面中部骨折的16层CT诊断

目的:分析面中部骨折的CT影像表现,以提高临床诊断水平.材料和方法:回顾性分析65例经临床证实的面中部骨折的16层CT图像.图像后处理采用GE AW4.1,行多平面重建(MPR)、表面遮盖显示(SSD)及容积重建(VR).结果:16层CT图像显示了65例面中部骨折,其中上颌窦骨折占55.90%;眼眶骨折(不包括眶下壁)22.18%;颧骨颧弓骨折10.36%;鼻骨骨折5.54%;蝶骨翼突骨折6.02%.结论:面中部骨折的CT影像显示清晰,16层螺旋CT在诊断中有重要作用.     

陈旧性面中部骨折的治疗探讨

目的 探讨陈旧性面中部骨折的治疗方法及效果。方法回顾性分析我院2002年1月。2003年12月收治的93例陈旧性面中部骨折的临床资料，其中多数因初期治疗不当或不彻底，导致错位愈合及继发畸形。根据不同的骨折类型，采用不同的手术入路及治疗方法，可恢复颅面骨性轮廓结构。结果大多数患者获得了较大程度的外型和功能的改善，无严重并发症出现。结论对陈旧性面中部骨折选择恰当的治疗方法，对患者面中部功能及外形的恢复至关重要。     

头皮冠状切口联合局部小切口治疗面中部复杂骨折的应用体会

目的:探讨应用头皮冠状切口联合局部小切口治疗面中部骨折的方法及并发症的处理。方法:回顾性分析2005年—2010年我院收治的面中部复杂骨折患者经头皮冠状切口联合局部小切口切开复位微型钛板坚固内固定病例63例的临床资料。结果:63例患者创口均Ⅰ期愈合,8例术后出现咬合关系不良,经过理疗、调合后咬合关系恢复良好,颌面部外型及张口度正常,经治疗并随访均取得了较为满意的效果。结论:头皮冠状切口联合局部小切口治疗面中部骨折,术野暴露清楚,在直视下便于操作;切口隐蔽安全,不影响美观,微型钛板固定稳定,组织相容性好,是治疗面中部骨折的一种较理想的方法。     

LeFortⅠ型截骨术治疗陈旧性面中部骨折的临床研究

目的回顾性探讨面中部陈旧性骨折的手术治疗方法.方法统计我科2001年5月～2004年11月收治的43例面中部骨折的病例资料,对其中16例陈旧性面中部骨折用LeFort Ⅰ型截骨术治疗手术效果进行分析.结果 LeFort Ⅰ型截骨术治疗陈旧性面中部骨折均获得良好疗效,患者口腔咬合和面型恢复满意,无严重手术并发症.结论 LeFort Ⅰ型截骨术是治疗陈旧性面中部骨折的重要手术方法,术前应依照正颌外科原则进行X线头影测量和模型外科准备,术中应同期进行上颌骨骨折之外的其他面骨骨折的复位固定.     

38例面中部骨折的治疗

临床资料　 1995～ 1999年间收治12 7例颌面部外伤 ,其中面中部骨折 38例。对 38例面中部骨折患者采用经冠状切口或应用鼻根部、眼眶外侧、上颌前庭龈颊切口 ,暴露所有骨折部位 ,恢复颧骨的解剖位置 ,进行骨折复位 ,置微型夹板处于或平行于上颌骨力支柱方向作骨折内固定 ,保持面中部垂直高度、宽度及深度。已经恢复重建的上颌骨可作为骨折下颌骨恢复咬　关系基础 ,先行上、下颌间固定 ,恢复咬　关系 ,再行下颌骨骨折内固定。如下颌骨无骨折 ,则以下颌骨为基础 ,作上颌骨骨折复位、固定。术后半年、1年对患者进行随访、颜面部外形功能检查。…     

