AMAÇMaksillofasiyal kırığı bulunan hastalar, bu travmaya eşlik eden kafa travması geçirme konusunda yüksek risk altın-dadırlar. Bu hastalarda kafa travmasının erken anlaşılma-sı hastanın sağkalımı ve iyileşmesi için kritik öneme sahiptir. GEREÇ VE YÖNTEMOcak 2006 ile Eylül 2009 tarihleri arasında hastanemizin acil servisine maksillofasiyal kırık nedeniyle gönderilen 246 hastanın kayıtları geriye dönük olarak tarandı. Hastaların yaş, cinsiyet, maksillofasiyal travmanın nedeni, tipi, yerleşimi ve kafa travması analiz edildi. BULGULARHastaların yaşlarının ortalaması 23,61±16,75 idi (%83,3 erkek, %16,7 kadın). Kraniyal yaralanma maksillofasiyal travmalı 38 hastada gözlendi. Hastalar arasında tek yüz kemiği kırığı bulunanlarda kafa travması riski çoklu kırıklı hastalara göre 3,44 kat daha az gözlenirken (p<0,001), yüz kemiği çoklu kırılan hastalarda kafa travması geçirme riski anlamlı derecede artmıştı (p<0,001). İçinde nazal kemik, maksiller kemik, mandibular kemik ve frontal bölge kırığı bulunan hastalarda kafa travması riski önemli derecede artmıştı (p<0,05 her bir grupta). SONUÇÇoklu yüz kemik kırığı bulunan hastalarda klinik bulguları olmasa dahi kafa travması yönünden araştırılmaları gerekir.Anahtar Sözcükler: Maksillofasiyal travma; kafa travması; yüz kemik kırığı.

Purpose This is a descriptive analysis, of victims of Turkey's October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma.Methods We retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total Conclusions The results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

Transorbital intracranial injury is uncommon, representing 0.04% of penetrating head trauma with a high mortality rate. Orbital penetrating injuries may cause severe brain injury if the cranium is entered, typically via the orbital roof, the superior orbital fissure, or the optic canal. A 13-year-old male sustained a severe brain injury due to penetration of the right orbit with an iron bar. The bar entered the inferiomedial aspect of the orbit and emerged from the left occipital bone. Neurological examination revealed deep coma (GCS: E1M2V1) with fixed, dilated, and non-reactive pupils. The bar followed an intracranial trajectory, through the third ventricle and suprasellar cistern. The patient underwent an immediate exploration with removal of the bar. Unfortunately, he died 10 days postoperatively due to severe diencephalic injury with brainstem herniation. In this case report, we discuss the radiologic diagnosis and surgical management of transorbital orbitocranial injury by foreign body penetration.

AIm: Timing of shunt insertion in infants with myelomeningocele (MM) and hydrocephalus (HCP) has been debated. Many authors have suggested to perform the repair of MM and shunt insertion during same operation. However, there is also an opposite view. mAterIAl and methOds:We analyzed retrospectively 166 patients who underwent MM Sac repair to evaluate whether there are difference between these two methods in terms of shunt infection rate. results:In the same session, V-P (ventriculoperitoneal) shunt placement was performed onto 65 infants within the first 48 hours of postnatal and 36 infants were operated 48 hours after birth. In separate sessions, repair of MM were performed onto 29 infants within the first 48 hours of postnatal and shunting was peformed 7 days after sac repair. 14 infants were performed MM sac repair 48 hours after birth, then shunt was applied 7 days after closure of MM. Shunt infection rate in concurrently operated groups was markedly high (12.3 % in early surgery, 33.3% in late surgery); in separatedly operated groups' shunt infection rate was lower (3.44% in early surgery, 14.29% in late surgery). COnClusIOn:We propose to perform V-P shunt placement and MM repair in separate sessions. BulGulAr: Yaşamın ilk 48 saat içinde 65 infanta aynı seansda şant yerleştirilmesi ve myelomeningosel tamiri yapıldı ve doğumdan 48 saat sonra (3 ile 7 gün arasında) 36 infanta yine aynı seansda şant yerleştirilmesi ve kese tamiri yapıldı. Ayrıca yaşamın ilk 48 saat içinde 29 infanta myelomeningosel tamiri yapıldı ve ortalama 7 gün sonra ayrı bir seansda şant takıldı. 14 infanta myelomeningosel tamiri yapıldı doğumdan 48 saat sonra (doğumdan sonra 3 ile 7 gün arasında) ve kese tamirinde 7 gün sonra şant takıldı. Şant infeksiyon oranı aynı anda ameliyat edilen grupta belirgin olarak yüksekti (erken cerrahi yapılan grupta: %12.3, Geç cerrahi yapılan grupta: %33.3). Ayrı seanslarda ameliyat edilen grupta şant infeksiyon oranı düşüktü (erken cerrahi yapılan grupta: %3.44, geç cerrahi yapılan grupta: %14.29).sOnuÇ: Sonuç olarak biz ayrı seanslarda myelomeningosel kese tamiri ve şant yerleştirilmesini öneriyoruz.

Small meningomylocele defects can be closed primarily. Other repair techniques are required for closure of meningomyelocele defects of >5 cm. In this anomaly, in which random or musculocutaneous flaps are usually used, the technique for skin defect closure should have the following criteria: a safely harvested flap with good blood supply; minimal morbidity in the donor site; closure with adequate thickness to protect the underlying neural structure; and a repair to prevent leakage of cerebrospinal fluid. The dorsal intercostal artery perforator flap is a new perforator flap with a large skin island that can be used safely in the dorsal region. In this article, repair of large skin defects due to myelomeningocele has been attempted using a dorsal intercostal artery perforator flap, and the results are discussed.