ABSTRACT
OBJECTIVES: To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications. METHODS: A retrospective study was carried out in King Saud Medical City, Riyadh, Saudi Arabia. The study analyzed the records of patients who were diagnosed and treated with FSF from 2011-2021. Files with missing documents or incomplete treatment were excluded. The retrieved data includes: patients age, gender, types, locations, treatment, and complications of FSF. Data was analyzed by the statistical Package for the Social Sciences Statistics, version 23.0 using descriptive statistics and Chi-square test. RESULTS: A total of 72 cases were included, 94.4% males and 5.6% females. Road traffic accidents were the common cause of trauma (91%). Frontal sinus fractures were unilateral in 59.7% and associated other injuries in 80.6% of cases. Anterior table fractures were the largest proportion (58.3%), followed by anterior and posterior table (37.5%). The carried out surgical procedures were obliteration (23.9%), cranialization and obliteration (23.9%), and fixation only (52.2%). The post-operative complications were categorized into; neurological (22.2%), ophthalmic (15.3%), infection (2.8%), and deformity (16.7%). Anterior and posterior table had the highest percentage among these categories. CONCLUSION: Frontal sinus fractures were mostly required surgical treatment (63.9%) and post-operative complications occurred especially the neurological and ophthalmic. We recommend studies on the association of complications and different types of obliteration materials.
Subject(s)
Accidents, Traffic , Frontal Sinus , Skull Fractures , Tertiary Care Centers , Humans , Saudi Arabia/epidemiology , Male , Retrospective Studies , Female , Frontal Sinus/injuries , Frontal Sinus/surgery , Adult , Skull Fractures/epidemiology , Skull Fractures/therapy , Skull Fractures/surgery , Middle Aged , Accidents, Traffic/statistics & numerical data , Incidence , Tertiary Care Centers/statistics & numerical data , Young Adult , Adolescent , Postoperative Complications/epidemiology , Aged , ChildABSTRACT
Midface fractures present a clinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides a radiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires a multidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.
Subject(s)
Skull Fractures , Humans , Skull Fractures/diagnostic imaging , Skull Fractures/surgery , Skull Fractures/therapy , Skull Fractures/diagnosis , Facial Bones/injuries , Facial Bones/diagnostic imaging , Facial Bones/surgery , Treatment Outcome , Evidence-Based Medicine , Plastic Surgery Procedures/methods , Fracture Fixation, Internal/methodsABSTRACT
PURPOSE OF REVIEW: To present the current literature on management of facial nerve disorder secondary to trauma, with a focus on the utility of electrodiagnostic testing in this setting. RECENT FINDINGS: Patients with facial palsy related to temporal bone fractures should be started on high-dose corticosteroids as early as possible. Recent literature on the benefit of surgical intervention in the setting of temporal bone fracture is mixed. Some studies support early surgical decompression whereas others have found no benefit compared with conservative treatment. SUMMARY: The management of facial nerve trauma is based on location and extent of injury. Extratemporal trauma and transected nerve should be treated with surgical exploration and tension-free coaptation ideally within 72âh. There are no guidelines for intratemporal facial nerve trauma. Surgical decompression compared with medical management is debated in the literature without consensus and more large studies are needed.