LeFortⅠ型截骨术治疗陈旧性面中部骨折的临床研究

目的 回顾性探讨面中部陈旧性骨折的手术治疗方法。方法 统计我科2001年5月～2004年11月收治的43例面中部骨折的病例资料，对其中16例陈旧性面中部骨折用LeFort I型截骨术治疗手术效果进行分析。结果 LeFort I型俄骨术治疗陈旧性面中部骨折均获得良好疗效，患者口腔咬合和面型恢复满意，无严重手术并发症。结论 LeFort I型截骨术是治疗陈旧性面中部骨折的重要手术方法，术前应依照正颌外科原则进行X线头影测量和模型外科准备，术中应同期进行上颌骨骨折之外的其他面骨骨折的复位固定。     

169例面中部复合骨折临床分类治疗探讨

目的 探讨面中部复合骨折三维立体结构上的分类法,以提高临床治疗水平.方法 收集169例面中部复合骨折病例,通过螺旋CT片检查,从三维立体结构角度将骨折分为A、B、C、D、E五型:A型:面中部复合骨折处无明显移位;B型:伴有眶外壁、眶下壁明显错位骨折;C型:伴有上颌骨明显错位骨折;D型:伴有鼻骨、眶内侧壁、上颌骨额突、筛...     

锁定钢板治疗肱骨多段骨折21例分析

肱骨多段骨折是一种高能量损伤所致骨折,近年来呈上升趋势。由于肱骨的解剖特点是：肱骨体上半部呈圆柱形,下半部呈三棱柱形,体中部前外侧呈“V”形粗面,这种复杂的解剖特点使得肱骨干多段骨折在临床上很难处理,普通钢板难做到良好的塑形．置于骨折端又要进行过多的组织分离。由于外科技术及内固定物的发展．近年来我科对肱骨干多段骨折采用锁定钢板（locking compression plate,LCP）固定,不但获得良好的固定效果,而且简化了手术步骤．现报道如下。     

半冠状切口结合坚强内固定在眶颧骨折治疗中的应用

眶颧骨折是面中部较复杂的骨折类型之一。受伤后局部水肿或血肿掩盖骨折移位畸形，常影响骨折的正确诊断和及时处理，致晚期眶颧骨塌陷畸形，造成二期处理困难。从解剖、功能和美观的原则出发，除少数骨折移位不明显，功能又无影响者外，均应开放复位。笔者采用半冠状切口结合坚强内固定(RIF)治疗眶颧骨折70例，取得满意的效果。报告如下。     

面中部复合骨折39例的临床治疗分析

目的　分析面中部复合骨折的病例特点 ,评价其临床治疗方法。方法　对 39例面中部复合骨折病人进行回顾性分析。结果　 39例病人有 2 9(74 .4 % )例于受伤后 5d内进行手术治疗 ,6 (15 .4 % )例进行二期手术治疗 ,4 (10 .3% )例进行保守治疗。结论　面中部复合骨折病人病情复杂 ,治疗效果受治疗时间、手术进路、治疗方法等多种因素影响 ,应综合考虑 ,及早实行坚固内固定。     

Temporal bone fractures.

High-resolution technique is essential to the evolution of temporal bone fractures. Axial and coronal scan planes are optimal but may not be possible in acutely traumatized patients. A knowledge of normal temporal bone anatomy is important and can be obtained from standard texts, so it will not be considered in detail in this article. Classically, petrous temporal bone fractures have been classified as longitudinal, transverse, or mixed. Recent publications have emphasized the importance of describing fractures in terms of planes rather than lines. According to this concept, most temporal bone fractures are actually oblique, and true longitudinal fractures are rare. Petrous temporal bone fractures may be associated with cranial nerve or vascular injuries when the fracture extends to the skull base. This is particularly true of the oblique fracture, which characteristically extends anteromedially to the skull base through weak places in that area, thus avoiding the compact bone of the otic capsule surrounding the labyrinth. The most common associated injury is to the facial nerve in its geniculate or proximal tympanic segment. Transverse fractures frequently involve the labyrinth. A careful search for various types of ossicular dislocation should be performed in association with temporal bone fractures, because this may result in conductive hearing loss. The site of cerebrospinal fluid otorhinorrhea resulting from temporal bone fractures can usually be defined on plain high-resolution temporal bone images, but intrathecal contrast may be helpful. Temporal bone fractures caused by gunshot wounds are frequently complex and may be limited by metallic streak artifacts. Pediatric patients have different proportions of facial nerve injury and types of hearing loss as compared with adults.     

