RESUMEN
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.
Asunto(s)
Traumatismos Craneocerebrales , Síndrome de Ehlers-Danlos , Fracturas Craneales , Masculino , Niño , Humanos , Preescolar , Fracturas Craneales/complicaciones , Fracturas Craneales/diagnóstico por imagen , Síndrome de Ehlers-Danlos/complicaciones , Síndrome de Ehlers-Danlos/cirugía , Traumatismos Craneocerebrales/complicaciones , Hueso Frontal/cirugíaRESUMEN
Panfacial fractures are considered the most aggressive and complex facial fracture, and most of them are the results of a high energy trauma. Therefore, a clinical report of a male patient with a panfacial fracture and Richards type 3 fracture resulting in an airway obstruction is presented. This type of fracture can promote an upper airway obstruction, which needs a correct and fast diagnosis to the life support of the patient.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Huesos Faciales/lesiones , Fracturas Múltiples/complicaciones , Fracturas Múltiples/cirugía , Fracturas Craneales/complicaciones , Obstrucción de las Vías Aéreas/cirugía , Humanos , Masculino , Fracturas Craneales/cirugía , Traqueostomía , Adulto JovenRESUMEN
Abstract The surgical management of firearm injuries to the zygomaticomaxillary complex is a topic that needs to be addressed with much care. The complications that can arise during treatment, as well as the potential residual problems that can appear, lead to the need of recognizing these injuries as a maxillofacial treatment challenge. The infraorbital zone is the second most common area of injury in the face, accounting for up to 45% of midfacial fractures. The case presented is of a 54 year old man affected by the backward firing of a gun rifle that caused an oblique impaction towards the posterior lateral inferior side of the infraorbital complex. He was rapidly stabilized with an antibiotic and analgesic scheme, yet presented the following: a comminute fracture of the orbit floor with consequent communication towards the maxillary sinus, a non-displacing fracture of the frontomalar suture, a non-displacing fracture of the zygomatic arch and a lesion with loss of osseous tissue in the petrous region of the temporal bone. Rigid fixation followed stabilization, and the area was covered with a titanium mesh. Occasional tinnitus and photopsia were reported by the patient upon return, yet all other evaluated factors were in order. There have been different forms of management described in the literature, and it is recognized that each patient has different needs, therefore each case must be closely evaluated, so it is approached in the most appropriate manner.
Resumen El manejo quirúrgico de las lesiones por armas de fuego al complejo cigomaticomaxilar representa una situación compleja en la práctica maxilofacial que debe ser abordada con extrema cautela, debido a las complicaciones que pueden surgir durante el tratamiento y los potenciales problemas residuales. La zona infraorbitaria es la segunda área más común de lesiones en la cara, representando hasta 45% de las fracturas mediocraneales. El presente caso es de un masculino de 54 años de edad, que sufrió trauma ocasionado por la parte trasera de un rifle de caza que causó un impacto en sentido oblicuo hacia el lado lateral inferior del complejo infraorbitario. El paciente fue estabilizado con esquema antibiótico y analgésico, el diagnóstico fue: fractura cominuta del piso de la órbita, con consecuente comunicación al seno maxilar, fractura no desplazada de la sutura frontomalar, fractura no desplazada del arco cigomático, y lesión con pérdida de tejido óseo en la región petrosa del hueso temporal. El tratamiento quirúrgico consistió en reducción de las fracturas y fijación rígida de las estructuras. Al control post operatorio el paciente refirió acufenos y fotopsia ocasional, no presentando otras alteraciones. Se ha descrito en la literatura diferentes abordajes para el manejo de estos traumatismos, sin embargo cada caso debe ser individualizado y evaluado de forma minuciosa para que éste, sea el adecuado.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fracturas Craneales/complicaciones , Heridas por Arma de Fuego/complicaciones , Cigoma/cirugía , Fracturas Mandibulares/complicacionesRESUMEN
