A ten year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: Complications and treatment

Maxillofacial trauma is often associated with injuries to the cranium, especially in high-energy trauma. The management of such cases can be challenging and requires close cooperation between oral and maxillofacial surgery and neurosurgical teams. There are few reports in the current literature describing the complications that develop in patients with maxillofacial trauma and traumatic brain injury (TBI). Complications can be categorized as early or late and/or minor and major. The exact definition of complications and their categorization remains a matter of current debate. We present a 10 year retrospective study of complications and their subsequent management in patients receiving maxillofacial and neurosurgical treatment for maxillofacial trauma associated with TBI. The study population consisted of 47 people, excluded from a maxillofacial trauma population of 579 patients. The severity of the trauma was scored as mild, moderate or severe, using the Glasgow Coma Scale at presentation of the Emergency Department. In total 36 patients (76.6%) developed complications. Patients involved in road traffic collision were most likely to develop complications (92.3%). This was followed by falls (66.7%) as mechanism of the injury. Patients aged 60–69 years experienced the highest complication rate (5), followed by patients aged 20–29 years (4.1) and 30–39 years (3.5). The majority of complications were infection and inflammation (36.4%), followed by neurological deficit (24.0%), physiological dysregulation (11.6%) and facial bone deformity (8.3%). Patients who developed no complications, most often presented with mild TBI (72.7%).The most common treatment modality employed to manage complications was pharmacological, followed by antibiotic treatment, conservative treatment and decompression therapy. The mean hospital stay after the trauma for the patients with complications was 28 days. Thirteen patients (36.1%) were transferred to a rehabilitation centre, a nursing home, or a home for the elderly. Nine patients (25%) completely recovered from their complications and 4 patients (11.1%) died after the trauma. This report provides useful data concerning the rate and type of complications that occur, and the multidisciplinary treatment that is required in traumatic maxillofacial and brain injury patients.     

Surgical treatment of oral and facial soft tissue cystic lesions in children. A retrospective analysis of 60 consecutive cases with literature review

ObjectivesTo present the experience in the treatment of soft tissue cysts of the orofacial region in children treated at the Department of Oral and Maxillofacial Surgery at Children's Hospital “A. and P. Kyriakou”, Dental School, University of Athens.Study designThis is a retrospective study including 60 young individuals, 4 months to 14 years old. Surgical treatment was provided under general anaesthesia, during a 13-year period from 2000 to 2012.ResultsThe majority of cysts were mucoceles (n = 36, 60.0%), followed by ranulas (n = 15 or 25.0%), dermoid cysts (n = 4 or 6.6%), branchial cysts (n = 2 or 3.3%), thyroglossal duct cysts (n = 2, 3.3%) and one case of cystic hygroma (n = 1 or 1.6%). The primary method of treatment was enucleation and secondary marsupialization.ConclusionIt is very important to appreciate that although soft tissue cysts are benign lesions, some of them may grow to a large size and become a major threat, especially in developing orofacial regions in children. In addition, as some types of soft tissue cysts such as cystic hygroma show a tendency to recur, early examination and follow-up is required for the young population.     

Stability of class II subdivision malocclusion treatment with 3 and 4 premolar extractions

Background

The purpose of this study was to compare the occlusal stability of class II subdivision malocclusion treatment with 3 and 4 first premolar extractions. A sample of 156 dental casts from 52 patients with class II subdivision malocclusion was divided into two groups according to the extraction protocol. Group 1 comprised 24 patients treated with 3 premolar extractions and group 2 included 28 patients treated with 4 premolar extractions.

Methods

Peer assessment rating (PAR) indexes were measured on the dental casts obtained before (T1) and after treatment (T2) and at a mean of 6.9 years after the end of treatment (T3). The groups were matching regarding sex distribution, pretreatment, posttreatment and long-term posttreatment ages, and treatment and long-term posttreatment times. They were also comparable concerning the initial malocclusion severity and the occlusal results at the end of treatment. Stability evaluation was calculated by subtracting the posttreatment from the long-term posttreatment index values (T3 − T2). T tests were used to compare the amount and percentage of long-term posttreatment changes.

Results

There were no intergroup differences regarding the amount and percentage of long-term posttreatment changes.

Conclusion

Treatment of class II subdivision malocclusion with 3 and 4 premolar extractions have a similar long-term posttreatment occlusal stability.     