Weapon identification using antemortem CT with 3D reconstruction,is it always possible? – A report in a case of facial blunt and sharp injuries using an ashtray

An interesting case of homicide involving the use of a heavy glass ashtray is described. The victim, a 81-years-old woman, has survived for few days and died in hospital. The external examination of the victim showed extensive blunt and sharp facial injuries and defense injuries on both the hands. The autopsy examination showed numerous tears on the face, as well as multiple fractures of the facial bones. Computer tomography scan, with 3D reconstruction, performed in hospital before death, was used to identify the weapon used for the crime. In recent years new diagnostics tools such as computer tomography has been widely used, especially in cases involving sharp and blunt forces. Computer tomography has proven to be very valuable in analyzing fractures of the cranial teca for forensic purpose, in particular antemortem computer tomography with 3D reconstruction is becoming an important tool in the process of weapon identification, thanks to the possibility to identify and make comparison between the shape of the object used to commit the crime, the injury and the objects found during the investigations. No previous reports on the use of this technique, for the weapon identification process, in cases of isolated facial fractures were described. We report a case in which, despite the correct use of this technique, it was not possible for the forensic pathologist to identify the weapon used to commit the crime. Authors wants to highlight the limits encountered in the use of computer tomography with 3D reconstruction as a tool for weapon identification when facial fractures occurred.     

重型口腔颌面部创伤的临床救治

目的通过520例口腔颌面部创伤病例的回顾性临床分析，探讨特殊类型重型颌面部损伤的救治方法。方法选取我科近21年口腔颌面部创伤住院患者病例资料，分析损伤类型、相应救治方法和临床疗效。通过4例典型病例，探讨颈部血管损伤、颅面多发伤、中面部骨折和面神经损伤的救治要点。结果全部患者无一例死亡，均获得良好疗效。结论颈动脉损伤应即刻修复，恢复大脑血供；颅面多发伤应在颅脑伤情稳定后，于伤后7—14d行颌面部骨损伤的确定性治疗；中面部骨折采用骨折开放复位、坚固内固定的手术方法可获更好的治疗效果；面神经损伤应尽可能在伤后30d内行神经修复手术。     

The spectrum of facial fractures in motor vehicle accidents: an MDCT study of 374 patients

Road traffic accidents are a major health problem worldwide resulting frequently in maxillofacial injuries. The purpose of the study was to assess the incidence and spectrum of facial fractures in patients involved in a motor vehicle accident (MVA). Using picture archiving and communication system, all requests for suspected facial trauma were retrieved during a 62-month period; 374 met the inclusion criteria. Two researchers interpreted the multidetector computed tomography images by consensus. The motor vehicles involved were divided into two groups: those involving a passenger car or a larger vehicle and those involving a motorized two-wheeler. Furthermore, the motor vehicle accidents were divided into collisions and run-off-road accidents. Of the 374 patients (aged 15–80, mean 34), 271 (72 %) were male and 103 (28 %) female. Of all patients, 262 (70 %) had a facial or skull base fracture; of these, multiple separate fractures were present in 56 %. Nasal fractures were the most common fractures followed by orbital, skull base, and maxillary fractures. Frontal bone, LeFort, and zygomatic arch fractures were always accompanied by other fractures. Fractures were more frequent in the group of collisions compared with run-off-road accidents. In the two-wheeled group, only 15 % did not have facial or skull base fractures. Fractures often occur in multitudes as 39 % of all patients have multiple facial or skull bone fractures, and thus, emergency radiologists should be familiar with the complexity of the injuries. Negative clear sinus sign and low-energy sentinel injuries should be trusted as indications of undetected injuries in MVA victims.     

