of W54.0 for dog bites in the head and neck region between 1/1/2015 and 12/31/2019 and were treated in the emergency department by either an emergency department, otolaryngology, or plastics surgery provider. Multivariable logistic regressions were used to examine the association between patient age, sex, and dog size, and the outcomes: laceration depth (epidermis, dermis, muscle, bone), and facial subsite (upper, middle, lower third). RESULTS Males had a lower laceration penetration at the epidermis level (aOR = 0.36; 95% CI 0.19, 0.69) but a higher laceration penetration at the muscle level (aOR = 2.29; 95% CI 1.04, 5.04) compared to females. No significant findings were observed for the levels of dermis and bone. In the multivariable analysis, there were no significant associations to suggest facial fractures found between facial subsites and age, sex and dog size. CONCLUSION No significant associations between depth or facial subsite of facial injury from dog bites and the presence of facial fractures in pediatric patients except with regard to male sex and laceration level of epidermis and muscle.
Collapse
Affiliation(s)
- Henya Sandhaus
- Department of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA; Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA
| | - Matthew Johnson
- Department of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
| |
Collapse
|
20
|
Kim SY, Kang D. Management of Mid-Facial Fracture Complicated by Pseudoaneurysm of Posterior Superior Alveolar Artery. J Craniofac Surg 2023; 34:e600-e602. [PMID: 37394698 DOI: 10.1097/scs.0000000000009518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023] Open
Abstract
Facial fractures, particularly mid-facial fractures, can result in various complications, such as functional and esthetic problems. Prompt reconstruction of the fractured bones is crucial for restoring normal anatomy and function and preventing complications. However, such procedures can be complex and carry the risk of potential complications. The authors report the case of a 27-year-old man who underwent open reduction and internal fixation of the left zygomatic complex fracture and reconstruction of the left inferior orbital wall. During the surgery, heavy bleeding from the posterior superior alveolar artery due to a broken bone near the pterygomaxillary region caused a prolonged surgery time and the development of a pseudoaneurysm. The pseudoaneurysm was eventually treated with superselective transcatheter embolization using 25% N-Butyl cyanoacrylate glue. This case highlights the challenges in the management of mid-facial fractures and the potential complications that can arise during surgery, particularly when dealing with the pterygomaxillary region.
Collapse
Affiliation(s)
- So Yeon Kim
- Department of Neurosurgery, International Saint Mary's Hospital, Catholic Kwandong University
| | - Daihun Kang
- Department of Plastic and Reconstructive Surgery, International Saint Mary's Hospital, Catholic Kwandong University, Seo-gu, Incheon, Republic of Korea
| |
Collapse
|
21
|
Wanderley BG, Formentin C, de Castro Oliveira DL, Joaquim AF, Raposo-Amaral CE, Ghizoni E. Growing skull fracture in a child with Ehlers-Danlos syndrome: case report and literature review. Childs Nerv Syst 2023; 39:2399-2405. [PMID: 37344678 DOI: 10.1007/s00381-023-06035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Growing skull fracture (GSF) is a rare complication of head trauma in the pediatric population, commonly observed in children younger than 3 years. DISCUSSION In this report, the authors describe a case of a 3-year-old male child, with clinical features of Ehlers-Danlos syndrome (EDS), who developed a GSF in frontal bone after a crib fall, treated with duraplasty and cranioplasty with autologous craft. Here, pertinent literature was reviewed with an emphasis on surgical techniques, and correlation with the mentioned syndrome. CONCLUSION This is the first case of GSF in association with EDS in the literature. The relevance of the case described concerns the rarity of the condition itself, the atypical presentation, and the intraoperative findings, which showed the important fragility of the dura mater, probably due to EDS. Therefore, this syndrome, besides having influenced the pathogenesis, was also a challenging factor in the surgical treatment.
Collapse
Affiliation(s)
- Bianca Gomes Wanderley
- Division of Neurosurgery, Department of Neurology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Cleiton Formentin
- Division of Neurosurgery, Department of Neurology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Andrei Fernandes Joaquim
- Division of Neurosurgery, Department of Neurology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Enrico Ghizoni
- Division of Neurosurgery, Department of Neurology, University of Campinas (UNICAMP), Campinas, SP, Brazil.
| |
Collapse
|
22
|
Diab J, Flapper WJ, Moore MH. Facial Fractures in Indigenous and Non-indigenous Populations of South Australia. J Craniofac Surg 2023; 34:1207-1211. [PMID: 36694300 DOI: 10.1097/scs.0000000000009195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Maxillofacial trauma in indigenous populations is complex with sociocultural factors, access to health care, and poorer general health issues that impact outcomes. Assaults and road traffic accidents are disproportionately experienced by indigenous persons compared with non-indigenous. METHODS A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures that attended or were referred to the unit were included in this study. The primary objective was to analyze epidemiological trends of facial fractures and clinical outcomes in the South Australian indigenous and non-indigenous populations. RESULTS Maxillofacial fractures in indigenous persons were less than in non-indigenous (31.2 versus 38.2 y, P < 0.001) with 3.8 odds of a facial fracture. Assault was 2.9 times more likely to result in a facial fracture, falls 40.9% less likely, and sports 29.4% less likely compared with non-indigenous ( P < 0.001). Alcohol-related facial fractures had significantly higher rates [odds ratio (OR = 3.8)] compared with non-indigenous. Indigenous from most disadvantaged areas and very remote areas also had significantly higher odds of a facial fracture. Indigenous persons had higher operative rates (OR = 2.8), postoperative complications (OR = 3.1), and a 3.7-day mean difference for the length of stay (6.6 versus 2.9 d, P < 0.001). CONCLUSIONS Indigenous people are more likely to experience facial fractures from assault resulting in mandibular fractures, whereas non-indigenous people are likely to have sport or fall-related midface fractures. Young indigenous women from outer regional and very remote areas have greater odds of facial fractures caused by assault and alcohol with higher operative rates, postoperative complications, and extended length of stay.
Collapse
Affiliation(s)
- Jason Diab
- Australian Craniofacial Unit
- Royal Adelaide Hospital
- Women and Children's Hospital
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Walter J Flapper
- Australian Craniofacial Unit
- Royal Adelaide Hospital
- Women and Children's Hospital
- University of Adelaide, Adelaide
| | - Mark H Moore
- Australian Craniofacial Unit
- Royal Adelaide Hospital
- Women and Children's Hospital
- University of Adelaide, Adelaide
| |
Collapse
|
23
|
Kim YH, Lee WS, Kim JW, Chung KJ. Cosmetic Open Rhinoplasty in Acute Nasal Bone Fracture With Pre-Existing Deformity. J Craniofac Surg 2023; 34:e358-e363. [PMID: 36959116 DOI: 10.1097/scs.0000000000009232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/26/2022] [Indexed: 03/25/2023] Open
Abstract
The simultaneous reduction of nasal bone fracture and cosmetic rhinoplasty is a challenging procedure, because of fracture severity and skeletal instability. Our aim was to investigate the surgical strategy and outcomes of cosmetic rhinoplasty according to the pre-existing nasal deformity when performing simultaneous reduction of nasal bone fracture and cosmetic rhinoplasty. In total, 71 patients who underwent cosmetic rhinoplasty were included. All patients were categorized according to pre-existing deformity, dorsal hump and irregularities, and deviation of the nose, wide nose, and flat nasal dorsum. The authors performed individual maneuvers to correct each deformity. Autologous tissue was used in all maneuvers for graft. Photoanalysis was performed to measure the deviation, nasal length, radix height, dorsal height, tip projection, nasofrontal angle, and nasolabial angle. Subjective evaluation of the functional and esthetic problems was confirmed through rhinoplasty outcome evaluation. In the analysis of the photographs, most patients presented improved scores ( P <0.05). The scores of satisfaction were significantly higher in the postoperative state ( P <0.05). As a postoperative complication, 2 cases of deviated tip occurred due to septal instability and were successfully revised with septoplasty and columellar strut graft. The authors created a harmonious face by evaluating, categorizing, and treating each deformity of the nose in patients with nasal fractures according to our algorithm.