OBJECTIVE: The aim of the study was to compare the traditional and newer temporal bone fracture classification systems and their reliability in predicting serious outcomes of hearing loss and facial nerve (FN) injury. METHODS: We queried the medical record database for hospital visits from 2002 to 2013 related to the search term temporal. A total of 1144 records were identified, and of these, 46 records with documented temporal bone fractures were reviewed for patient age, etiology and classification of the temporal bone fracture, FN examination, and hearing status. Of these records, radiology images were available for 38 patients and 40 fractures. RESULTS: Thirty-eight patients with accessible radiologic studies, aged 10 months to 16 years, were identified as having 40 temporal bone fractures for which the otolaryngology service was consulted. Twenty fractures (50.0%) were classified as longitudinal, 5 (12.5%) as transverse, and 15 (37.5%) as mixed. Using the otic capsule sparing (OCS)/violating nomenclature, 32 (80.0%) of fractures were classified as OCS, 2 (5.0%) otic capsule violating (OCV), and 6 (15.0%) could not be classified using this system. The otic capsule was involved in 1 (5%) of the longitudinal fractures, none of the transverse fractures, and 1 (6.7%) of the mixed fractures. Sensorineural hearing loss was found in only 2 fractures (5.0%) and conductive hearing loss (CHL) in 6 fractures (15.0%). Two fractures (5.0%) had ipsilateral facial palsy but no visualized fracture through the course of the FN canal. Neither the longitudinal/transverse/mixed nor OCS/OCV classifications were predictors of sensorineural hearing loss (SNHL), CHL, or FN involvement by Fisher exact statistical analysis (for SNHL: P = 0.37 vs 0.16; for CHL: P = 0.71 vs 0.33; for FN: P = 0.62 vs 0.94, respectively). CONCLUSIONS: In this large pediatric series, neither classification system of longitudinal/transverse/mixed nor OCS/OCV was predictive of SNHL, CHL, or FN palsy. A more robust database of audiologic results would be helpful in demonstrating this relationship.
Asunto(s)
Parálisis Facial/etiología , Pérdida Auditiva/etiología , Fracturas Craneales/clasificación , Hueso Temporal/lesiones , Adolescente , Niño , Preescolar , Bases de Datos Factuales , Femenino , Humanos , Lactante , Masculino , Reproducibilidad de los Resultados , Fracturas Craneales/complicacionesRESUMEN
Facial fractures are commonly managed nonoperatively. Patients with facial fractures involving sinus cavities commonly receive 7 to 10 days of prophylactic antibiotics, yet no literature exists to support or refute this practice. The aim of this study was to compare the administration and duration of antibiotic prophylaxis on the incidence of soft tissue infection in nonoperative facial fractures. A total number of 289 patients who were admitted to our level I trauma center with nonoperative facial fractures from the beginning of 2012 to the end of 2014 were studied. Patients were categorized into 3 groups: no antibiotic prophylaxis, short-term antibiotic prophylaxis (1-5 days), and long-term antibiotic prophylaxis (>5 days). The primary outcome was the incidence of facial soft tissue infection and Clostridium difficile colitis. Fifty patients received no antibiotic prophylaxis. Sixty-three patients completed a short course of antibiotic prophylaxis and 176 patients received long-term antibiotics. Ampicillin/sulbactam, amoxicillin/clavulanic acid, or a combination of both were used in 216 patients. Twenty-three patients received clindamycin due to penicillin allergy. Short and long courses of antibiotic prophylaxis were administered more commonly in patients with concomitant maxillary and orbital fractures (Pâ<0.0001). No mortality was found in any group. Soft tissue infection was not identified in any patient. C. difficile colitis was identified in 1 patient who had received a long course of antibiotic prophylaxis (Pâ=â0.7246). There was no difference in the outcome of patients receiving short-term, long-term, and no antibiotic prophylaxis. Prospective randomized studies are needed to provide further clinical recommendations.
Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica/estadística & datos numéricos , Traumatismos Faciales/complicaciones , Fracturas Craneales/complicaciones , Infecciones de los Tejidos Blandos/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones de los Tejidos Blandos/etiologíaRESUMEN
Describimos el caso de una paciente femenina de 5 años de edad, con antecedente de fractura craneal asociado a trauma directo en su segundo día de vida, posteriormente se diagnostica quistes porencefálico y aracnoideo frontoparietal izquierdo a los 3 meses de edad. Fue tratada en un primer momento con la colocación de sistema derivativo cistoperitoneal, y se le realizaron estudios de imágenes de seguimiento. A los 5 años de edad es traída a consulta de nuestro servicio de neurocirugía, por presentar deformidad calvarial en la superficie frontoparietal izquierda. El seguimiento con tomografía de cráneo demostró un cese relativo en la progresión en las dimensiones del quiste porencefálico y aumento del espacio entre los bordes óseos de la fractura. La paciente fue llevada a mesa operatoria, en la cual se realizó un abordaje hemicoronal izquierdo con resección de tejido gliótico, duroplastia con pericráneo y colocación de craneoplastía con tejido óseo craneal autólogo. El seguimiento al mes de la intervención correctiva mostró evolución satisfactoria y sin complicaciones. La cirugía correctiva de la fractura evolutiva, debe realizarse en el momento del diagnóstico para evitar su expansión. En concordancia con la teoría de Moss, se observa aumento del espacio entre los bordes de la fractura, aún con la disminución de la presión intracraneal al derivar el líquido cefalorraquídeo. En este caso, la intervención correctiva de la fractura, determinó una evolución satisfactoria, en ausencia de hidrocefalia o crisis convulsiva, posiblemente debida a la presión disminuida del quiste porencefálico sobre el parénquima subyacente.
We describe the case of a female patient of five years old, with a history of a skull fracture associated with direct trauma on his second day of life, then porencephalic left frontoparietal arachnoid cysts was diagnosed at 3 months of age. She was iniatially treated by plaing cystoeritoneal derivative system and follow-up imaging studies was performed. At 5 years of age is brought to clinic in our departmen of neurosurgery, for presenting calvarial deformity in the left frontoparietal area. The follow-p scan of the head showed a cease progression relative dimensions porencephalic cyst an increased space between the bone edges of the fracture. The patient was transferred to operating table, on which a hemicoronal left gliotico approach with resection of tissue was performed with dural graft placement craneoplasty bone tissue. Monitoring the month showed satisfactory corrective intervention and hassle evolution was performed with dural graft placement craneoplasty scalp and skull with autologous bone tissue. Corrective surgery of evolutionary fracture should be performed at the time of diagnosis to prevent its expansion. In agreement with the Moss theory, increasing the space between the edges of the fracture even with decreasing intracranial pressure deriving the cerebrospinal fluid was observed. In this case corrective intervention of the fracture produced a satisfactory outcome in the absence of hydrocephalus or seizure, possibly due to decreased pressure of porencephalic cyst on the underlying parenchyma.
Asunto(s)
Humanos , Femenino , Preescolar , Quistes Aracnoideos , Craneotomía/métodos , Derivación Ventriculoperitoneal/métodos , Duramadre/cirugía , Duramadre/lesiones , Fracturas Craneales/cirugía , Fracturas Craneales/complicaciones , Quistes Aracnoideos/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
A 9 year-old male sustained multiple maxillofacial fractures after falling from a two-store building. Frontal sinuses suffered a bilateral non-displaced linear fractures extending into the anterior and posterior walls. Magnetic resonance imaging (MRI) at this time showed a small encephalocele extending into the right frontal sinus. Operative repair was performed using an Endoscopic-Assisted Trephination approach.
