These findings illustrate the need for prompt identification and proper management of the associated life-threatening injuries in facial fracture patients. Clinical assessment should begin with evaluation of cerebral trauma, followed by hemorrhagic shock, airway compromise, and hemopneumothorax. Proper management may require a multidisciplinary and coordinated team approach.
Involvement of the nasofrontal duct and persistence of cerebrospinal fluid leaks are two key determinants of the treatment algorithm. The amount of displacement of the posterior table has not been found to be a key determinant of the need for surgical intervention. When the sinus is to be obliterated, partial obliteration can achieve a good result, with limited sinus complication and minimal donor-site morbidity.
Functioning muscle transfer can be performed posttraumatically in lower limbs with composite soft-tissue and motor-unit defects, resulting in acceptable functional results and reliable limb salvage.
Traumatic superior orbital fissure syndrome is an uncommon complication of craniomaxillofacial trauma with an incidence of less than 1%. The syndrome is characterized by ophthalmoplegia, ptosis, proptosis of eye, dilation and fixation of the pupil, and anesthesia of the upper eyelid and forehead. This article describes a detailed anatomy of the superior orbital fissure as it related to pathophysiology and clinical findings. Etiology and diagnosis are established after detailed physical and radiographic examination. On the basis of our clinical experience in the management of superior orbital fissure syndrome and from the data reported previously in the literature, an algorithm for treatment of traumatic superior orbital fissure syndrome including use of steroid, surgical decompression of superior orbital fissure, and reduction of concomitant facial fracture is presented and its rationale discussed.
Cranial nerve IV suffered the least injury, whereas cranial nerve VI experienced the most neurologic deficits. Cranial nerve palsies improved to their final recovery endpoints by 6 months. Surgical decompression is considered when there is evidence of bony compression of the superior orbital fissure.
Free tissue transfer in pediatric patients is a viable and reliable option. Skin/musculocutaneous flaps and skin-grafted muscle flaps both had equal survival rates; however, flaps with a skin component required fewer secondary procedures to correct deformities. Whenever a skin component was present, it provided useful tissue during the secondary procedure and minimized complications. For plantar foot reconstructions, skin-grafted muscle flaps demonstrated a higher incidence of trophic ulcers and a higher need for resurfacing procedures than flaps with a skin component. Reconstructions of tendons in the immediate setting led to fewer secondary operations than staged tendon reconstructions.
This study showed that a protocol that promotes controlled bleeding from the fingertip is essential to achieve consistent high success rates in fingertip replantation. The protocol is safe and reliable, as it avoids the use of medical leeches and the removal of nail plate from the replanted finger. However, full informed patient consent must include the potential need for transfusion and extended hospital stay.
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