Subject(s)
Facial Nerve Injuries , Humans , Facial Nerve Injuries/therapy , Facial Nerve Injuries/etiology , Facial Nerve Injuries/complications , Decompression, Surgical/methods , Facial Paralysis/therapy , Facial Paralysis/etiology , Temporal Bone/injuries , Skull Fractures/complications , Skull Fractures/surgery , Skull Fractures/therapy , ElectrodiagnosisABSTRACT
OBJECTIVE: To discuss patient demographics and management and better understand the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center. STUDY DESIGN: Retrospective chart review. METHODS: We identified 5088 facial fractures in 2479 patients who presented from 2008 to 2022. Patient demographics, mechanism of injury, associated injuries, treatment information, and hospital charges were collected and analyzed to determine factors associated with surgical management and increased cost burden. RESULTS: Our 14-year experience identified 1628 males and 851 females with a mean age of 45.7 years. Orbital fractures were most common (41.2%), followed by maxilla fractures (20.8%). The most common mechanism was fall (43.0%). Surgical management was recommended for 41% of patients. The odds of surgical management was significantly lower in female patients, patients age 65 and older, and patients who presented after the onset of the COVID-19 pandemic. The odds of surgical management was significantly higher for patients who had a mandible fracture or greater than 1 fracture. The average cost of management was highest for naso-orbito-ethmoidal fractures ($37,997.74 ± 52,850.88), followed by LeFort and frontal fractures ($29.814.41 ± 42,155.73 and $27,613.44 ± 39.178.53, respectively). The highest contributor to the total average cost of management was intensive care unit-related costs for every fracture type, except for mandible fractures for which the highest contributor was operating room (OR)-related costs. CONCLUSIONS: This study represents one of the largest comprehensive databases of facial fractures and one of the first to provide a descriptive cost analysis of facial trauma management. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3120-3126, 2024.
Subject(s)
Skull Fractures , Humans , Male , Female , Retrospective Studies , Middle Aged , Skull Fractures/economics , Skull Fractures/surgery , Skull Fractures/epidemiology , Skull Fractures/therapy , Adult , Aged , Facial Bones/injuries , Facial Bones/surgery , Adolescent , COVID-19/epidemiology , COVID-19/economics , Trauma Centers/economics , Trauma Centers/statistics & numerical data , Cost of Illness , Young Adult , Orbital Fractures/economics , Orbital Fractures/surgery , Orbital Fractures/epidemiology , Health Care Costs/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Skull Fractures/congenital , Skull Fractures/surgery , Skull Fractures/therapy , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/therapy , Tomography, X-Ray Computed/instrumentation , Tomography, X-Ray Computed/methods , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Female , Humans , Infant, Newborn , Male , Skull Fracture, Depressed/diagnosis , Skull Fractures , Skull Fractures/therapy , Tomography, X-Ray Computed , Congenital Abnormalities , Craniotomy , Extraction, Obstetrical/adverse effectsABSTRACT
Occipital condyle fractures (OCF) had been difficult to diagnose, but the widespread use of computed tomography (CT) as a diagnostic tool in patients with significant cranio-cervical injury has led to increased recognition of this injury. The incidence of OCF in severely injured blunt trauma patients is estimated at 0.1 - 4.4 percent and as high as 16 percent overall when less severely injured patients are included. OCFs are important because they may be associated with instability of the occipito-atlanto-axial joint complex and there is wide variability in the clinical presentation of individuals with an OCF. This cranio-cervical injury may result in increased morbidity associated with long-term cranio-cervical pain and reduced neck mobility. Patient outcomes tend to reflect the severity of additional injuries rather than independent OCF pathology. We described three OCF cases with severe traumatic brain injury, treated without surgery with favorable outcome and we performed a literature review.
Subject(s)
Humans , Male , Adult , Middle Aged , Skull Fractures , Skull Fractures/therapy , Occipital Bone , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
A fratura de côndilos occipitais é uma afecção considerada rara, mas que pode estar sendo subdiagnosticada. Fatores como a apresentação clínica variável, o exame físico frustro e a não identificação por radiografia simples dificultam esse diagnóstico, podendo levar a complicações como paralisia de nervos cranianos caudais e até mesmo a óbito. O presente estudo tem como objetivo revisar a literatura pertinente às fraturas de côndilos occipitais, com enfoque nas considerações anatômicas da junção craniocervical e ressaltando aspectos fisiopatológicos, parâmetros clínicos e as controvérsiasquanto ao tratamento. O incremento das técnicas radiológicas e a maior disponibilidade e uso de tomografia computadorizada possibilitaram o aumento do número de casos descritos dessas fraturas nas últimas décadas. A apresentação clínica é inespecífica e a tomografia da junção craniocervical é o método diagnóstico de escolha. A ausência de diagnóstico é responsável por sequelas, como déficits neurológicos, e foram descritas taxas de mortalidade de até 16% em casos de fraturas bilaterais. Omecanismo de injúria exato não é bem conhecido, mas a maioria dos autores indica a hiperextensão do pescoço associada à força vertical sobre a junção craniocervical. O tratamento é controverso, por causa da inconsistência nos resultados obtidos com o tratamento conservador baseado na classificação de Anderson e Montesano, em comparação com o escasso número de doentes tratados cirurgicamente.