创伤患者急性创伤性凝血病的相关因素与救治措施分析

目的探讨创伤患者急性创伤性凝血病的相关因素与救治措施。方法对我院收治的120例创伤患者,回顾性分析其急性创伤性凝血病的相关因素以及救治措施。结果酸中毒组及非酸中毒组、休克组与非休克组、低体温组与非低体温组患者的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）以及凝血酶时间（TT）比较,差异有统计学意义（P〈0．05）。结论针对创伤患者急性创伤性凝血病的相关发病因素,采取对症措施防治疾病发生,可有效防止创伤性凝血病发生,提高患者生命质量,效果显著。     

42例节育器异位诊疗分析

目的：探讨宫内节育器异位的原因、诊断方法,分析IUD异位的危险因素、处理方法。方法回顾性分析42例节育器异位的临床资料。结果爱母环占61.90%（26/42）,O形环占28.57%（12/42）,T环形占4.76%（21/42）,吉妮环占4.76%（2/42）;爱母环发生异位的机率明显高于其它类型节育器;位于子宫肌层内30例,穿破浆膜层4例;子宫外异位：位于盆腔内6例,阔韧带后叶3例;爱母环的一条金属臂穿入乙状结肠1例,穿入宫旁1例,1例位于右上腹大网膜内,1例位于肠管表面。取器方式利用宫腔镜、腹腔镜、宫腹腔镜联合、膀胱镜及开腹等方式,均成功。有随访记录的14例占33.4%,其中,术后1＋月随访3例占7.1%,1年内随访者有12例占21.4%,3年内随访者2例占4.8%,无随访者28例占66.7%。节育环异位穿孔率无随访者高于有随访记录者。在节育器异位患者中,上环后有再次妊娠15例占35.7%。结论选择合适的节育器,适宜的安环时间可减少节育器异位的发生。充分术前评估,选择适宜的手术方式、及时、合理转换术式是取环成功的关键。     

管状胃和膈肌缝合预防食管癌切除术后胃排空障碍的效果分析

目的总结管状胃和膈肌缝合固定在预防经颈、胸、腹三切15食管癌切除术后胃排空障碍中的应用经验。方法回顾性分析我科2009年6月至2013年7月980例经颈、胸、腹三切口手术治疗食管癌患者,均行管状胃代食管手术。将患者分为两组：A组530例,未作特殊处理,其中食管上段癌63例,食管中段癌382例,食管下段癌85例;B组450例,将胃缝合固定于膈肌,其中食管上段癌43例,食管中段癌343例,食管下段癌64例。比较两组患者术后胃排空障碍的发生情况。结果A组患者均顺利完成手术,无患者死亡。B组与A组相比较,其术后胃排空障碍的发生率显著减少（P〈0．05）。结论在经颈、胸、腹三切口治疗食管癌手术中,通过将管状胃与膈肌缝合固定可以降低经颈、胸、腹三切口食管癌切除术后胃排空障碍的发生率。     

肾脏原发性恶性纤维组织细胞瘤2例诊治报告并文献复习

目的探讨肾脏原发性恶性纤维组织细胞瘤（malignant fibrous histiocytoma,MFH）的临床特点及治疗方法。方法总结我院2009年至2013年收治的2例肾脏MFH患者的临床资料,并结合文献进行讨论。2例患者分别以腰痛、血尿症状就诊,影像学均发现肾脏占位性病变,但缺乏特异性,均行手术治疗,术后病检确诊为肾脏MFH,术后均予辅助化疗。结果 1例随访26个月,1例随访14个月,均无肿瘤复发。结论肾脏MFH是罕见的恶性肾原发肿瘤,术前诊断困难,确诊主要依靠病理和免疫组化检查,根治性肾切除术是首选治疗方式,辅助治疗是否能改善患者预后还值得进一步探讨。     

成人肾母细胞瘤的诊断与治疗（附12例报告）

目的探讨成人肾母细胞瘤的诊断和治疗方法。方法回顾性分析12例成人肾母细胞瘤患者的临床资料。结果本组患者年龄16-63岁,表现为肉眼血尿2例,腰腹痛6例,4例为体检发现;术前诊断为肾肿瘤9例,肾盂肿瘤3例。12例均行手术治疗,术后病理均诊断为肾母细胞瘤。按照美国国家肾母细胞瘤研究组（NWTS）分期标准,本组分别为Ⅰ期5例、Ⅱ期3例、Ⅲ期3例、Ⅳ期1例。术后辅以放疗和化疗,平均随访41个月,3年生存率为48%。结论成人肾母细胞瘤是一种比较少见的恶性肿瘤,术前确诊困难,手术治疗并辅以放疗、化疗是其主要的治疗方法。