A Rare Case of Spontaneous Intrauterine Skull Fracture.

Skull fractures are rare in newborns and normally caused by maternal abdominal trauma or complicated deliveries. However, in rare cases, these fractures are found in neonates born after an uneventful pregnancy and delivery. We report a case of a primigravida who underwent cesarean delivery due to failure of descent and malpositioning of the fetal head. After birth, a right temporoparietal fracture and congenital muscular torticollis were diagnosed. The newborn's blood tests showed hypocalcemia and relative hypoparathyroidism. Both mother and newborn presented low vitamin D levels. Serial imaging control showed gradual resolution of the lesions, with the newborn being discharged at the 10th day of life with vitamin D supplementation. This is an interesting case because the combination of three conditions - maternal and fetal hypovitaminosis D, congenital torticollis and malposition of the cephalic pole during labor - may have synergistically contributed to a spontaneous intrauterine skull fracture.

As fraturas do crânio são raras em recém-nascidos, sendo mais comummente causadas por trauma abdominal ou como complicação do parto. Contudo, em casos mais raros, estas fraturas são encontradas isoladamente, sem associação a intercorrências da gravidez ou do parto. Apresentamos o caso de uma primigesta submetida a cesariana por ausência de descida da apresentação e mau posicionamento da mesma no canal de parto. Após o nascimento, foi diagnosticada fratura temporoparietal direita e torcicolo congénito. Analiticamente, o recém-nascido apresentava hipocalcemia e hipoparatiroidismo relativo. A díade mãe - recém-nascido apresentaram hipovitaminose D. Estudos imagiológicos seriados demonstraram resolução gradual das lesões, possibilitando a alta do recém-nascido ao 10º dia de vida com suplementação de vitamina D. Este caso é interessante porque se conjugam três condições ­ hipovitaminose D materna e fetal, torcicolo congénito e má orientação do polo cefálico ­ que, conjuntamente, podem ter contribuído para a ocorrência de fratura craniana intrauterina espontânea.

Projectile, blunt, or sharp force trauma? A facial lesion on a Bronze Age skull from Uglemose, Denmark.

This study presents and discusses the differential diagnosis of a unique case of facial trauma. The adult male skull was excavated in 1948 from Uglemose (Owl Bog) outside of Birket, on the island of Lolland (Denmark). Carbon-14 samples from an adult tibia excavated with the skull dates to the end of the Danish Bronze Age and transition period into the pre-Roman Iron Age. The skull shows a traumatic ante-mortem lesion to the left maxilla, directly below the orbit, that opens into the maxillary sinus. The left margin of the injury is slightly rounded and angled into the lesion while the right margin is pulled out from the lesion and has a much sharper border, suggesting a directional force from left to right. A previous assessment of the lesion suggested that projectile trauma caused the injury, but the lesion does not conclusively demonstrate features of projectile trauma. CT scans and 3D visualization of the skull show no evidence of structural changes to the maxillary sinus to support a conclusion of projectile trauma. Differential diagnosis through macroscopic and microscopic analysis of the lesion would suggest rapid blunt force or slow sharp force trauma as a potential etiology. The aim of this case study is to discuss the potential mechanisms of injury, including type of trauma as well as accidental versus intentional etiologies.

[Retrospective analysis of 2461 patients with maxillofacial fractures].

OBJECTIVE: To review the 2461 cases of maxillofacial fractures. METHODS: From 2003 to 2009, 2461 maxillofacial fracture cases were treated in Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine. Data regarding sex, age, cause of injury, occupation, geographic distribution, blood type, fracture site, multiple associated injuries, injury severity, the patient's first admitted department, treatment results were reviewed. RESULTS: The male and female ratio was 4.28:1, 1424(57.86 %) patients were between 20 and 40 years of age. The most common cause of injury was road traffic accident (938 cases, 40.98%). People in tertiary industry (900 cases, 78.53%) were most vulnerable to injuries. The zygomatic complex (22.08%), nasal bone (20.67%) and mandible (16.35%) were the most frequent fracture sites, which were often associated with skull (21.74%), brain (38.36%) and soft tissue contusion injury (48.84%). 85.98% (2116/2461 cases), of patients' AIS score was less than 2. Orthopaedics (939/2461 cases, 38.16%) was the first admitted department. CONCLUSIONS: The traffic accidents are the main cause of the maxillofacial fractures. Most injuries are found in the young and middle-aged people.