Asunto(s)
Encefalocele/cirugía , Endoscopía/métodos , Seno Frontal/lesiones , Fracturas Craneales/cirugía , Trepanación/métodos , Accidentes por Caídas , Bioprótesis , Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/cirugía , Niño , Sordera/etiología , Lesión Axonal Difusa/etiología , Encefalocele/etiología , Adhesivo de Tejido de Fibrina/uso terapéutico , Seno Frontal/cirugía , Pérdida Auditiva Sensorineural/etiología , Humanos , Masculino , Meningitis/etiología , Fracturas Craneales/complicaciones , Mallas Quirúrgicas , TitanioRESUMEN
É bem estabelecido que o diagnóstico da fratura de côndilo occipital tem aumentado nas últimas décadas, provavelmente devido à disponibilidade e ao uso comum da tomografia computadorizada durante a investigação do trauma craniano, além da maior gravidade dos mecanismos de trauma. Por causa da baixa especificidade da apresentação clínica, e também pelo pouco conhecimento sobre o mecanismo de lesão, o diagnóstico desta condição é um desafio para neurocirurgiões. A abordagem terapêutica destes pacientes é baseada em estudos com baixa casuística e em relatos de caso. Uma revisão sobre este tema foi realizada a fim de discutir alguns aspectos controversos sobre o manejo da fratura de côndilo occipital. As fraturas de côndilo occipital são eventos raros, entretanto podem relacionar-se à alta morbidade em pacientes que sofreram trauma encefálico. Alguns sintomas, como intensa dor cervical, podem estar associados com esta fratura; portanto, paciente com suspeita de fratura de côndilo occipital deve ser submetido a investigação radiológica detalhada da região. O diagnóstico precoce desta fratura permite investigação apropriada, minimizando a chance de sequelas.
It is well established that diagnoses of occipital condyle fracture have increased in past decades, probably because of the availability and common use of computed tomography for investigating traumatic brain injuries, as well as themajor seriousness of trauma mechanism. Because of the low specificity of clinical presentation besides the lesion mechanism not well known, this condition is a diagnostic challenge for neurosurgeons. Therapeutic approaches of these patients are based on studies with low samples and case reports. A review of this theme was performed objecting to discuss some controversial topics about management of occipital condyle fracture. The occipital condyle fracture is a rare event, and it, however, could be related to high morbidity in patients who suffered traumatic brain injury. Some symptoms such as severe neck pain are related with this fracture, and thus patients suspicious of this fracture should undergo detailed radiologic investigation of this region. Early diagnosis of this fracture allows appropriate investigation, thus minimizing the risk of sequelae.
Asunto(s)
Humanos , Fracturas Craneales/complicaciones , Fracturas Craneales/diagnóstico , Traumatismos Craneocerebrales/complicaciones , Hueso Occipital/lesionesRESUMEN
Introducción: Las fracturas del tercio superior facial corresponden a una patología importante pero poco frecuente en la especialidad de cabeza, cuello y máxilo-facial, consecuencia de traumatismos severos; determinarlas por edad, sexo y agente causal ayudará para su manejo. Objetivos: Determinar la presentación de fracturas del tercio superior facial por edad, sexo, agente causal y clasificación. Diseño: Estudio observacional descriptivo. Lugar: Servicio de Cirugía de Cabeza, Cuello y Máxilo-Facial del Hospital Nacional Dos de Mayo, Lima-Perú. Participantes: Pacientes con fractura del tercio superior facial. Métodos: Recolección de datos registrados en las historias clínicas, entre junio 1999 y mayo 2009. Principales medidas de resultados: Edad, sexo, agente causal y clasificación. Resultados: Se encontró 49 pacientes, 90 por ciento de sexo masculino, 67,5 por ciento entre 21 y 40 años de edad, 55 por ciento por accidentes de tránsito y 23 por ciento por robos; 41 por ciento eran solamente fracturas del tercio superior y 59 por ciento acompañadas del tercio medio facial. Conclusiones: Las fracturas del tercio superior facial son importantes en la región de la cara. El diagnóstico clínico depende de la estructura afectada. Se debe actuar oportunamente para evitar secuelas y complicaciones. Los accidentes de tránsito y robos son causas que van en aumento. Se espera que este trabajo ayude a elaborar protocolos de atención en servicios de emergencia...