The occipital condyle fractures are rare lesions, but they may have been under-diagnosed. Factors such as variable clinical presentation, inconclusive physical examination and no identification in the simple radiography difficult the diagnosis and may lead to complications such as paralysis of cranial nerves and death. This study aims to review the literature about occipital condyle fractures, emphasizing the anatomical considerations of the craniovertebral junction, pathophysiological view, clinical presentationand controversies regarding treatment. The improvement in radiological techniques and the increased availability and usage of computed tomography allowed the growth of reported cases of these fracturesin recent decades. The clinical presentation is nonspecific and CT of the craniocervical junction is the diagnostic method of choice. The absence of a diagnosis is responsible for sequel, such as neurologic deficits, and as mortality rates are of up to 16% in cases of bilateral fractures. The exact mechanism of injury is not well known, but most authors indicate the hyperextension of the neck associated with the vertical force on the craniocervical junction. The treatment is controversial due to the inconsistencies in the results obtained with conservative treatment based on the classification of Anderson and Montesano, compared to the small number of patients treated surgically.
Subject(s)
Atlanto-Occipital Joint/anatomy & histology , Skull Fractures/therapy , Skull Fractures/epidemiology , Skull Fractures/diagnostic imaging , Cervical Vertebrae/injuries , Occipital Bone/injuriesABSTRACT
No tratamento do paciente politraumatizado a atuação de uma equipe multidisciplinar é decisiva para o sucesso do tratamento. As fraturas do seio frontal são originadas a partir de acidentes de grande intensidade. Várias modalidades de tratmaneto têm sido descritas...
Subject(s)
Humans , Male , Adult , Skull Fractures/therapy , Frontal Bone/surgery , Frontal Bone/injuries , Frontal Sinus/surgery , Frontal Sinus/injuriesABSTRACT
Introdução: O aumento dos acidentes e da violência no Brasil tem repercutido na organização do sistema de saúde, o qual, por sua responsabilidade na atenção ao trauma, vem tendo seus gastos elevados. Objetivo: Realizar levantamento epidemiológico das internações decorrentes das fraturas do crânio e dos ossos da face, avaliando os gastos do Sistema Único de Saúde com as internações na região Nordeste por um de período de dez anos. Métodos: Estudo de série temporal com dados do Sistema de Informações Hospitalares. Foram selecionadas as internações cujo diagnóstico fazia parte do capitulo XIX da Classificação Internacional das Doenças e a sua distribuição segundo: sexo, faixa etária, Unidade Federativa, valor médio, permanência média e ano de internação. Resultados: Foram encontrados 67.086 registros de internações por essas fraturas. A incidência média das fraturas de crânio e dos ossos faciais foi de 13,66 por 100.000 habitantes. A maioria das internações ocorreu no sexo masculino, em 82,5%, e nas faixas etárias de 20 a 29 anos de idade. As Unidades Federativas que apresentaram elevados coeficientes foram Rio Grande do Norte, Paraíba e Sergipe. No período foram gastos R$ 39.058.339,80 com internação e o valor médio por internação aumentou até 2003. Conclusões: As incidências de fraturas dos ossos do crânio e da face cresceram no período avaliado nos estados do Nordeste, sendo mais frequente no sexo masculino e nas faixas etárias de 20 a 29 anos. Consequentemente, os gastos públicos com internações por causa de fraturas dos ossos do crânio e da face cresceram no decorrer dos anos (AU)