Collapse
Affiliation(s)
- Yong-Ha Kim
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | | | | | | |
Collapse
|
24
|
Feldman KW, Sokoloff M, Otjen JP, Wright JN, Lee A, Ebel B, Blair AB. Short Falls in Childhood Occasionally Cause Major Brain Injuries Because of Unusual Circumstances. Pediatr Emerg Care 2023; 39:335-341. [PMID: 37115991 DOI: 10.1097/pec.0000000000002749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS Records and imaging were reviewed for children younger than 6 years, hospitalized between 2015 and 2020 for major closed head injuries following less than 4-ft falls. Major injury was defined as intensive care admission more than 2 days, neurosurgical intervention, death, or disability at hospital discharge. Subjects were identified through Seattle and Spokane, Washington abuse consultations. Harborview Medical Center's trauma registry and Seattle Children's Hospital's Hemophilia Treatment Program and Radiology were searched for subjects. RESULTS We identified 12 young children who sustained major closed head injury due to short falls. Seven developed major space-occupying epidural hemorrhages. One child developed internal hydrocephalus after intraventricular hemorrhage. One child with prior meningomyelocele, Chiari 2 malformation, and ventriculoperitoneal shunt developed shunt decompensation after an acute-on-chronic subdural hemorrhage. One child developed an internal capsule stroke because of a previously undiagnosed calcifying angiopathy. Another child developed space-occupying subdural hemorrhage associated with previously unrecognized platelet pool disorder. Only this child had abuse concerns, which were resolved with his coagulopathy diagnosis. One child had a diastatic skull fracture leading to pseudomeningocele.At Harborview Medical Center, 140 children were seen for short falls in the emergency department or inpatient service. Among the 40 needing intensive care, 4 (12.5%) had major injuries after short falls. Our hemophilia treatment program did not see any children who had sustained major injury following a short fall in a 5½ year period. CONCLUSIONS Although young children rarely sustain major head injury following short falls, serious head injuries do occasionally occur because of unusual injury mechanisms or preexisting conditions. It is important to fully evaluate these patients to differentiate these unintentional falls from abusive head injury.
Collapse
|
25
|
Abstract
Traumatic brain injury is one of the most common causes of morbidity and mortality and significantly impacts the patients' quality of life and socioeconomic status. It can be classified into primary and secondary injuries. Primary injury occurs at the time of the initial head trauma, such as skull fracture, extra-axial hemorrhage, brain contusion, and diffuse axonal injury. Secondary injury develops later as complications such as diffuse cerebral edema, brain herniation, and chronic traumatic encephalopathy. This article describes the indication for imaging, imaging modalities, recommended imaging protocols, and imaging findings of primary and secondary injuries, including pitfalls of each pathology.
Collapse
Affiliation(s)
- Aniwat Sriyook
- Department of Radiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, and Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Rajiv Gupta
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| |
Collapse
|
26
|
Wamkpah NS, Kallogjeri D, Snyder-Warwick AK, Buss JL, Durakovic N. Incidence and Management of Facial Paralysis After Skull Base Trauma, an Administrative Database Study. Otol Neurotol 2022; 43:e1180-e1186. [PMID: 36214506 PMCID: PMC9649848 DOI: 10.1097/mao.0000000000003721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Report the incidence of and treatment patterns for facial nerve palsy after skull base fracture. STUDY DESIGN Retrospective cohort study. SETTING IBM MarketScan Commercial Database (2006-2019). PATIENTS Human subjects with skull base fracture, per International Classification of Diseases-9th and 10th Revisions-Clinical Modification diagnosis codes. MAIN OUTCOME MEASURES The primary outcomes were the incidence and median time to facial nerve palsy diagnosis within 30 days of skull base fracture. Secondary outcomes were treatments (corticosteroids, antivirals, facial nerve decompression, botulinum toxin, and facial reanimation), demographics, and rates of hearing loss, vertigo, tympanic membrane rupture, cerebrospinal fluid leak, comorbidities, and loss of consciousness. RESULTS The 30-day incidence of facial nerve palsy after skull base trauma was 1.0% (738 of 72,273 patients). The median (95% confidence interval [CI]) time to diagnosis was 6 (6-7) days, and only 22.9% were diagnosed within 1 day. There were significantly higher rates (risk difference, 95% CI) of hearing loss (26%, 22-29%), tympanic membrane rupture (6.3%, 4.5-8.1%), cerebrospinal fluid leak (6.4%, 4.5-8.3%), comorbidity (14%, 10.4-17.6%), and loss of consciousness (24.3%, 20.7-27.9%). Loss of consciousness was associated with longer median (95% CI) time to facial nerve palsy diagnosis: 10 (9-10) days. Corticosteroids were the most common treatment but only reported for less than one-third of patients. Only eight patients underwent facial nerve decompression. CONCLUSIONS Facial nerve palsy after skull base fracture is associated with higher comorbidity, and the diagnosis is often delayed. Few patients were treated with surgery, and there are inconsistencies in the types and timing of treatments.
Collapse
Affiliation(s)
- Nneoma S. Wamkpah
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Dorina Kallogjeri
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Alison K. Snyder-Warwick
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO
| | - Joanna L. Buss
- Institute of Clinical and Translational Sciences, Center for Administrative Data Research, Washington University in St. Louis, St. Louis, MO
| | - Nedim Durakovic
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| |
Collapse
|
27
|
Dumitru M, Vrinceanu D, Banica B, Cergan R, Taciuc IA, Manole F, Popa-Cherecheanu M. Management of Aesthetic and Functional Deficits in Frontal Bone Trauma. Medicina (B Aires) 2022; 58:medicina58121756. [PMID: 36556958 PMCID: PMC9781007 DOI: 10.3390/medicina58121756] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and scooters. Usually, the patients are involved in high-velocity accidents and the resulting lesions could be life-threatening. Moreover, there are immediate and long-term aesthetic and functional deficits resulting from such pathology. The immediate complications range from local infections in the frontal sinus to infections propagating inside the central nervous system, or the presence of cerebrospinal fluid leaks and vision impairment. We review current trends and available guidelines regarding the management of cases with frontal bone trauma. Treatment options taken into consideration are a conservative attitude towards minor lesions or aggressive surgical management of complex fractures involving the anterior and posterior frontal sinus walls. We illustrate and propose different approaches in the management of cases with long-term complications after frontal bone trauma. The team attending to these patients should unite otorhinolaryngologists, neurosurgeons, ophthalmologists, and maxillofacial surgeons. Take-home message: Only such complex interdisciplinary teams of trained specialists can provide a higher standard of care for complex trauma cases and limit the possible exposure to further legal actions or even malpractice.