The adherence to guidelines for facial radiography in an Accident & Emergency Department

OBJECTIVES: To evaluate the degree of adherence to guidelines for facial radiography. METHODS: A retrospective review of 1538 facial radiographs from a consecutive series of 414 patients attending the Accident & Emergency Department of the North Staffordshire Hospital with suspected facial injuries over a 6 month period was undertaken. Information on age, sex and aetiology of injury was recorded along with the type of view and total number of films taken. The results were compared with guidelines from the Department of Oral & Maxillofacial Surgery. RESULTS: Almost one-half of all injuries were due to assault. There was general adherence to the guidelines in terms of the number of films taken for mid-face and mandibular fractures. CONCLUSIONS: There was a good adherence to the guidelines in terms of the number of films taken for midface and mandibular fractures. However, a small number of patients were still being exposed to a high radiation dose where combinations of skull and facial views were taken. Guidelines need to be subjected to regular audit.     

Pattern of craniofacial injuries in patients admitted to Tanta University Hospital – Egypt

The goal of this work was to determine the craniofacial injury patterns in hospitalized patients to facilitate the awareness, by identifying, describing and quantifying trauma for use in planning and evaluation of preventive programs. Two-hundred and fifty five patients with craniofacial injuries were registered at the department of neurosurgery in Tanta University Hospital. Data were collected including age, gender, medical history, cause of injury and type of injury, location and frequency of soft tissue injuries, skull fractures, facial bone fractures, brain injuries and concomitant injuries, patient symptoms, clinical signs and the radiological findings. The most common causes of craniofacial injuries were road traffic accidents, followed by activity of daily life and assaults. Gender distribution showed that, males were at higher risk than females with a ratio of 5.5/1. In total of skull fractures, 47.84% were fissure fracture and 24.31% were depressed fractures. In total of brain injuries, 7.06% for concussion, 4.71% for contusion, 10.98% for brain laceration, 14.12% for pneumocephalus and 36.47% for brain edema. Regression analysis revealed increased risk for skull fractures and brain injuries in traffic accidents were 84.78%, 94.20%, respectively, and 59.14%, 50.54% in activity of daily life, but the probability of soft tissue injuries increase in traffic accident and violence.     

The importance of soft tissues in certain skeletal traumatic lesions

Soft tissue aspects of skeletal trauma are discussed according to two categories: (1) those injuries in which the significance of the soft tissue in the pathophysiology of the skeletal lesion is indicated by the characteristics of the skeletal injury (such as extension teardrop fracture, little leaguer's elbow, "baseball fracture," and Bennett's fracture); and (2) those injuries in which the associated soft tissue injury, or complication, may be reasonably inferred by the location and nature of the skeletal injury (such as major facial fractures, posterior sternoclavicular dislocations, fractures of the lower rib and lumbar transverse processes, and pelvic disruptions).     

Facial injuries in skiing. A retrospective study of 549 cases

In the last 2 decades, reports of skiing injuries have shown an increasing number of skiers with severe trauma. This article provides an account of a retrospective study of 549 patients with 1155 facial injuries sustained while skiing who received treatment at the Department of Oral and Maxillofacial Surgery at the University Hospital in Innsbruck, Austria between 1991 and 1996. The study was based on a questionnaire answered by the patients and on case report forms. Most of the patients were male (65.2%) and were aged between 3 and 81 years (average 28.4 years). A simple fall while skiing was the main type of accident (45.9%), followed by collisions with other people (23.5%). Injuries were classified into 1 of 3 groups: (i) lesions of the soft tissue (32.2% of all injuries); (ii) dentoalveolar traumas (24.3%); and (iii) fractures of facial bones (43.5%). Lacerations and haematomas were the most frequent lesions in patients with injuries to the soft tissues. The group of patients with dentoalveolar trauma mainly presented with fractures of tooth crowns. Fractures involving the mandible and the zygomatic bone were predominant in patients in the third group. Concomitant injuries mainly included injuries to the brain and skull fractures. Treatment was ambulatory, or by admission and surgery. We did not observe an increase in the number of skiing accidents causing facial injury in the last 5 years. Facial injuries represented 4% of all skiing injuries, a lower proportion than in other sports.