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1.
J Craniofac Surg ; 30(7): 2239-2244, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503116

RESUMO

BACKGROUND: A skull fracture widely occurs in patients with traumatic brain injury, leading to intracranial hematoma, brain contusion, and intracranial infection. It also influences the prognosis and death of patients. This study aimed to discuss cases of patients with comminuted skull fractures. METHODS: From October 2015 to December 2018, 38 patients with comminuted skull fractures were admitted to the hospital. All patients underwent three-dimensional reconstruction of computed tomography scan images. Digital subtraction angiography or magnetic resonance venography was performed to find out the venous sinus. The clinical findings of the patients were significant regarding gender, age, injury mechanism, location, admission Glasgow Coma Scale (GCS), combined epidural, subdural, cerebral contusion, intracranial pneumatosis, maximum depth of depression, admission to surgery, dural tear, post-operative cerebrospinal fluid leakage, post-operative infection, and Glasgow Outcome Scale (GOS) 3 months after surgery. RESULTS: The incidence of traffic accidents, fall from a height, railway accidents, fall of an object, and chop injury was 60.5%, 18.4%, 13.2%, 5.3%, and 2.6%, respectively. Intra-operative dural trar negatively correlated with epidural hematoma, cerebral contusion, and subdural hematoma. Also, post-operative infection negatively correlated with intracranial pneumatosis, depth of fracture depression, and pre-operative cerebrospinal fluid leakage. No correlation was found between contusion, subdural hematoma, intracranial pneumatosis, depth of fracture depression, and post-operative infection. The GOS score positively correlated with age, pre-operative cerebrospinal fluid leakage, and admission GCS score. CONCLUSIONS: A perfect pre-operative examination is a key to successful surgery. Further studies should be conducted to find out more effective treatments for traumatic comminuted skull fractures.


Assuntos
Fratura do Crânio com Afundamento/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/etiologia , Contusões , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Fratura do Crânio com Afundamento/complicações , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
2.
Pediatr Neurosurg ; 54(1): 28-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673675

RESUMO

OBJECTIVE: To evaluate pediatric patients who were operated with the diagnosis of depressed skull fracture. METHODS: The records of pediatric patients who presented with traumatic head injury to multicenter neurosurgery clinics between 2002 and 2018 and who were operated with a diagnosis of depressed skull fracture were retrospectively reviewed. All of the patients underwent primary bone fragment replacement operation, and the patients' own bone flaps were used to repair depressed skull fractures in all of them. RESULTS: A total of 78 patients were included in the study. Of the study group, 20 patients presented with mild head injury, 37 had moderate head injury, and 21 had severe head injury. Dural injury was present in 67 patients (86%) and the dura was intact in 11 patients (14%). After surgery, 63 patients (81%) had good outcome, 8 patients (10%) had moderate disability, and 5 patients (6.5%) had severe disability. Two patients with multiple accompanying cranial pathologies died and the mortality rate was 2.5%. Infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma. One of them had meningitis and the other skin infection. Both patients were treated with appropriate antibiotherapy. None of the patients in the study group had an infection involving the bone, such as osteomyelitis, or the tissues under the bone, such as subdural-epidu-ral empyema or abscess. None of the patients required reoperation and removal of the bone. CONCLUSION: In the present study, as the pathologies accompanying the depressed skull fractures of the patients increased, Glasgow Coma Scale scores at arrival and Glasgow Outcome Scale scores at discharge decreased. Regardless of whether the depressed fracture is simple or compound, primary bone fragment replacement with appropriate decontamination of the fractured bone and operation area via single-session intervention gives good results. It is important to perform the surgery as soon as possible to reduce the risk of contamination. Primary bone fragment replacement seems to be an appropriate treatment option for depressed skull fractures.


Assuntos
Transplante Ósseo/métodos , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/cirurgia , Adolescente , Transplante Ósseo/tendências , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
Am J Emerg Med ; 36(10): 1925.e1-1925.e2, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30064821

RESUMO

A 9 week-old female, born via normal spontaneous vaginal delivery at 40 weeks, presented to the emergency department for a depression to her left skull, first noticed 3 three weeks prior. Ping Pong Fractures should be recognized and appropriately treated by an emergency physician.