Collapse
Affiliation(s)
- Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Bogdan Banica
- OMF Surgery Department, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Romica Cergan
- Anatomy Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence:
| | - Iulian-Alexandru Taciuc
- Department of Pathology, “Carol Davila” University of Medicine and Pharmacy, 050096 Bucharest, Romania
| | - Felicia Manole
- Department of ENT, Faculty of Medicine, University of Oradea, 410073 Oradea, Romania
| | - Matei Popa-Cherecheanu
- Department of Cardiovascular Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania
| |
Collapse
|
28
|
Nabil S, Nordin R, Rashdi MF. Are Facial Soft Tissue Injury Patterns Associated With Facial Bone Fractures Following Motorcycle-Related Accident? J Oral Maxillofac Surg 2022; 80:1784-1794. [PMID: 36049531 DOI: 10.1016/j.joms.2022.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The unprotected nature of motorcycle riding exposes motorcyclists to an elevated risk of sustaining facial soft tissue injuries (STIs); however, its link with underlying facial bone fractures remains unexplored. The purpose of this study is to determine whether the type and site of STI sustained by motorcyclists were associated with the presence of underlying facial bone fractures. MATERIALS AND METHODS This was a retrospective cohort study of patients identified from the Oral and Maxillofacial Surgery Department of Universiti Kebangsaan Malaysia Medical Center trauma census who had motorcycle-related injury and met the inclusion criteria. The primary predictor variable was the type (laceration, contusion, abrasion, and no injuries) and site of STIs sustained. The site of the facial STI was categorized as per 17 different zones based upon the modified MCFONTZL classification. The primary outcome variable was the presence or absence of facial bone fractures as determined from the computed tomography scan. Descriptive and bivariate statistics were computed to measure the association between sustaining facial bone fractures and type/site of STI. RESULTS Seventy three patients (65 men and 8 women) were included in this study. The average age was 31.9 years (standard deviation ± 13.6) with a range of 18 to 70 years. There were 1,241 facial zones being assessed with 285 (23%) and 214 (17%) zones having STI and fractures, respectively. Laceration (124/285, 43%) and the orbital zone (53/285, 19%) were the most common type and site of STI, respectively, among motorcyclists. Facial bone fractures are more commonly seen following STI in the midface (71% of STI had fractures) compared to upper face (53%) and lower face (31%). Sustaining laceration type of STI was not associated with a higher rate of facial bone fracture when compared with other type of STI (54.8% vs 55.9%, P = .858) with the exception of laceration in the frontal zone (42.9% vs 10.5%, P = .022). CONCLUSIONS The different types of STI in the facial area cannot be used as a predictor for sustaining underlying facial bone fractures.
Collapse
Affiliation(s)
- Syed Nabil
- Associate Professor, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Malaysia.
| | - Rifqah Nordin
- Senior Lecturer, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Malaysia
| | - Muhd Fazlynizam Rashdi
- Science Officer, Oral and Maxillofacial Surgery Department, Universiti Kebangsaan Malaysia Medical Centre, Universiti Kebangsaan, Malaysia
| |
Collapse
|
29
|
Abstract
PURPOSE Orbital fractures are common facial fractures that can be challenging to repair and require careful attention to avoid unacceptable ophthalmic complications. Customized implants that are unique to an individual patient, or patient-specific implants (PSIs), have been increasingly used to repair orbital wall fractures. This systematic review summarizes the current evidence regarding custom-made orbital wall implants. METHODS A keyword search of published literature from January 2010 to September 2021 was performed using Ovid MEDLINE, PubMed, and the Cochrane Library databases. Original articles that included more than 3 human subjects with an orbital fracture repaired with a PSI were included. The search results were reviewed, duplicates were removed and relevant articles were included for analysis. RESULTS Fifteen articles meeting the inclusion criteria. The articles were categorized into 3 separate groups based on the method of PSI fabrication: manual molding of a PSI on a 3D-printed orbital model (53%), directly from a 3D printer (27%), or via a template fabricated from a 3D printer (20%). Three primary postoperative outcomes were assessed: rates of diplopia, enophthalmos, and orbital volume. Postoperative rates of diplopia and enophthalmos improved regardless of the PSI technique, and postoperative orbital volumes were reduced compared with their preoperative state. When PSIs were compared to conventional implants, patient outcomes were comparable. CONCLUSIONS This review of existing PSI orbital implant literature highlights that while PSI can accurately and safely repair orbital fractures, patient outcomes are largely comparable to orbital fractures repaired by conventional methods, and PSI do not offer a definitive benefit over conventional implants.
Collapse
Affiliation(s)
- Dominic I Maher
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - StellaMay Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elad Ben Artsi
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
30
|
Eisinger RS, Sorrentino ZA, Cutler C, Azab M, Pierre K, Lucke-Wold B, Murad GJ. Clinical risk factors associated with cerebrospinal fluid leak in facial trauma: A retrospective analysis. Clin Neurol Neurosurg 2022; 217:107276. [PMID: 35526511 DOI: 10.1016/j.clineuro.2022.107276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Cerebrospinal fluid (CSF) leak occurs most commonly following skull fracture, with a CSF leakage complicating up to 2% of all head traumas. This study aims to identify demographic and injury characteristics correlated with the highest risk of CSF leak in patients with known facial fractures. METHODS Retrospective data was collected from a previously described trauma registry from 2010 to 2019. Patients over 18 years old with any type of facial fracture, known CSF leak status, available neuroimaging, and hospital admission were included. Chi-Square analysis for demographic and injury characteristic data were utilized. RESULTS A total of 79 patients with CSF leak and 4907 patients without CSF leak were included in the database. Patients with CSF leak tended to be younger than those without CSF leak (38.45 +/- 0.28 vs 44.08 +/- 0.28, M +/- SE, p = 0.0197). CSF leak depended on the mechanism of injury (MOI; X2 =27.02, df=2, p = 0.0000013), with CSF leak rates highest in penetrating injuries (4.87%) and motor vehicle accidents (1.78%) compared to blunt injuries (0.95%); age did not significantly differ between the MOI groups (p = 0.11). CSF leak was also more common in patients with a lower Glasgow coma scale (GCS; 7.95 +/- 0.58 vs 12.21 +/- 0.10, p = 10-15), LeFort type 2&3 and pan-facial fractures compared to all other facial fracture types (8.9% vs 1.2%, p = 10-15), and radiographic midline shift (29.4% vs 9.1%, p = 10-15). There was a trend towards a higher proportion of males in those with CSF leak compared to those without (83.3% vs 73.7% males, p = 0.073), and in patients with prolonged loss of consciousness (LOC; 9.43% with LOC > 1 h vs 2.69% LOC < 1 h, p = 0.056). CONCLUSION Facial fractures often present with CSF leak, and certain demographic and injury risk factors including younger age, worse GCS score, evidence of midline shift, and certain mechanisms of injury (penetrating and motor vehicle) are correlated with increased risk and warrant close screening and follow-up for CSF leak detection. LeFort type 2&3 and pan-facial fractures are at high risk of CSF leak.