Introduction: Superior third facial fractures represent an important but rare pathology in the specialty of head, neck and maxillofacial surgery, and result from severe trauma. Objectives: To determine the presentation of superior third facial fractures by age, sex, causal agent and classification. Design: Observational descriptive study. Setting: Head, Neck and Maxillofacial Surgery Service, Dos de Mayo National Hospital, Lima, Peru. Participants: Patients with superior third facial fracture. Methods: Medical records data between June 1999 and May 2009 were captured. Main outcome measures: Age, sex, causing agent and classification. Results: Forty nine patients were included. Ninety per cent were male, about two thirds (67.5 per cent) were between 21 and 40 years old. More than half of the lesions (55 per cent) resulted from traffic accidents and 23 per cent from robberies; more than 40 per cent had superior third fractures only and 59 per cent were accompanied by midface fractures. Conclusions: Superior third facial fractures are important in the facial region. Clinical diagnosis depends on the affected structure. Treatment should be timely to prevent sequelae and complications. Traffic injuries and robberies are increasingly important causes. This study may contribute to developing treatment protocols in emergency services...
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Fracturas Craneales/complicaciones , Hueso Frontal/lesiones , Neurocirugia , Traumatismos Craneocerebrales , Estudios Observacionales como AsuntoAsunto(s)
Medicina de Emergencia/legislación & jurisprudencia , Mala Praxis , Nivel de Atención/legislación & jurisprudencia , Adulto , Preescolar , Resultado Fatal , Femenino , Síndrome Hemolítico-Urémico/complicaciones , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Masculino , Vacunas Neumococicas , Neumonía Neumocócica/complicaciones , Seudotumor Cerebral/diagnóstico , Fracturas Craneales/complicacionesRESUMEN
Introducción: Las fracturas son generalmente clasificados como simples (cerrada) o compuesta (abierta). En el caso de las fracturas de cráneo, pueden ser fracturas lineales, elevados, o triturado con la depresión. Fractura de cráneo compuesta rara vez se ha reportado en la literatura médica y cursa con una alta morbilidad y mortalidad. Los autores presentan seis casos de fracturas múltiples del cráneo, hablan sobre el tratamiento y pronóstico. Pacientes y métodos: Se analizaron seis casos de fractura compuesta del cráneo. Analizado por sexo, causa, localización, diagnóstico, tratamiento y pronóstico. Resultados: El sexo 5M / 1F. La edad media fue de 22 a. Las causas fueron: tres por agresión física, dos por accidente de coche y uno por explosión de neumático. Todos los pacientes fueron sometidos a TC. GCS medio al ingreso fue de 8. El tratamiento quirúrgico fue instituido en todos los casos. Tres pacientes desarrollaron infecciones (meningitis 2, empiema 1). Las secuelas fueron tres convulsiones, trastornos de la conducta 2. Hubo una muerte. Conclusión: La fractura compuesta del cráneo es rara y depende de la superficie del objeto y energía cinética. Las fracturas compuestas del cráneo con fragmentos de la depresión, son más frecuentes debido a la fuerza que se aplica hacia el cráneo. Su tratamiento inicial es quirúrgico y frecuentemente evoluciona con un mal pronóstico.
Introduction: Fractures are usually classified as simple (closed) or compound (open). In the case of skull fractures, they may be linear, high, or comminuted fracture with subsidence. The compound skull fracture has been rarely reported in medical literature and courses with high morbidity and mortality. The authors present six cases of compound fractures of the skull, discuss the treatment and prognosis. Patients and methods: We reviewed six cases of compound fracture of the skull. Analyzed according to gender, causes, location, diagnostic, treatment and prognosis. Results: The gender 5M / 1F. The mean age was 22 a. The two causes were physical aggression 3, car accident 2 and explosion of a tire 1. All patients underwent CT. Average score on ECG in admission 8. Surgical treatment was instituted all cases. Sequels were seizures 3 and behavioral disorders 2. There is one death. Conclusion: The compound fracture of the skull is rare and depends on the surface of blunt object and kinetic energy. The compound skull fractures with fragments of depression are more common, due to the force that is applied toward the skull. The initial treatment is surgical, and usually evolves with poor prognosis.
Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Femenino , Adulto Joven , Absceso Encefálico , Duramadre/lesiones , Empiema Subdural , Epilepsia Postraumática , Fractura Craneal Deprimida/etiología , Fracturas Craneales/cirugía , Fracturas Craneales/complicaciones , Fracturas Craneales/diagnóstico , Meningitis , Fractura Craneal Deprimida , Diagnóstico por ImagenRESUMEN
The aim of this retrospective research was to establish the association between variables for the surgical treatment of zygomatic complex (ZC) fractures. In a 10-year period, 532 patients were examined for ZC fractures. The medical records of patients were analyzed to obtain information related to sociodemographic characteristics, trauma etiology, sign and symptoms of patients, and surgical or nonsurgical treatment. Statistical analysis was performed using χ test with statistical significance of P < 0.05. Most fractures were sustained by subjects between 21 and 40 years of age (55.8%), being principally men (80.1%), and 153 patients underwent surgery (28.8%). Surgical treatment of ZC fractures was statistically associated to the presence of other facial fractures (P = 0.004), alteration of occlusion (P = 0.0001; probably due to jaw fractures), presence of the comminuted fractures (P = 0.0002), and infraorbital nerve sensory disturbances (P = 0.003). A mixture of complex variables can be associated to surgical treatment; however, variables as comminuted fracture and alteration of occlusion were associated to surgical treatment indications.
Asunto(s)
Fracturas Cigomáticas/cirugía , Accidentes por Caídas , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Huesos Faciales/lesiones , Femenino , Estudios de Seguimiento , Fracturas Conminutas/complicaciones , Humanos , Lactante , Luxaciones Articulares/complicaciones , Masculino , Maloclusión/complicaciones , Traumatismos Maxilofaciales/complicaciones , Persona de Mediana Edad , Órbita/inervación , Estudios Retrospectivos , Trastornos de la Sensación/complicaciones , Factores Sexuales , Fracturas Craneales/complicaciones , Violencia , Adulto Joven , Fracturas Cigomáticas/terapiaRESUMEN
There have been limited reports on machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial injuries from machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated head injuries from machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow Coma Score < 8 at any point during admission; compound skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial bleeding; parenchymal contusions; lacerations and/or oedema. The data were analysed using the SPSS version 12.0. Of the 40 patients with complex injuries to the cranium, there was a 6:1 male preponderance with a mean age of 32.5 ± 13.7 years (Mean ± SD). The injuries included open skull fractures in all the 40 (100%) patients, depressed skull fractures in 20 (50%) patients, CSF leaks in 4 (10%) patients, protruding brain matter in 4 (10%) patients, cerebral contusions in 3 (7.5%) patients and extra cranial injuries in 16 (40%) patients. Tetanus prophylaxis and intravenous antibiotics were administered to all patients, and phenytoin was required in 16 (40%) cases. There were 37 (92%) patients requiring operative intervention at a mean of 10.4 h after presentation (SD ± 18.1; Median 6). The operative procedures included elevation of depressed fractures in 20 (54.1%) patients, dural repair in 10 (27.0%) patients and intra-cranial debridement in 7 (18.9%) patients. There were three deaths (7.5%), and seizures were recorded in 5 (12.5%) cases with no reports of infectious morbidity. Eighty percent of patients had a normal Glasgow outcome score on discharge. Complicated machete head trauma is uncommon at this health care facility in Jamaica. We achieved a satisfactory outcome with aggressive management consisting of prompt assessment of the extent of injury, appropriate antibiotics, anticonvulsants for those with seizures or cortical injury and early operation to decrease the risk of complications.