Assuntos
Traumatismos do Nascimento/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Nascimento/patologia , Feminino , Fraturas Espontâneas/patologia , Humanos , Lactente , Recém-Nascido , Fratura do Crânio com Afundamento/patologia
4.
J Craniofac Surg ; 29(5): 1358-1362, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29521750

RESUMO

The aim of this study was to elucidate the precise location of the maxillary ostium using computed tomography for the reduction of depressed nasomaxillary fractures.Computed tomography images (61 males, 42 females; age range, 3-97 years) were analyzed. Coronal sections were cut every 3 mm.The primary maxillary ostium (PMO) was located 24.7% ±â€Š3.9% of bizygomatic distance (BZD) lateral to septum. The horizontal distance of the PMO significantly increased with age (P = 0.032). The PMO was located 53.3% ±â€Š8.0% of nasal length (NL) above superior surface of the palatal bone (SP). The vertical-to-horizontal ratio of the PMO decreased with age (P = 0.013). The PMO was located 30.3 ±â€Š4.3 mm posterior to the tip of nasal bone. The PMO was located 24.6 ±â€Š4.8 mm posterior to the anterior nasal spine (ANS). The ANS-PMO distance significantly increased with age (P = 0.027). The hiatus semilunaris (HS) was located 11.9% ±â€Š3.2% of BZD lateral to septum. The HS was located 62.4% ±â€Š10.3% of NL above SP. The vertical distance of the HS significantly decreased with age (P = 0.019). The accessory maxillary ostium (AMO) was located 14.9% ±â€Š2.8% of BZD lateral to septum. The horizontal distance of the AMO significantly increased with age (P = 0.027). The AMO was located 44.8% ±â€Š6.9% of NL above SP. The vertical distance of the AMO significantly decreased with age (P < 0.001). The vertical-to-horizontal ratio of the AMO decreased with age (P < 0.001).The distances of the ostium from surgical landmarks measured in this study might be helpful when inserting a small curved elevator into the maxillary ostium in the reduction of medial maxillary fractures.


Assuntos
Fixação de Fratura/métodos , Fraturas Maxilares/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/lesões , Osso Nasal/diagnóstico por imagem , Osso Nasal/lesões , Fratura do Crânio com Afundamento/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fraturas Maxilares/cirurgia , Pessoa de Meia-Idade , Osso Nasal/cirurgia , Valores de Referência , Estudos Retrospectivos , Fratura do Crânio com Afundamento/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
World Neurosurg ; 110: 256-262, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29051109

RESUMO

BACKGROUND: Spontaneous intrauterine depressed skull fractures (IDSFs) are rare fractures that often require neurosurgical evaluation and therapy. Most of the reported congenital depressions are secondary to maternal abdominal trauma or instrumentation during delivery. Spontaneous IDSFs occur in the setting of uneventful normal spontaneous vaginal delivery or cesarean section, without obvious predisposing risk factors. The etiology and optimal management of spontaneous IDSFs remain controversial. CASE DESCRIPTION: We describe 2 cases of spontaneous IDSF who underwent cranioplasty at our institution using an absorbable mesh, as well as review the current state of knowledge regarding the diagnosis and management of spontaneous IDSF. The 2 neonates, 1 male and 1 female, presented at Lucile Packard Children's Hospital with spontaneous IDSF after uneventful normal spontaneous vaginal deliveries. The fractures were located in the left frontal and right parietotemporal calvarium, respectively. Both patients underwent open craniotomy and elevation of their IDSFs with mesh cranioplasty. At last follow-up, both patients were normocephalic and neurologically intact. CONCLUSIONS: Neurosurgery consultation is necessary for initial evaluation of spontaneous IDSF. Surgical intervention is indicated for larger defects and/or intracranial involvement. Expectant management and negative-pressure elevation have also been shown to be effective.


Assuntos
Traumatismos do Nascimento/cirurgia , Procedimentos Neurocirúrgicos/métodos , Fratura do Crânio com Afundamento/cirurgia , Traumatismos do Nascimento/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Masculino , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
World Neurosurg ; 109: e305-e312, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28989045

