37例全面部骨折救治体会

目的:探讨全面部骨折的急诊处理和治疗方法。方法:对37例全面部骨折患者实施切开复位钛板坚强内固定+颌间或颅颌牵引,复位次序遵循"从固定到活动,从简单到复杂"的原则。结果:34例患者经治疗后均取得满意效果,咬合关系恢复良好,功能恢复正常,面形基本恢复正常。结论:全面部骨折通过面部小切口切开,按从固定到活动,从简单到复杂的复位固定顺序,辅以颌间结扎牵引进行固定,方便、可行,可取得良好效果。     

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提要： 全面部骨折特指面中1／3 和面下1／3 的骨骼同时发生的骨折。全面部骨折除有严重的局部损伤外,常伴发颅脑伤以及全身多个器官损伤,救治中不仅要考虑局部因素,更要涉及初期急救时系统损伤救治的相关问题。因此,初期救治中应遵循标准的急诊创伤处理ABCs法,首先救治危及生命的损伤,然后尽早实施专科确定性手术治疗。术前应有明确的影像学诊断,精确了解骨折部位、骨折段移位情况。遵循良好显露,直视下骨折复位,坚强内固定的手术原则。本文根据作者的临床经验,简要评述全面部骨折的治疗原则和方法要点。     

全面部骨折的诊治进展

全面部骨折主要指面中1／3和面下1／3骨骼同时发生的骨折。由于颌骨维持着面部的外形和轮廓，一旦发生全面部骨折，面部外形则遭到严重破坏，常伴发颅脑损伤且常合并胸腹脏器和四肢伤。因此，全面部骨折的诊治一直是颌面部创伤外科研究的重点和难点，其诊治原则及方法仍存在不少争议。本文就全面部骨折诊断和治疗的进展作一综述。     

The prosthetic rehabilitation of a panfacial fracture patient after reduction: A clinical report

Panfacial fractures involve trauma to the lower, middle, and upper facial bones and often require a team approach for management. Early and complete restoration of preinjury facial contours and function should be the goal of the oral and maxillofacial surgeon and the prosthodontist. When the intraoral landmarks are lost, overall facial anatomic landmarks can be used to restore the oral cavity. A patient with complex clinical panfacial fractures, including a vertically and horizontally malpositioned native alveolar bone and severe facial asymmetry, is presented. A functional and esthetic rehabilitation was successfully accomplished by using a partial removable dental prosthesis retained with telescopic crowns and magnetic attachments in the maxilla and osseointegrated implants to support a definitive dental prosthesis in the mandible.     

Superolateral dislocation of the intact mandibular condyle associated with panfacial fracture: a case report and literature review

Abstract – 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.     

Supraclavicular flap: reconstructive strategy for massive facial arteriovenous malformations

Arteriovenous malformations (AVMs) are uncommon errors of vascular morphogenesis. Hemodynamically, they are high-flow lesions. Approximately 50% of AVMs are located in the craniofacial region. The successful treatment of vascular anomalies depends on the profound knowledge of the biologic behavior of vascular lesions and their correct classification. Vascular malformations that persist lifelong require treatment in most cases, especially when clinical symptoms occur. On the basis of individual parameters such as the diameter, location, or growth behavior, different therapeutic options such as cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgical intervention, and/or embolization can be performed successfully. Subtotal excision or proximal ligation of the feeding vessel frequently results in rapid progression of the AVMs. Hence, the correct treatment consists of highly selective embolization (superselective) followed by complete resection 24 to 48 hours later. Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly fasciocutaneous flaps and skin grafts, to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. The supraclavicular flap has been used successfully for difficult facial reconstruction cases, providing acceptable results without using microsurgical techniques. We treated 2 patients with facial AVM by this method. Both of the lesions were located within the cheek and lip. There were no procedure-related complications, and the cosmetic results were excellent.     

Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures

Facial palsy is a severe condition that may be ameliorated by facial reanimation, but there is no consensus about how to judge its success. In this study we aimed to test a new method for assessing facial movements based on 3-dimensional analysis of the facial surfaces. Eleven patients aged between 42 and 77 years who had recently been affected by facial palsy (onset between 6 and 18 months) were treated by an operation based on triple innervation: the masseteric to temporofacial nerve branch, 30% of the hypoglossal fibres to the cervicofacial nerve branch, and the contralateral facial nerve through two cross-face sural nerve grafts. Each patient had five stereophotogrammetric scans: at rest, smiling on the healthy side (facial stimulus), biting (masseteric stimulus), moving the tongue (hypoglossal stimulus), and corner-of-the-mouth smile (Mona Lisa). Each scan was superimposed onto the facial model of the “rest” position, and the point-to-point root mean square (RMS) value was automatically calculated on both the paralysed and the healthy side, together with an index of asymmetry. One-way and two-way ANOVA tests, respectively, were applied to verify the significance of possible differences in the RMS and asymmetry index according to the type of stimulus (p = 0.0329) and side (p < 0.0001). RMS differed significantly according to side between the facial stimulus and the masseteric one on the paralysed side (p = 0.0316). Facial stimulus evoked the most asymmetrical movement, whereas the masseteric produced the most symmetrical expression. The method can be used for assessing facial movements after facial reanimation.     