Collapse
Affiliation(s)
| | | | | | | | - Kevin Pierre
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Brandon Lucke-Wold
- University of Florida College of Medicine, Gainesville, FL, USA; Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Gregory Ja Murad
- University of Florida College of Medicine, Gainesville, FL, USA; Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
31
|
Pitak-Arnnop P. Response to Adelaide study on injuries associated with facial fractures. J Plast Reconstr Aesthet Surg 2022; 75:2033-2034. [PMID: 35341705 DOI: 10.1016/j.bjps.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/12/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| |
Collapse
|
32
|
Tewfik K, Covelli C, Rossini M, Burlini D. Lump on the scalp of a child arising over a previous parietal fracture: growing skull fracture or post-traumatic lipoma? BMJ Case Rep 2022; 15:e246283. [PMID: 35379677 PMCID: PMC8981367 DOI: 10.1136/bcr-2021-246283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
A young girl was referred to our Institution for the appearance of a painless soft swelling in the right parietal region of the scalp. In the same site, the patient had a parietal bone fracture 1 year ago. In the suspicion of a growing skull fracture, the patient underwent radiological investigations. Ultrasound showed a soft, poorly vascularised swelling with parenchymatous content. The skull X-ray showed an apparent healing of the previous fracture. CT scan and MRI confirmed the correct healing of the fracture and described the presence of a lipomatous mass. The mass was surgically removed and histology confirmed the diagnosis of encapsulated lipoma. The postoperative period was uneventful, with no evidence of infections or recurrence in the 6-month follow-up.
Collapse
Affiliation(s)
- Karim Tewfik
- Head&Neck Department, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
- Pediatric Maxillofacial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudia Covelli
- Pathology Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Manuela Rossini
- Pediatric Maxillofacial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Dante Burlini
- Pediatric Maxillofacial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| |
Collapse
|
33
|
Barkho JO, Cooper MJ, McRae MH, Choi M. Isolated Medial Maxillary Buttress Displacement in Naso-Orbito-Ethmoid Fractures: A Surgical Indication to Resolve Nasal Airway Obstruction. Ann Plast Surg 2022; 88:410-414. [PMID: 34393196 DOI: 10.1097/sap.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to present a case series emphasizing low medial maxillary (pyriform) buttress displacement in naso-orbito-ethmoid (NOE) fractures as an operative indication, in the absence of the typical NOE surgical indications (medial canthus displacement, midface bony comminution, nasal bone collapse, and orbital indications), to prevent nasal airway obstruction. METHODS Five cases of minor NOE fractures are reviewed, where only the low medial maxillary buttress was displaced. The typical surgical indications for NOE repair were absent. RESULTS In each case, the pyriform buttress was medially and posteriorly displaced, creating nasal airway obstruction in each patient. The medial canthal tendons were all nondisplaced, there was no diplopia, and the other 2 cardinal buttresses (infraorbital rim and nasofrontal junction) were minimally displaced or greensticked. In the acute setting, patients were treated with open reduction and internal fixation. With delayed presentation, septorhinoplasty or osteotomy and fixation were used. Among the patients who had adequate follow-up, nasal airway obstruction was resolved. CONCLUSIONS This series suggests that, in NOE fractures with isolated displacement at the medial maxillary buttress, nasal airway obstruction should be considered an operative indication (independent of the classical indications) in order to prevent or resolve nasal airway obstruction.
Collapse
Affiliation(s)
- Jouseph O Barkho
- From the Division of Plastic Surgery, McMaster University, Hamilton
| | | | - Mark H McRae
- From the Division of Plastic Surgery, McMaster University, Hamilton
| | - Matthew Choi
- From the Division of Plastic Surgery, McMaster University, Hamilton
| |
Collapse
|
34
|
Onisor FG, Andrei TP, Ovidiu M, Mihai J. Global avulsion of the globe associated with frontal sinus and naso-orbital-ethmoid (FSNOE) complex fracture. A rare case report and short literature review. Ann Ital Chir 2022; 11:S2239253X22036878. [PMID: 35670024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Post-traumatic avulsion of the globe is a rare and uncommon pathology with serious morpho-physiological, cosmetic and aesthetic implications. The association with complex fractures of the skull increases the morbidity and complexity of the case. CASE REPORT We present a rare case of FSNOE complex fracture associated with avulsion of the left globe, with complete sectioning of the optic nerve and loss of vision. DISSCUSION The prompt diagnosis and the immediate establishment of a correct multidisciplinary treatment, led to the favorable evolution of the case. Three-dimensional reconstruction of the skull architecture and resizing of the orbital contour, as well as successful prosthesis of the eyeball concured for a satisfactory anatomic and cosmetic result. CONCLUSION The therapeutic decision to reposition the globe in the case of complete avulsion should be made depending on the severity of associated lesions, the patient's general state, age, and the risk of potential postoperative complications. KEY WORDS Word, Post-traumatic, Avulsion of the globe, Frontal sinus, Naso-orbito-ethmoid, NOE, Fracture.
Collapse
|
35
|
Ye Z, Jin H, Chen Y, Ji H, Xu H, Jin Y. Endovascular treatment of traumatic oronasal hemorrhage complicated with progressive acute epidural hemorrhage: A case report. Medicine (Baltimore) 2022; 101:e28654. [PMID: 35060558 PMCID: PMC8772654 DOI: 10.1097/md.0000000000028654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Massive oronasal hemorrhage can induce shock and is life-threatening, and early endovascular treatment is the standard of care. Few studies have reported the use of endovascular treatment for acute epidural hemorrhage (AEDH). However, endovascular treatment of oronasal hemorrhage complicated by AEDH has not yet been demonstrated. Many patients with a low to moderate volume of oronasal hemorrhage complicated by AEDH choose conservative treatment but eventually undergo craniotomy due to increased intracranial hemorrhage. PATIENT CONCERNS A 32-year-old man presented to our hospital with traumatic oronasal hemorrhage complicated by AEDH after being hit by a blunt object. DIAGNOSIS Computerized tomography suggested progressive AEDH and multiple basilar skull fractures. Emergency cerebral angiography showed rupture of the right middle meningeal artery and a branch of the left maxillary artery causing AEDH and oronasal hemorrhage. INTERVENTIONS The patient underwent interventional embolization to treat the ruptured intracranial vessels. OUTCOMES After 23 days, cranial computerized tomography showed remarkable absorption of the right frontal epidural hematoma, with the patient having a Glasgow Coma Scale score of 15. LESSONS This case provides a valuable treatment for patients with AEDH complicated with oronasal hemorrhage, early interventional embolization may be an effective treatment strategy to prevent further complications and ensure a good patient outcome.