RESUMO

OBJECTIVE: The most common birth-associated head injuries during vaginal delivery are cephalhematomas and subgaleal hematomas. Cranial injuries are rarely encountered. The neonate cranium is soft and pliable, and greenstick skull fractures (GSFs) are expected to be more frequent than linear or depressed fractures, but they are extremely difficult to detect with simple skull radiography. As a result, no reports have been issued on this topic to date. Recent reports suggest that technological advances in 3-dimensional (3D) computed tomography (CT) have successfully enhanced the diagnostic accuracy for cranial fractures. The authors researched the types and characteristics of GSFs and the diagnostic accuracy of 3D CT for cranial fractures in neonates. METHODS: The simple skull radiographs and 3D CT images of 101 neonates were retrospectively evaluated and compared with respect to diagnosis of cranial fractures, and skull GSFs were classified on the basis of 3D CT findings into 5 types depending on multiplicity and location. RESULTS: 3D CT detected 88 cases of cranial fractures, that is, 89 GSFs, 4 combined GSFs and linear fractures, and 3 combined GSFs and depressed fractures. The diagnostic rate of 3DCT was 91% and this was significantly higher than the 13% rate of simple skull radiographs (P < 0.001). CONCLUSIONS: GSFs rather than linear fractures were found to account for most cranial injuries among neonates. The diagnostic accuracy of 3D CT was considerably superior than simple skull radiography, but the high radiation exposure levels of 3D CT warrant the need for development of a modality with lower radiation exposure.


Assuntos
Traumatismos do Nascimento/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Imagem Tridimensional , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Nascimento/classificação , Traumatismos do Nascimento/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Fratura do Crânio com Afundamento/classificação , Fratura do Crânio com Afundamento/epidemiologia , Fraturas Cranianas/classificação , Fraturas Cranianas/epidemiologia
7.
Medicine (Baltimore) ; 96(22): e7055, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28562569

RESUMO

RATIONALE: The superior sagittal sinus (SSS) is the major dural sinuses that receive a considerable amount of venous drainage. Interruption of its posterior third has been suggested to cause intracranial hypertension and lead to potentially fatal consequences. PATIENT CONCERNS: We presented a 22-year-old man with a severe headache and scalp bleeding after a head chop wound. Physical examination identified a 20-cm straight laceration in his parietooccipital scalp. Computed tomography (CT) demonstrated a depressed cranial fracture (DCF) in the left parietooccipital bone, a fracture line across the midline to the right side, and penetrations of bone fragments into the brain parenchyma. DIAGNOSES: Traumatic open DCF in left parietooccipital bone. INTERVENTIONS: An emergent left parietooccipital craniotomy, followed by cranioplasty to restore the depressed bone flap, was delivered to the patient. Postoperative CT confirmed successful elevation of the DCF and removal of intracerebral bone fragments. However, postoperative CT angiography (CTA) demonstrated an absence of venous flow distal to the fracture, suggesting occlusion of the posterior third of SSS. MRV revealed a persistent absence of venous flow in the posterior third of SSS with dilated cortical venous drainage. Anticoagulation treatment was initiated 3 days after surgery, and follow-up CTA and digital subtraction angiography showed gradually improved patency in the anterior and middle two-thirds of SSS. OUTCOMES: Despite occlusion of the posterior third of SSS, patient's symptoms resolved after the operation and he was discharged without complications. LESSONS: The favorable clinical outcome after complete occlusion of the posterior third of the SSS has rarely been reported and it might be explained by our timely surgical intervention and development of compensatory cerebral collateral circulation.


Assuntos
Fraturas Expostas/complicações , Fratura do Crânio com Afundamento/complicações , Seio Sagital Superior/lesões , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Masculino , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/cirurgia , Seio Sagital Superior/diagnóstico por imagem , Seio Sagital Superior/cirurgia , Adulto Jovem
8.
Br J Neurosurg ; 31(5): 624-625, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27340736

RESUMO

Depressed skull fractures sustained from golf balls are quite rare. We report such a case in a 16-year old, and demonstrate its appearance in a 3D CT reconstruction.


Assuntos
Golfe/lesões , Fratura do Crânio com Afundamento/cirurgia , Criança , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Artigo em Inglês | MEDLINE | ID: mdl-27722022

RESUMO

Depression is predicted to be the most common cause of disability in the coming decade. Self-inflicted hammer blow to the cranium is a rare phenomenon seen in patients with a history of attempted suicide. The resulting comminuted depressed skull fracture of the midline vertex is life threatening. Rapid interdisciplinary communication and intervention are essential to reduce morbidity and mortality. We present a case of self-inflicted hammer blows to the head, review the relevant literature on this topic, and discuss neurosurgical and psychiatric implications.