Introduction: The increase of accidents and violence in Brazil has affected the organization of health systems, whose expenditures have been increasing due to their responsibility for attending to injuries. Aim: To perform an epidemiological survey of hospital admissions due to skull fractures and maxillofacial injuries, evaluating the expenses of the Single Health System with hospitalizations in northeast Brazil for 10 years. Methods: Temporal series study with data from the Hospital Information System. The cases selected were those diagnosed as part of the XIX Chapter of the International Classification of Diseases (ICD) and their distribution according to sex, age group, state, mean value, mean stay, and year of admission. Results: There were 67.086 records of admissions due to these fractures. The mean incidence of skull fractures and maxillofacial injuries was 13.66 per 100.000 people. Most of the admissions occurred among males (82.5%) in their twenties. The states with the highest indexes were Rio Grande do Norte, Paraíba, and Sergipe. In this period, R$ 39.058.339,80 were spent with hospitalizations, and the mean value per hospitalization increased until 2003. Conclusions: The incidence of skull fractures and maxillofacial injuries increased in the studied period in the northeast states, being more frequent among males in the 20-29 age group. Consequently, the public expenses with hospitalizations due to skull and maxillofacial injuries have increased over the years (AU)
Subject(s)
Humans , Male , Female , Skull Fractures/epidemiology , Hospitalization/statistics & numerical data , Skull Fractures/economics , Skull Fractures/therapy , Incidence , Retrospective Studies , Hospital Costs/statistics & numerical data , Hospitalization/economicsSubject(s)
Humans , Brain Edema/etiology , Brain Injuries/therapy , Cerebral Hemorrhage/etiology , Brain Concussion/etiology , Hematoma, Epidural, Cranial/etiology , Hematoma, Subdural/etiology , Lymphangioma, Cystic/etiology , Subarachnoid Hemorrhage/etiology , Brain Edema/drug therapy , Brain Injuries/complications , Cerebral Hemorrhage/drug therapy , Brain Concussion/drug therapy , Skull/injuries , Hematoma, Epidural, Cranial/drug therapy , Hematoma, Subdural/drug therapy , Intracranial Pressure , Lymphangioma, Cystic/drug therapy , Skull Fractures/therapy , Subarachnoid Hemorrhage/drug therapyABSTRACT
As fraturas com afundamento da calota craniana (FAC) säo relativamente frequentes e seu tratamento neurocirúrgico está bem estabelecido, porém pouca atençäo tem sido dada a esta patologia na faixa etária de 0 a 2 anos de idade. Este estudo baseia-se na análise retrospectiva de 43 pacientes com FAC e idade entre 0 e 2 anos. As principais causas da FAC foram as quedas, seguidas pelos atropelamentos. A maioria apresentava FAC tipo I, isto é, aquela na qual o osso deprimido permanece conectado à calota craniana. Tratamento cirúrgico foi instituído em 69,8 por cento dos casos. A incidência de lesöes encefálicas associadas foi mais baixa do que a relatada na literatura
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Frontal Bone/injuries , Occipital Bone/injuries , Parietal Bone/injuries , Skull Fractures/surgery , Temporal Bone/injuries , Accidental Falls , Accidents, Traffic , Fractures, Closed/surgery , Fractures, Closed/therapy , Fractures, Open/surgery , Fractures, Open/therapy , Frontal Bone/surgery , Incidence , Occipital Bone/surgery , Parietal Bone/surgery , Skull Fractures/etiology , Skull Fractures/therapy , Temporal Bone/surgeryABSTRACT