Asunto(s)
Hospitales/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Fracturas Craneales/complicaciones , Armas , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Pérdida de Líquido Cefalorraquídeo , Rinorrea de Líquido Cefalorraquídeo , Niño , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/epidemiología , Femenino , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Fenitoína/uso terapéutico , Radiografía , Fracturas Craneales/diagnóstico por imagen , Fracturas Craneales/cirugía , Tétanos/prevención & control , Adulto JovenRESUMEN
Superolateral dislocation of the intact mandibular condyle (SDIMC) is rare. This case report focuses on a 15-year-old teenager who was involved in a motor vehicle accident as well a literature review regarding the SDIMC. Clinical examination demonstrated a diffuse edema in the midfacial area and a left lateral deflection of the mandible, including an open bite and a crepitation in the symphyseal region. Three-dimensional computed tomography scans were taken, which presented a superolateral dislocation of the left mandibular condyle as well as panfacial fracture. The patient was set in intermaxillary fixation for 2 weeks and underwent subsequent active jaw physiotherapy, the evaluation of which presented satisfactory results. This case study also presents a literature review, which demonstrated 21 well-documented cases of SDIMC. The patients' mean age was of 29 years. The male gender proved to be more prevalent, with road traffic collisions representing the most common form of accident. Type II, with unilateral dislocation, proved to be the most common. The mean reduction time was 7 days. The open methods were the most commonly used reduction methods. Mandible fracture was associated with dislocation in 82% of the cases, with other facial fractures appearing in only 23% of the cases. Patient follow up presented satisfactory results in 59% of the cases.
Asunto(s)
Huesos Faciales/lesiones , Luxaciones Articulares/etiología , Cóndilo Mandibular/lesiones , Fracturas Craneales/complicaciones , Adolescente , Hueso Etmoides/lesiones , Terapia por Ejercicio , Femenino , Estudios de Seguimiento , Humanos , Imagenología Tridimensional/métodos , Técnicas de Fijación de Maxilares , Fracturas Mandibulares/complicaciones , Fracturas Maxilares/complicaciones , Hueso Nasal/lesiones , Fracturas Orbitales/complicaciones , Tomografía Computarizada por Rayos X/métodos , Fracturas Cigomáticas/complicacionesRESUMEN
Vascular complications after head and neck surgical procedures are rare but can life-threatening. A pseudoaneurysm may appear weeks or months after the initial injury and may be difficult to diagnose. The authors report the case of a 43-year-old man involved in a motor vehicle accident presenting with multiple facial fractures, which after surgical treatment presented episodes of bleeding. After an angiography was performed, a pseudoaneurysm of the facial artery was detected. The patient later underwent endovascular embolization and had a satisfactory resolution.
Asunto(s)
Aneurisma Falso/etiología , Cara/irrigación sanguínea , Hemorragia Posoperatoria/etiología , Fracturas Craneales/complicaciones , Adulto , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Angiografía , Arterias/lesiones , Embolización Terapéutica/métodos , Enbucrilato/uso terapéutico , Huesos Faciales/lesiones , Humanos , Masculino , Hemorragia Posoperatoria/terapiaRESUMEN
We report a case of orbital emphysema secondary to ethmoidal fracture after minimal trauma as differential diagnosis of orbital cellulitis not reported before in children. An 8 year-old girl with diagnosis of orbital cellulitis was remitted for admittance, IV antibiotics and evaluation by an ophthalmologist. However, further evaluation led to a diagnosis of ethmoidal lamina papyracea fracture. Patient showed complete resolution in 4 days with outpatient treatment. Once again, this case corroborates that meticulous history taking and physical examination are irreplaceable for decision making.