Collapse
Affiliation(s)
- Zhinan Ye
- Department of Neurology, Municipal Hospital Affiliated to Taizhou University, Zhejiang, China
| | - Hanghuang Jin
- Department of Neurosurgery, Municipal Hospital Affiliated to Taizhou University, Zhejiang, China
| | - Yuan Chen
- Department of Neurosurgery, Municipal Hospital Affiliated to Taizhou University, Zhejiang, China
| | - Hailong Ji
- Department of Neurosurgery, Municipal Hospital Affiliated to Taizhou University, Zhejiang, China
| | - Hao Xu
- Department of Neurology, Municipal Hospital Affiliated to Taizhou University, Zhejiang, China
| | - Yong Jin
- Department of Neurosurgery, Municipal Hospital Affiliated to Taizhou University, Zhejiang, China
| |
Collapse
|
36
|
Jarab F, Bataineh A. Pattern of Facial Fractures and Its Association with a Cervical Spine Injury in a Tertiary Hospital in Jordan. Int J Clin Pract 2022; 2022:4107382. [PMID: 35989870 PMCID: PMC9356895 DOI: 10.1155/2022/4107382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/05/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Facial fractures can be accompanied by serious and life-threatening injuries such as cervical spine injury (CSI), which can lead to serious consequences if misdiagnosed. OBJECTIVE To assess the patterns of maxillofacial fractures and to explore the association between these fractures and cervical spine injuries (CSIs) in patients with a traumatic facial injury. METHODS A retrospective analysis was conducted on the data of the subjects who were admitted to the King Abdullah University Hospital (KAUH) and had a maxillofacial fracture in the period from January 2017 through December 2020. Stepwise binary logistic regression analysis was conducted to find the variables which are significantly and independently associated with CSIs. RESULTS A total of 394 maxillofacial fractures were reported for a total of 221 subjects. The mandible was the most common site of the reported fractures (41.88%). The majority of the subjects had associated injuries (70.6%), of which 82.7% were CSIs. The most common type of the CSIs was the vertebral fracture (52%). Increased age (OR = 1.543, P < 0.05), having a mandibular fracture (OR = 4.382, P < 0.01), and having a maxillary fracture (OR = 3.269, P < 0.05) were significantly associated with the presence of CSI. CONCLUSION The current study revealed that the most common type of facial fracture occurred in the mandible area, and CSI was the most common fracture-associated injury (82.7%). Increased age and having mandibular or maxillary fracture were associated with an increased risk of developing CSI. Therefore, it is necessary to rule out the presence of concomitant CSI during the emergency management of maxillofacial fractures, particularly for elderly patients and those with mandibular or maxillary fractures.
Collapse
Affiliation(s)
- Fadi Jarab
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Anwar Bataineh
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| |
Collapse
|
37
|
Bal’afif F, Wardhana DW, Alfandy TN, Jesse A. Contrecoup epidural hematoma: a rare case report. Pan Afr Med J 2022; 41:169. [PMID: 35655673 PMCID: PMC9120746 DOI: 10.11604/pamj.2022.41.169.31986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Epidural hematoma (EDH) is defined as a traumatic accretion of blood separating the dural membrane and the internal table of the skull that caused from contact bending or skull fracture. The cases of contrecoup EDH are as not common, and there are just 10 recorded cases on this. As a result of its uncommonness, we disclose one subject of a 33-year-old man having countrecoup EDH who suffered from a head trauma caused by falling from 4 meters high. The main symptoms were decreasing consciousness and vomiting. Clinical findings showed a Glasgow Coma Scale score of 9, laceration in the left parietal region with stable hemodynamic. Head Computed tomography showed a large EDH in the right frontal and temporal region with coronal suture diastasis. The patient immediately underwent surgery, and craniotomy with evacuation of extradural hematoma were performed. This case presents that a force, which creates an angle, can propagates and causes opposite coronal suture diastasis and makes contrecoup EDH.
Collapse
Affiliation(s)
- Farhad Bal’afif
- Division of Neurosurgery, Department of Surgery, Brawijaya University, Saiful Anwar Hospital, Malang, Indonesia
- Corresponding author: Farhad Bal’afif, Division of Neurosurgery, Department of Surgery, Brawijaya University, Saiful Anwar Hospital, Malang, Indonesia.
| | - Donny Wisnu Wardhana
- Division of Neurosurgery, Department of Surgery, Brawijaya University, Saiful Anwar Hospital, Malang, Indonesia
| | - Tommy Nazwar Alfandy
- Division of Neurosurgery, Department of Surgery, Brawijaya University, Saiful Anwar Hospital, Malang, Indonesia
| | - Ariel Jesse
- Department of Surgery, Brawijaya University, Malang, Indonesia
| |
Collapse
|
38
|
Kabakus IM, Spampinato MV, Knipfing M, Cervantes G, Patel A, Eskandari R, Yazdani M. Fast Brain Magnetic Resonance Imaging With Half-Fourier Acquisition With Single-Shot Turbo Spin Echo Sequence in Detection of Intracranial Hemorrhage and Skull Fracture in General Pediatric Patients: Preliminary Results. Pediatr Emerg Care 2021; 37:e1168-e1172. [PMID: 31804431 DOI: 10.1097/pec.0000000000001949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the accuracy of fast brain magnetic resonance imaging (MRI) in the detection of intra- and extra-axial intracranial hemorrhage compared with standard-of-care computed tomography (CT) or MRI in pediatric patients. Unlike previous studies, we did not focus exclusively on patients with head trauma. We evaluated the fast brain MRI findings in a general pediatric population referred for indications other than evaluation of ventricular size. METHODS We retrospectively reviewed 48 pediatric patients with indications other than hydrocephalus and shunt follow-up, who underwent a standard head CT or standard MRI within 15 days of the fast brain MRI. All fast brain MRI scans included half-Fourier acquisition with single-shot turbo spin echo (HASTE) sequences in the axial, coronal, and sagittal plane. Two neuroradiologists blinded to patient information and study indications reviewed the fast brain MRI studies independently and then concurrently. RESULTS A total of 48 patients met the inclusion and exclusion criteria. The median and mean time interval between the standard and fast imaging were 2 and 3.9 days, respectively. The sensitivity and specificity of fast brain MRI to detect intraparenchymal hemorrhage were 100% and 97%, respectively. The sensitivity and specificity of fast brain MRI in the detection of extra-axial hemorrhage (subdural and/or epidural) were 86% and 96%, respectively. The sensitivity and specificity of fast brain MRI were, respectively, 10% and 100% for subarachnoid hemorrhage, 50% and 100% for intraventricular hemorrhage, and 47% and 97% for skull fracture, respectively. CONCLUSIONS Our results show that fast brain MRI with HASTE sequence is as sensitive as CT and standard MRI in the detection of intra-axial hemorrhage and has moderate sensitivity in the detection of extra-axial hemorrhage. Our preliminary results show that T2-weighted HASTE imaging may be suitable for the follow-up of intraparenchymal and extra-axial (subdural and/or epidural) hemorrhages.