Bleeding from posterior superior alveolar artery in Le Fort I fracture.

This article describes a patient in whom significant oronasal bleeding developed after an injury to posterior superior alveolar artery of the maxillary artery in Le Fort I fracture.A 34-year-old man had a facial injury after an explosion of a furnace. Computed tomography demonstrated Le Fort I fracture, right open zygomatic tripod fracture, and open nasal bone fracture. Blood pressure, hemoglobin, and hematocrit levels had fallen to 110/60 mm Hg, 5.7 mg/dL, and 16.1%, respectively, 10 hours after injury despite continuous blood transfusion. Selective digital angiography confirmed an injury to the posterior superior alveolar artery, with extravasated pooling of contrast material in the maxillary sinus. The distal internal maxillary artery was embolized with n-butyl cyanoacrylate and lipiodol. Postembolization angiogram showed resolution of the contrast leak, and the patient's oronasal bleeding resolved.We suggest that if the oronasal bleeding continues in Le Fort fracture, bleeding from the posterior superior alveolar artery should be suspected. In case the vital sign is not stable, selective angiography should be performed before surgery.

Fracture of the coronoid and pterygoid processes by firearms: case report.

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

Fracture of the coronoid and pterygoid processes by firearms: case report

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

Um caso raro de fratura dos processos coronóide e pterigóide por arma de fogo é descrito. Paciente do sexo masculino, 28 anos de idade, foi atingido por projétil de arma de fogo na face, resultando em limitação na abertura da boca, dificuldade para mastigar e dor ao abrir a boca. Exame clínico revelou ferimento perfurante em região parotídea direita e ferida similar do lado esquerdo na mesma região. Tomografia computadorizada (TC) mostrou fratura cominutiva do processo coronóide esquerdo e fratura cominutiva bilateral dos processo pterigóides. O tratamento foi conservador, através de fonoterapia, obtendo-se sucesso. Uma descrição detalhada das características clínicas, radiológicas (TC com reconstrução 3D), tratamento e proservação do caso é apresentada.

Use of the vacuum extractor by midwives--what has changed in the last decade?

This article provides an update on use of vacuum extraction by certified nurse-midwives (CNMs) and certified midwives (CMs). Research findings from the last decade relevant to the training and use of vacuum extractors are reviewed along with professional guidelines and legal implications.

Nasal fractures--the details.

Due to the nose's prominent location and functional and cosmetic importance, nasal fractures present a challenge to the facial plastic surgeon to restore all things to normal. Although little groundbreaking news has been reported recently in the literature on nasal fractures, there is ample literature already in print on virtually every topic concerning nasal fractures. This article concentrates on the details of actually managing nasal fractures, with comments on present-day coding of posttraumatic septorhinoplasty.

Potato gun ocular injury.

PURPOSE: This study aimed to identify a dangerous new weapon capable of causing damage to the ocular and periocular regions. METHODS: The authors report two patients who had penetrating ocular injury in the past year because of homemade recreational potato guns. RESULTS: In one 14-year-old boy, projectiles from the firing of a potato gun resulted in orbital and cranial injuries that were life threatening with widespread fractures, marked disruption of facial structures, a cerebrospinal fluid fistula requiring bifrontal surgical repair, and loss of one eye. In a separate accident with a different potato gun, a 14-year-old boy who was wearing glasses at the time of injury had a sight-threatening perforating corneal laceration. CONCLUSION: Practitioners must be aware of the existence of these new, homemade unregulated devices. Information about the use and construction of these guns is widespread on the Internet, but no injuries resulting from these guns currently are documented in the medical literature.

A case of subdural hematoma and temporal bone fracture as complications of chiropractic manipulation.

We present a case of subdural hematoma and temporal bone fracture as a complication of chiropractic manipulation. Subdural hematoma in the elderly may follow insignificant, often forgotten, trauma and may develop slowly and progress. Our patient presented with a complaint of headache three days after forceful chiropractic manipulation, but denied any history of trauma. Computed tomography confirmed the presence of a subdural hematoma and a temporal bone fracture and the patient underwent successful surgical treatment. Our experience identifies a previously unreported mechanism of injury in patients with subdural hematoma presenting to the emergency department with a complaint of headache.