Glenoid fossa fracture and facial nerve palsy

Facial nerve palsy associated with traumatic injury in the temporomandibular joint area is a rather infrequent condition. Fracture of the glenoid fossa is a very rare condition, especially when it is not combined with displacement of the condyle in the middle cranial fossa. We are reporting the combination of these 2 conditions in a victim of a road traffic accident.     

Isolated fracture of the first rib associated with facial trauma

Isolated fractures of the first rib are rare and often, though not always, indicative of severe trauma. The causes of first rib fracture are various, as are the sometimes serious complications of such a fracture. Since the oral and maxillofacial surgeon is involved many times in the primary care of the trauma patient, he must consider the possibility of first rib fracture and be alerted to the possible sequelae.     

Role of X-ray cephalometric analysis in planning reconstructive interventions in patients with combined maxillodental and facial abnormalities

A retrospective analysis of case histories of 110 patients subjected to reconstructive surgery for occlusion abnormalities was carried out. The data indicate that complete correspondence of teleroentgenography to planned treatment was observed in only 34.5% cases; this correspondence was partial in 48.3% cases, and in 17.2% patients planned treatment did not correspond to the pathogenesis of the abnormality at all. The majority of patients in whom the diagnosis was in complete disagreement with planned treatment were subjected to maxillary osteotomy for mesial occlusion. This choice was based on esthetic preferences of the patient and stability of the results.     

Severe symmetrical facial lipoatrophy in a patient with discoid lupus erythematosus

ABSTRACT: Acquired partial lipodystrophy is a rare disorder, and it is characterized by the absence of subcutaneous fat from the face, the neck, the trunk, and the upper extremities. The etiology of acquired partial lipodystrophy includes scleroderma and discoid lupus erythematosus. Literature review reveals studies involving 10 patients until today with lipoatrophy due to or after the onset of discoid lupus erythematosus; all are female patients. We want to report a young male patient with progressive symmetrical facial lipoatrophy. In addition, he has discoid lupus erythematosus and celiac disease. Fat grafting and adjuvant oral coenzyme Q10 tablets (Deka-none; Deka Pharmaceuticals, ?stanbul, Turkey) were administered for treatment. To our knowledge, this case involves the first male patient in the literature presenting with symmetrical facial lipoatrophy with very prominent periorbital lipoatrophy and bitemporal hollowing symptoms.     

Disease recurrence following reconstructive procedures: a 6- to 8-year follow-up observational study

PURPOSE: The aims of the present study were to determine (i) the long-term disease recurrence in intraosseous defects that had undergone an open flap debridement (OFD) procedure with or without enamel matrix derivative (EMD); and (ii) whether and to what extent clinical changes recorded on teeth treated with surgery were similar at sites involved or adjacent to the intraosseous defect. MATERIALS AND METHODS: Eleven patients contributing twelve reconstructed intraosseous defects were retrospectively recruited and included for analysis. Immediately before surgery, at 12 months post-surgery and at long-term examination (6-8 years post-surgery), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the test site (representative of the reconstructed intraosseous defect) and the control site (representative of an adjacent non-reconstructed site) of each tooth treated with surgery. RESULTS: All patients received monthly professional maintenance up to 12 months after surgery, and every 6 months or less frequently thereafter. In test sites, CAL varied from 5.4 +/- 0.8 mm at 12 months to 6.5 +/- 1.0 mm at the long-term examination. PPD increased from 3.7 +/- 0.4 mm at 12 months to 4.3 +/- 0.6 mm at the long-term examination, the changes being not statistically significant. When PPD and CAL changes from 12 months to the long-term examination were compared between test and control sites, no significant differences were found. CONCLUSIONS: Within its limitations and considering the limited sample size, the present study indicates that (i) the attachment gain that has been achieved by means of a surgical reconstructive procedure (based on OFD with/without EMD) may be mostly maintained over a 6-8 year follow-up period; and (ii) the extent of disease recurrence, as assessed by attachment loss and pocket deepening, was similar at sites involved or adjacent to the intraosseous defect.