Collapse
Affiliation(s)
| | | | | | | | | | - Ramin Eskandari
- Neurosurgery, Medical University of South Carolina, Charleston, SC
| | | |
Collapse
|
39
|
Metz JB, Otjen JP, Perez FA, Done SL, Brown ECB, Wiester RT, Jenny C, Ganti S, Feldman KW. Fracture-Associated Bruising and Soft Tissue Swelling in Young Children With Skull Fractures: How Sensitive Are They to Fracture Presence? Pediatr Emerg Care 2021; 37:e1392-e1396. [PMID: 32205799 DOI: 10.1097/pec.0000000000002058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine how reliable scalp bruising and soft tissue swelling/cephalohematomas (STS) are for underlying young child skull fractures. METHODS This was a retrospective clinical and imaging review from 2011 to 2012 of children younger than 4 years with skull fractures from 2 tertiary care hospitals. Imaging was reread by 3 pediatric radiologists. Descriptive statistics were utilized. The retrospective review had institutional review board approval. RESULTS We identified 218 subjects for review: 210 unintentional and 8 abusive. One hundred forty-three had available 3-dimensional computed tomography reconstructions: 136 unintentional and 7 abused. Two-thirds were younger than 1 year. Twelve subjects had visible scalp bruising, but 73% had clinically and 93% radiologically apparent fracture-associated STS. There was no difference in clinical STS with simple (79%) versus complex (68%) fractures. Nor was there difference in subjects with fractures from minor (77%) versus major (70%) trauma. Unintentionally injured infants did not differ from abused for detectable STS (74% vs 50%). Parietal and frontal bones most frequently sustained fractures and most consistently had associated STS. CONCLUSIONS Clinically apparent STS is present in approximately three-fourths of children with skull fractures. It may not be important to consistently identify skull fractures in unintentionally injured children. Point-of-care ultrasound may be adequate. For abuse concerns, it is important to identify skull fractures as evidence of cranial impacts and intracranial hemorrhages. The most sensitive, widely available imaging technique, cranial computed tomography scan with 3-dimensional skull reconstruction, should be utilized. Scalp bruising is present in a minority of young children with skull fractures. Its absence does not exclude cranial impact injury.
Collapse
Affiliation(s)
- James B Metz
- From the Children's Hospital, Department of Pediatrics, University of Vermont, Burlington, VT
| | | | | | | | - Emily C B Brown
- Children's Protection Program, University of Washington, Seattle Children's Hospital
| | - Rebecca T Wiester
- Children's Protection Program, University of Washington, Seattle Children's Hospital
| | - Carole Jenny
- Children's Protection Program, University of Washington, Seattle Children's Hospital
| | | | - Kenneth W Feldman
- Children's Protection Program, University of Washington, Seattle Children's Hospital
| |
Collapse
|
40
|
Newall N, Gajuryal S, Bidari S, Karki A, Karki P, Bodkin P, Pant B. Epidemiology and Pattern of Traumatic Brain Injuries at Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal. World Neurosurg 2020; 141:413-420. [PMID: 32407914 DOI: 10.1016/j.wneu.2020.04.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally. TBIs are a leading cause of death and disability in Nepal, despite improvements in safety regulations and implementation of strict drunk driving laws. We describe the epidemiology of patients with TBI following admission to our hospital. We discuss the implementation of specific strategies to reduce its incidence. METHODS We conducted a retrospective cross-sectional study of patients presenting to Annapurna Neurological Institute & Allied Sciences (ANIAS), Kathmandu, with a TBI between September 2018 to September 2019. RESULTS One-hundred and sixty-seven patients presented with a TBI. The most common age groups were younger than 15 years old and 15-25 years old, and the majority were male (73%). The commonest cause of TBI was road traffic accidents (RTA) (59%). Drivers riding motorcycles were the predominant mechanism of RTA (38%). Helmet use was seen in 57% of patients riding 2-wheelers. Alcohol consumption was reported in 22% of all patients. Skull fractures were the most common diagnosis. Most patients were managed conservatively (84%). CONCLUSIONS TBI should be recognized as an important public health problem in Nepal. TBI is responsible for a considerable number of neurosurgical admissions to ANIAS. Our study showed patients most vulnerable to TBI are males younger than 25 years old. The implementation of stricter traffic rules and regulations, helmet law enforcement, and public education programs may be helpful in decreasing the number of TBI.
Collapse
Affiliation(s)
- Nicola Newall
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal.
| | - Sharad Gajuryal
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Sangita Bidari
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Ashmita Karki
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Prashmita Karki
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Peter Bodkin
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Basant Pant
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| |
Collapse
|
41
|
Ren L, Wang D, Liu X, Yu H, Jiang C, Hu Y. Influence of Skull Fracture on Traumatic Brain Injury Risk Induced by Blunt Impact. Int J Environ Res Public Health 2020; 17:E2392. [PMID: 32244585 PMCID: PMC7177884 DOI: 10.3390/ijerph17072392] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 12/28/2022]
Abstract
This study is aimed at investigating the influence of skull fractures on traumatic brain injury induced by blunt impact via numerous studies of head-ground impacts. First, finite element (FE) damage modeling was implemented in the skull of the Total HUman Model for Safety (THUMS), and the skull fracture prediction performance was validated against a head-ground impact experiment. Then, the original head model of the THUMS was assigned as the control model without skull element damage modeling. Eighteen (18) head-ground impact models were established using these two FE head models, with three head impact locations (frontal, parietal, and occipital regions) and three impact velocities (25, 35, and 45 km/h). The predicted maximum principal strain and cumulative strain damage measure of the brain tissue were employed to evaluate the effect of skull fracture on the cerebral contusion and diffuse brain injury risks, respectively. Simulation results showed that the skull fracture could reduce the risk of diffuse brain injury risk under medium and high velocities significantly, while it could increase the risk of brain contusion under high-impact velocity.
Collapse
Affiliation(s)
- Lihai Ren
- State Key Laboratory of Vehicle NVH and Safety Technology, China Automotive Engineering Reasearch Institute Co., Ltd. and Chongqing Chang’An Automobile Co., Ltd., Chongqing 401122, China; (L.R.); (Y.H.)
- Key Laboratory of Advanced Manufacturing Technology for Automobile Parts, Ministry of Education, Chongqing University of Technology, Chongqing 400054, China; (D.W.); (C.J.)
| | - Dangdang Wang
- Key Laboratory of Advanced Manufacturing Technology for Automobile Parts, Ministry of Education, Chongqing University of Technology, Chongqing 400054, China; (D.W.); (C.J.)
| | - Xi Liu
- State Key Laboratory of Vehicle NVH and Safety Technology, China Automotive Engineering Reasearch Institute Co., Ltd. and Chongqing Chang’An Automobile Co., Ltd., Chongqing 401122, China; (L.R.); (Y.H.)