Asunto(s)
Hueso Etmoides/lesiones , Enfermedades de los Párpados/etiología , Celulitis Orbitaria/diagnóstico , Fracturas Craneales/complicaciones , Fracturas Craneales/diagnóstico , Enfisema Subcutáneo/etiología , Niño , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
BACKGROUND: treatment of frontal sinus fractures remains controversial. If the posterior wall is fractured and there is cerebrospinal fluid leak, treatment seeks to restore the integrity of the dura and isolate the intracranial contents through the obliteration of the nasofrontal duct and cranialization. Another group supports nonoperative management CSF leakage is produced. The purpose is to avoid complications of meningitis, fistula and late sequelae. The difficulty lies in predicting which patients will develop complications. The aim of this study is to identify complications in patients with posterior wall fracture of the frontal sinus treated nonsurgically. METHODS: an observational, cross-sectional, retrospective study was conducted with 20 patients with posterior wall fractures of the frontal sinus treated nonsurgically at the Hospital de Traumatología y Ortopedia Lomas Verdes, Service of Maxillofacial Surgery from January 2007 to October 2009. RESULTS: twenty patients with posterior wall fractures of the frontal sinus were included. There were 17 males and 3 females. Fractures were divided into groups according to their degree of movement and presence of cerebrospinal fluid fistula. Postoperative complications were cerebrospinal fluid fistula and frontal abscess. CONCLUSIONS: nonsurgical treatment has proven to be an option, although not free from complications, the most common being CSF fistula and abscess. Future comparative studies should be carried out to define therapeutic strategies usibg clinical monitoring and long-term imaging.
Asunto(s)
Hueso Frontal/lesiones , Fracturas Craneales/complicaciones , Fracturas Craneales/terapia , Adolescente , Adulto , Anciano , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Pneumolabyrinth is a condition in which air is present in the vestibule and/or in the cochlea. Air inside the inner ear structures is uncommon, and is not detected even in otic capsule-violating fractures or in transverse fractures of the temporal bone. It is rarely described in the literature. We present a longitudinal computed tomography (CT) study of a significant pneumolabyrinth due to temporal bone trauma in a 31-year-old man. Routine CT of the cranium performed 3 hours after the accident showed air inside the vestibule (pneumolabyrinth). Two days later, a new CT study was performed. The air in the vestibule was partially resorbed. There was opacity over the oval window niche and the promontory. Thirteen months after the initial head trauma, another CT examination showed a fracture line running from the vestibule to the posterior wall of the petrous bone. The patient had profound sensorineural hearing loss after the trauma, and the pneumolabyrinth cleared over a few months. Surgical treatment was not indicated.
Asunto(s)
Enfermedades del Laberinto/diagnóstico por imagen , Fracturas Craneales/complicaciones , Hueso Temporal/lesiones , Tomografía Computarizada por Rayos X , Vestíbulo del Laberinto , Adulto , Aire , Humanos , Enfermedades del Laberinto/etiología , Estudios Longitudinales , MasculinoRESUMEN
OBJECTIVE: We studied the angiographic findings in patients with small epidural hematomas and cranial fractures crossing over the trajectory of the middle meningeal artery and its branches. Additionally, the occurrence of traumatic vascular lesions and their clinical relevance and treatment are discussed. METHODS: A consecutive analysis was performed for 24 patients who harbored small epidural hematomas in middle meningeal artery topography associated with cranial fractures. Computed tomographic scans and plain x-ray studies were used to diagnose linear cranial fractures. Patients with large epidural hematomas or associated traumatic lesions were excluded from the study. Selective ipsilateral external carotid angiograms were obtained, and an endovascular procedure was performed if any vascular injury was evidenced. RESULTS: In all patients with cranial fractures crossing over the middle meningeal artery and its branches, some kind of vascular lesion was seen. Two types of findings were noted: active extravasation of the contrast medium (71%) and pseudoaneurysms (29%). Early filling of diploic vessels was found in 8.3% of fractures concomitantly with active extravasation. Embolization was performed in all patients. No additional enlargement of the epidural hematoma was observed, and the postoperative period was uneventful. CONCLUSION: This study shows that pseudoaneurysms and active extravasation of contrast are common findings in this subset of patients. Although the natural history of these lesions is still poorly understood, additional investigation with ipsilateral external carotid angiography may be recommended, considering the potentially catastrophic consequences of late rupture.