An overview of maxillofacial trauma for nurses.

A team approach is necessary in order to maximally evaluate, treat, monitor, and rehabilitate the patient with maxillofacial injuries. An overview of the complexities of the management of patients with significant maxillofacial injuries is presented in a manner that should assist any nurse in the assessment and subsequent management of such patients.

The hemodynamic and hematologic effects of cigarette smoking versus a nicotine patch.

Patients who smoke have higher complication rates than nonsmokers in the postoperative period. The authors designed an experimental protocol for habitual smokers (n = 30) to determine the specific hemodynamic and hematologic adverse effects possibly caused by nicotine and whether the method of nicotine delivery and systemic nicotine levels achieved might influence these adverse effects. During the 5-day study, subjects were asked to refrain from smoking, and testing sessions were conducted as follows: on day 1, the subjects smoked two cigarettes immediately before testing; on day 3 (control day), testing was done after not smoking for 48 hours and then the subjects were instructed to wear a transdermal nicotine patch (PROSTEP 22 mg/day) for 24 hours and replace it with another so that, on day 5, testing took place after the subjects had worn the patch for approximately 34 hours. At each testing session, digital artery pulse amplitude and a number of clinical and serum blood level parameters were measured. Relative digital blood flow after smoking (69.2 +/- 5.8%) and with the patch (80.4 +/- 7.6%) was lower than on the control day (100.0 +/- 0.0%). The nicotine patch, unlike smoking, had no effect on vasopressin or fibrinogen concentrations, hematocrit, or white cell or platelet counts; both smoking and the patch resulted in elevated norepinephrine levels.

The radiology of upper airway obstruction in maxillofacial trauma.

One of the prime considerations in the management of maxillofacial trauma is the diagnosis and prevention of acute upper airway obstruction. Each division of the upper aerodigestive tract may cause respiratory obstruction. In the oral cavity, a "flail" mandible, an "Andy Gump" deformity, and a sublingual hematoma may occur. In the nasopharnynx, an impacted midface, a split palate, and a nasopharyngeal hematoma may result. In the oropharynx and hypopharynx, an expanding hematoma in the retropharyngeal or lateral pharyngeal spaces may be seen. Although airway obstruction in maxillofacial trauma is a clinical diagnosis, the judicious use of radiographs helps to identify patients at risk. In this study, we review the anatomy of the upper aerodigestive tract and the potential sites of airway obstruction. A review of the radiology of airway obstruction in maxillofacial trauma will also be presented.

Pseudomonas cervical osteomyelitis in a polytrauma patient.

Cervical osteomyelitis, an uncommon disease, is rarely associated with Pseudomonas organisms in non-drug-users. This report describes a case of cervical vertebral osteomyelitis associated with Pseudomonas aeruginosa pneumonia following panfacial trauma and closed head injury. Delays in diagnosing vertebral osteomyelitis are common because of the nonspecific nature of the history and the initial absence of clinical evidence, both of which may help to foster a generally low index of suspicion.

Preventing wound infections.

Quantitative bacterial studies have demonstrated that successful wound closure and healing can be expected if fewer than 10(5) bacteria per gram of tissue are present. The aim of wound management techniques is to reduce bacterial counts. Among the techniques are pulsatile jet lavage, with or without mechanical debridement; the application of biologic dressings; meticulous hemostasis and evacuation of hematomas, and antimicrobial therapy.

Injury to the glenoid fossa.

An illustrated case of fracture through the confines of the glenoid fossa by the mandibular condyle is presented. The mechanism of injury and postinjury sequelae of this rarely reported but frequently suspected occurrence are discussed and a treatment rationale proposed. The key to the diagnosis of this entity is an awareness of vector forces directed to the region of the glenoid fossa with or without evidence of subcondylar fracture.

Laceration repair.

Healing by primary intention is a threefold process, consisting of an initial phase in which red and white blood cells bind the wound; epithelialization and fibroplasia, and a maturation phase involving collagen synthesis. The appearance of the wound reflects its maturation. Skillful wound management is based on biologic principles. Time factors in wound closure, the effects of anesthetic techniques, debridement, the selection of sutures and the methods of suturing have profound effects on the outcome.

An approach to mid-facial fractures.

The purpose of this article is to present a concept which facilitates the plain film identification of mid-face fractures. The concept evolves from a logical classification of mid-face fractures based upon the region(s) of involvement (orbit, zygoma, maxilla), the extent of the fractures (unilateral or bilateral) and the characteristic distribution of the fracture lines. Recognition of these fractures depends upon an awareness of the fact that the radiographic signs of mid-face fractures differ in certain respects from those involving other skeletal parts. In addition to skeletal disruption, the radiographic signs of mid-face fractures include soft tissue abnormalities which may be localized or diffuse, and which may be either extrinsic or intrinsic to the facial skeleton, alterations of normal skeletal contour, the "bright white line" of displaced fragments, and the subcutaneous emphysema which may also be localized or diffuse. The application of this concept to the roentgen diagnosis of mid-face fractures will be described and illustrated.

The role of topical dimethyl sulfoxide in burn wound infection: evaluation in the rat.

The results of this study indicated that there were no statistically significant differences between the effectiveness of 1% silver sulfadiazine in DMSO and 1% silver sulfadiazine in a hydrophilic base (Silvadene), when these formulations were used as antimicrobials applied topically to thermal burn wounds. The antimicrobial efficacy of silver sulfadiazine was not destroyed by mixing this agent with DMSO, since the recovery of Pseudomonas aeruginosa was significantly lower in all animals treated with silver sulfadiazine, whatever the formulation, when compared to animals not treated with silver sulfadiazine. Further studies with higher concentrations of silver sulfadiazine in DMSO may be useful. Although the concept of DMSO as a medicinal "carrier" is not novel, with further investigation, it may prove to be germane in the treatment of eschar-covered thermal burns.