Los autores realizan una revisión de los casos de fractura del temporal, vistos en su servicio, entre los años 1987 y 1991, incentivados por un aumento de los casos vistos en los últimos años. Se analizan 42 casos que tenían la información adecuada en sus fichas. La gran mayoría adultos jóvenes, de sexo masculino. La principal causa de las fracturas fueron los accidentes y las agresiones. Se realiza también un comentario, con respecto al estudio imagenológico de los pacientes, dado el hecho que no todos ellos contaban con una tomografía computada. El principal signo indicador de fractura encontrado fue la otorragia y el hemotímpano. La gran mayoría de las fracturas eran de tipo longitudinal, siendo el daño auditivo, específicamente la hipoacusia de conducción, la complicación más frecuente (55 por ciento). El número de lesiones al nervio facial (17 por ciento), aunque de menor incidencia, eran porcentualmente mas graves. Finalmente, se propone una forma de diagnóstico y manejo de esta patología
Subject(s)
Humans , Male , Female , Adult , Skull Fractures/epidemiology , Temporal Bone/injuries , Skull Fractures/therapy , Accidents/statistics & numerical data , Deafness/etiology , Hearing Loss, Sensorineural/etiologyABSTRACT
A violencia dos grandes centros urbanos tem contribuido em muito para manter a elevada incidencia de fraturas de face. Sao casos que devem ser tratados adequadamente para evitar sequelas esteticas e funcionais e poder reintegrar os pacientes a sociedade. A partir de 1990, com a organizacao de equipe de Cirurgia Plastica no Pronto-Socorro do Hospital das Clinicas da Faculdade de Medicina de Sao Paulo, as fraturas de face vem sendo tratadas por elas. Em levantamento dos pacientes atendidos consecutivamente em 28 meses, analisamos os agentes etiologicos envolvidos e a frequencia dos diversos tipos de trauma. Em 130 casos analisados, o principal agente etiologico foi o acidente automobilistico (51 por cento) e a fratura mais encontrada foi a de mandibula (46 por cento). Uma correlacao entre o tipo trauma e o tipo de fratura foi realizada.
Subject(s)
Humans , Male , Female , Adult , Facial Bones/injuries , Facial Injuries/epidemiology , Skull Fractures/therapy , Seat Belts , Facial Injuries/etiologyABSTRACT
Transcreve-se o tratamento de uma lesäo craniencefalica publicado no seculo XVIII. A revisäo dos primeiros livros médicos no Brasil permite concluir que o relato significa a primeira publicaçäo de procedimento neurocirúrgico realizado no país. Acrescenta-se o contexto histórico do tratamento das fraturas de crânio com afundamento. (AU)
Subject(s)
History, 18th Century , Skull Fractures/therapy , BrazilABSTRACT
El presente estudio tiene como objetivo analizar el tratamiento y pronóstico de 77 casos con fractura craneal deprimida en niños hospitalizados en el Servicio de Neurocirugía del Hospital del Niño. Los casos provienen de la revisión de 1,300 historias clínicas, correspondiendo al 5.92 por ciento. Se usa el Método Descriptivo-Retrospectivo. El 72.7 por ciento tuvo como edad de 2 a 11 años. El 61 por ciento correspondió al sexo masculino. Las caídas de altura y accidentes de tránsito fueron las causa predominantes. El 11.6 por ciento presentó laceración cerebral y el 5.1 por ciento hematomas yuxtadurales. Las fracturas correspondieron mayormente a regiones fronto-parietal derecha e izquierda. Recibieron tratamiento quirúrgico 66 pacientes, tan pronto como fueron hospitalizados, realizándose unicamente levantamiento óseo en el 66.6 por ciento. En el resto se realizaron también extracción de hematoma, cierre de desgarro de duramadre, plastía con periostio o con duramadre homóloga almacenada, y extracción de parénquima cerebral lacerado. Se observó como complicaciones: infección de herida 3.8 por ciento, fístula de L.c.r. 2.5 por ciento y meningitis en 1.2 por ciento. Como secuelas neurológicas se observó signos focales de leve magnitud 3.9 por ciento, afasia 2.6 por ciento y cefalea 1.2 por ciento. Solamente falleció un paciente. Se concluye que el levantamiento óseo es el tratamiento quirúrgico mayormente realizado en el niño con fracturas craneales deprimidas, existiendo mínimas complicaciones y secuelas, y solamente 1.2 por ciento de mortalidad. Además el pronóstico fué bueno en un seguimiento promedio de 3 meses