- Key Laboratory of Advanced Manufacturing Technology for Automobile Parts, Ministry of Education, Chongqing University of Technology, Chongqing 400054, China; (D.W.); (C.J.)
| | - Huili Yu
- Chang’An Automobile Co., Ltd., Chongqing 400023, China;
| | - Chengyue Jiang
- Key Laboratory of Advanced Manufacturing Technology for Automobile Parts, Ministry of Education, Chongqing University of Technology, Chongqing 400054, China; (D.W.); (C.J.)
| | - Yuanzhi Hu
- State Key Laboratory of Vehicle NVH and Safety Technology, China Automotive Engineering Reasearch Institute Co., Ltd. and Chongqing Chang’An Automobile Co., Ltd., Chongqing 401122, China; (L.R.); (Y.H.)
- Key Laboratory of Advanced Manufacturing Technology for Automobile Parts, Ministry of Education, Chongqing University of Technology, Chongqing 400054, China; (D.W.); (C.J.)
| |
Collapse
|
42
|
Medha KK, Gupta M, Gupta M. Post-traumatic bilateral longitudinal temporal bone fracture with bilateral facial nerve palsy: a rare case. BMJ Case Rep 2020; 13:13/2/e233728. [PMID: 32086330 DOI: 10.1136/bcr-2019-233728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Facial paralysis is a potentially disabling complication of temporal bone fractures. Although unilateral palsy is commonly encountered, bilateral facial nerve palsy is rare, especially in post-traumatic situations. Other recognised causes of bilateral facial palsy are neurologic, infectious, neoplastic, idiopathic or metabolic disorders. A 25-year-old male patient presented with difficulty in talking, eating and closing eyes for 15 days since a post-vehicular accident. CT of skull showed bilateral longitudinal temporal bone fractures. Bilateral facial palsy was confirmed by clinical and topodiagnostic tests. Patient was given a course of steroids which led to an early improvement on left side followed by a delayed right-sided improvement at 6 months.
Collapse
Affiliation(s)
| | - Manish Gupta
- ENT, Maharishi Markandeshwar University, Mullana, Haryana, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
43
|
Dobitsch AA, Oleck NC, Mansukhani PA, Halsey JN, Le TMT, Hoppe IC, Lee ES, Granick MS. Facial Fracture-Associated Intracranial Hemorrhage in the Elderly Population. Am Surg 2019; 85:e315-e317. [PMID: 31405430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
44
|
Izura Gómez M, Misis Del Campo M, Puyalto de Pablo P, Castaño Duque C. Mechanical thrombectomy: an alternative for treating cerebral venous sinus thrombosis. Emergencias 2019; 30:123-125. [PMID: 29547236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report the use of mechanical venous thrombectomy in 2 cases of cerebral venous sinus thrombosis in which the usual first-choice treatment with systemic anticoagulants was contraindicated. Our aim is to present this treatment as an alternative to consider when anticoagulants therapy is too risky or is contraindicated in critically ill patients.
Collapse
Affiliation(s)
- Marta Izura Gómez
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | | | | |
Collapse
|
45
|
Reich W, Aust O, Eckert A. Prospective analysis of mid-facial fractures in a single-center pediatric-adolescent cohort. Int J Pediatr Otorhinolaryngol 2019; 119:151-160. [PMID: 30708183 DOI: 10.1016/j.ijporl.2019.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The complex architecture of the midface renders diagnosing and treating fractures challenging, especially for young patients who present the additional risk of suffering growth and development deficiencies, which is to be avoided at all costs. OBJECTIVES This study sought to characterize pediatric mid-facial fractures considering the possible complications. METHODS Between September 2008 and September 2018, data was collected on inpatients aged <18 years, treated for mid-facial fractures at the Halle University Hospital. Evaluated parameters were age, gender, cause and type of fracture, associated injuries, treatment, and complications. RESULTS In total, 31 patients were examined; 20 were boys. The most common cause of injury was road traffic accident (41.9%). Orbital floor fracture was the most common type of injury (58.1%). In 54.8% of cases, surgery was performed. CONCLUSION The incidence of complications associated with mid-facial fractures was low (n = 7), requiring treatment in only three cases (orthodontic, ophthalmological).
Collapse
Affiliation(s)
- Waldemar Reich
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, D-06120, Halle (Saale), Germany.
| | - Oliver Aust
- Dental Practice, Waldkerbelstraße 12, D-04329, Leipzig, Germany.
| | - Alexander Eckert
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, D-06120, Halle (Saale), Germany.
| |
Collapse
|
46
|
Abstract
IMPORTANCE Traumatic brain injuries (TBIs) can have serious long-term consequences, including psychiatric disorders. However, few studies have assessed the association between TBI and risk of suicide. OBJECTIVE To examine the association between TBI and subsequent suicide. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using nationwide registers covering 7 418 391 individuals (≥10 years) living in Denmark (1980-2014) with 164 265 624 person-years' follow-up; 567 823 (7.6%) had a medical contact for TBI. Data were analyzed using Poisson regression adjusted for relevant covariates, including fractures not involving the skull, psychiatric diagnoses, and deliberate self-harm. EXPOSURE Medical contacts for TBI recorded in the National Patient Register (1977-2014) as mild TBI (concussion), skull fracture without documented TBI, and severe TBI (head injuries with evidence of structural brain injury). MAIN OUTCOMES AND MEASURES Suicide recorded in the Danish Cause of Death register until December 31, 2014. RESULTS Of 34 529 individuals who died by suicide (mean age, 52 years [SD, 18 years]; 32.7% women; absolute rate 21 per 100 000 person-years [95% CI, 20.8-21.2]), 3536 (10.2%) had medical contact: 2701 with mild TBI, 174 with skull fracture without documented TBI, and 661 with severe TBI. The absolute suicide rate was 41 per 100 000 person-years (95% CI, 39.2-41.9) among those with TBI vs 20 per 100 000 person-years (95% CI, 19.7-20.1) among those with no diagnosis of TBI. The adjusted incidence rate ratio (IRR) was 1.90 (95% CI, 1.83-1.97). Compared with those without TBI, severe TBI (absolute rate, 50.8 per 100 000 person-years; 95% CI, 46.9-54.6) was associated with an IRR of 2.38 (95% CI, 2.20-2.58), whereas mild TBI (absolute rate, 38.6 per 100 000 person-years; 95% CI, 37.1-40.0), and skull fracture without documented TBI (absolute rate, 42.4 per 100 000 person-years; 95% CI, 36.1-48.7) had an IRR of 1.81 (95% CI, 1.74-1.88) and an IRR of 2.01 (95% CI, 1.73-2.34), respectively. Suicide risk was associated with number of medical contacts for TBI compared with those with no TBI contacts: 1 TBI contact, absolute rate, 34.3 per 100 000 person-years (95% CI, 33.0-35.7; IRR, 1.75; 95% CI, 1.68-1.83); 2 TBI contacts, absolute rate, 59.8 per 100 000 person-years (95% CI, 55.1-64.6; IRR, 2.31; 95% CI, 2.13-2.51); and 3 or more TBI contacts, absolute rate, 90.6 per 100 000 person-years (95% CI, 82.3-98.9; IRR, 2.59; 95% CI, 2.35-2.85; all P < .001 for the IRR's). Compared with the general population, temporal proximity since the last medical contact for TBI was associated with risk of suicide (P<.001), with an IRR of 3.67 (95% CI, 3.33-4.04) within the first 6 months and an incidence IRR of 1.76 (95% CI, 1.67-1.86) after 7 years. CONCLUSIONS AND RELEVANCE In this nationwide registry-based retrospective cohort study individuals with medical contact for TBI, compared with the general population without TBI, had increased suicide risk.
Collapse
Affiliation(s)
- Trine Madsen
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Sonja Orlovska
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ramy Mofaddy
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
47
|
Woriax HE, Hamill ME, Gilbert CM, Reed CM, Faulks ER, Love KM, Lollar DI, Nussbaum MS, Collier BR. Is the Face an Air Bag for the Brain and Torso?-The Potential Protective Effects of Severe Midface Fractures. Am Surg 2018; 84:1299-1302. [PMID: 30185304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We investigated the patterns of injury associated with major midface trauma. Our hypothesis is that midface injuries are associated with a decrease in certain traumatic brain injuries as well as major torso injuries. The registry of our Level I trauma center was queried for all adult patients treated over 25 years from 1989 to 2013. Patients with midface fractures were identified based on the ICD-9 code. Associated injuries were defined based both on individual ICD-9 codes as well as the Barell Injury Matrix. Injury etiology was defined based on e-codes. Univariate analysis was performed using chi-squared test, Fisher's exact test, and Wilcoxon test. A total of 29,152 patients were identified. Excluding pediatric patients, those with exclusively penetrating trauma, and patients with incomplete data, 20,971 patients were included for subsequent analysis. Midface fractures were identified in 752 patients. Patients with Le Fort fractures were more likely to be male, have a higher Injury Severity Score, a lower arrival Glasgow Coma Scale, and more likely to require intensive care unit admission and mechanical ventilation, with a longer hospital length of stay. Patients with midface fractures had significantly fewer subdural hematomas, subarachnoid hemorrhages, spine fractures, and were less likely to have associated abdominal and pelvic injuries. Patients with midface fractures were more likely to require facial reconstruction procedures and craniotomy. Patients presenting with midface fractures after blunt trauma have a distinctly different pattern of injuries. One potential mechanism for this is a deceleration effect, where midface impact and resulting fractures dissipate some of the energy.
Collapse
|
48
|
Bhindi A, Carpineta L, Al Qassabi B, Waissbluth S, Ywakim R, Manoukian JJ, Nguyen LHP. Hearing loss in pediatric temporal bone fractures: Evaluating two radiographic classification systems as prognosticators. Int J Pediatr Otorhinolaryngol 2018; 109:158-163. [PMID: 29728172 DOI: 10.1016/j.ijporl.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Temporal bone fractures (TBF) are traditionally classified by their angle of fracture relative to the petrous ridge, and more recently by whether or not they violate the otic-capsule. This study compared rates of hearing loss (HL) and signs of otologic dysfunction among fracture types of both classification systems, within the pediatric population. METHODS Pediatric patients were retrospectively characterized from a previously identified cohort of TBF patients, diagnosed from 2000 to 2014. CT scans were reviewed and TBFs were classified first as longitudinal (L), transverse (T) or mixed (M), and then as otic-capsule sparing (OCS) or otic-capsule violating (OCV). Medical records were reviewed, and rates of HL and presenting signs were compared among L, T and M fractures, and OCS and OCV fractures. RESULTS Forty-three patients with 47 TBFs met the inclusion criteria. Eighteen, 4 and 25 TBFs were classified as L, T and M fractures, respectively. Thirty-three and 9 were classified as OCS, and OCV, respectively. Among 24 cases of HL: 20, 3, and 1 were conductive HL (CHL), sensorineural HL (SNHL) and mixed HL, respectively. Two cases of SNHL were found among OCV fractures, with none in OCS fractures (estimated difference 0.22; 95% confidence interval 0.01-0.60). Similar rates of CHL were found across L, T and M fractures (range 36-50%), and across OCV and OCS fractures (range 42-44%). Hemotympanum was the most common presenting sign, found in 68% of TBFs and 80% of CHL cases. There were no significant differences in the incidence of signs or symptoms between fracture types. CONCLUSIONS In our cohort, both the traditional and otic-capsule radiographic classification systems failed to predict the incidence of CHL and other otologic signs in the pediatric population. Though OCV fractures conferred an increased risk for developing SNHL, we found a lower incidence than anticipated given violation to the bony labyrinth.
Collapse
Affiliation(s)
- A Bhindi
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - L Carpineta
- Department of Pediatric Medical Imaging, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - B Al Qassabi
- Department of Pediatric Medical Imaging, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - S Waissbluth
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - R Ywakim
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - J J Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - L H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Center for Medical Education, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
49
|
Abstract
To investigate the incidence and pattern of child and adolescent (≤18 years old) traumatic fractures (TFs) as a result of collisions.We retrospectively reviewed 270 child and adolescent patients (228 males and 42 females aged 12.8 ± 5.1 years old) with TFs as a result of collisions admitted to our university-affiliated hospitals from 2001 to 2010. The incidence and patterns were summarized with respect to different age groups, sex, etiology, and whether the patient presented with nerve injury.The most common etiologies were struck by object (105, 38.9%) and wounded by person (74, 27.4%). The most common fracture sites were upper limb fractures (126, 46.7%) and craniofacial fractures (82, 30.4%). A total of 65 (24.1%) patients suffered a nerve injury. The frequency of early and late complications/associated injuries was 35.6% (n = 96) and 8.5% (n = 23), respectively. The mean age (P = .001) and frequency of wounded by person (P = .038) was significantly larger in male than in female patients. The frequency of earthquake injury (P < .001) and lower limb fractures (P = .002) was significantly larger in females than in male patients. The frequency of upper limb fracture was significantly higher in the wounded by machine group (83.3%) than in the other groups (all P < .05). The frequency of lower limb fractures was significantly higher in the earthquake injury group (64.7%) than in the other groups (all P < .05). The frequency of craniofacial fracture was significantly higher in the wounded by person group (54.1%) than in the other groups (all P < .05). The emergency admission rate (P = .047), frequency of wounded by person (P < .001), craniofacial fracture (P < .001), and early complications/associated injuries (P < .001) were significantly larger in patients with nerve injury than in other patients.Struck by object and upper limb fractures were the most common etiology and site, respectively. Wounded by person and craniofacial fractures were risk factors for nerve injury. Therefore, we should pay more attention to patients wounded by person, presenting with craniofacial fracture, to find whether there is nerve injury.
Collapse
Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
- State Key Laboratory of Materials Processing and Die and Mould Technology, Huazhong University of Science and Technology, Wuhan, Hubei
- State Key Laboratory of Trauma, Burn and Combined Injury, Third Military Medical University, Chongqing
| | - Huan Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou
| | - Song Zhang
- Department of Radiology, Xinqiao Hospital
| | | | | | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Lan Ou
- Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| |
Collapse
|
50
|
Castillo JC, DeLa'O CM, Goettler CE. Traumatic Bilateral Anterior Cerebral Artery Entrapment with Subsequent Cerebral Infarction. Am Surg 2018; 84:e165-e167. [PMID: 30454319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jed C Castillo
- Department of Surgery, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | | | | |
Collapse
|