Assuntos
Fraturas Cominutivas/etiologia , Fraturas Cominutivas/cirurgia , Transtornos Mentais/complicações , Comportamento Autodestrutivo/terapia , Fratura do Crânio com Afundamento/etiologia , Fratura do Crânio com Afundamento/cirurgia , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/patologia , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/patologia , Tentativa de Suicídio
12.
Pan Afr Med J ; 24: 129, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27642467

RESUMO

Many neurosurgical procedures involve the use of a pin-type headrest to immobilize the patient's head. We report the case of depressed skull fracture in an adult patient secondary to the use of Mayfield headrest. The diagnosis was based on postoperative CT scan of the brain following surgical resection of medulloblastoma. Several factors seem to increase the risk of complications due to Mayfield headrest use. Preventive measures are outlined in our literature review.


Assuntos
Neoplasias Cerebelares/cirurgia , Meduloblastoma/cirurgia , Fratura do Crânio com Afundamento/etiologia , Adolescente , Desenho de Equipamento , Humanos , Imobilização/efeitos adversos , Imobilização/instrumentação , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
No Shinkei Geka ; 44(7): 599-603, 2016 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-27384121

RESUMO

Depressed skull fracture commonly results from trauma and usually occurs following high-speed impact with a small object. The outer and inner tables of the skull typically break concurrently. We present a case of depressed skull fracture involving only the inner table. The case resulted in a good outcome with only conservative treatment, although the mechanism remained unclear. Fracture models of cadavers have been the main tool for biomechanical investigation, but this classical method cannot accurately measure mechanical factors. We utilized a computer simulation model to assess the human head following skull fracture. This is the first report of an inner table fracture;the fracture mechanism was determined using a simulated computer model.


Assuntos
Fratura do Crânio com Afundamento/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
J Plast Reconstr Aesthet Surg ; 69(8): 1037-45, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27345471

RESUMO

Anterior table frontal sinus fractures can result in aesthetically displeasing contour deformities. Acute anterior table frontal sinus fractures that are depressed may be reduced with an open, closed, or endoscope-assisted approach. Delayed contour deformity camouflage can be achieved using bone grafts, titanium meshes, methyl methacrylate, hydroxyapatite cement, and polyether ether ketone implants. The selection of surgical approach to repair a frontal sinus contour deformity depends on the fracture severity, chronicity, complexity, patient comorbidities, and surgeon preference and experience. Advancement in endoscopic technology and expertise has created a paradigm shift toward a less invasive approach to the frontal region, with considerably less morbidity than conventional open techniques.


Assuntos
Fixação de Fratura , Seio Frontal/lesões , Procedimentos Cirúrgicos Reconstrutivos , Fratura do Crânio com Afundamento/cirurgia , Humanos , Fratura do Crânio com Afundamento/diagnóstico por imagem
15.
Forensic Sci Int ; 255: 106-11, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26232886

RESUMO

We report a craniocerebral trauma case in which a man sustained severe skull fractures and cerebral contusions and it demanded elucidating the injury mechanism of being formed by strike or tumble. However, the initial features of skull fractures were mostly lost when the forensic pathologists involved in the case 5 months later because of injury healing and craniocerebral surgery. Therefore, we aimed to reconstruct the original skull fracture features by utilizing the digital reconstruction technologies in terms of CT (computed tomography) scanning, 3D (3-dimentional) reconstruction, and virtual surgical tools. The original fracture skull was assembled by using Mimics 13.0 based on the CT slices of postoperative head and the removed craniotomy skull flaps, which revealed fracture features of focal and overall skull deformation. Based on the assembly skull model and the contrecoup cerebral contusions, we conclude that the man suffered a tumble after being drunk and the serious craniocerebral trauma occurred. The case demonstrated that the digital reconstruction technologies can serve as effective approaches for forensic investigation in case of survived craniocerebral trauma patients without direct evidences interpreting the original trauma patterns, which could potentially be helpful in exploring the injury mechanisms.


Assuntos
Medicina Legal/métodos , Imagem Tridimensional , Tomografia Computadorizada Multidetectores , Fratura do Crânio com Afundamento/diagnóstico por imagem , Acidentes por Quedas , Adulto , Intoxicação Alcoólica/complicações , Lesões Encefálicas/etiologia , Craniotomia , Humanos , Masculino , Fratura do Crânio com Afundamento/etiologia , Fratura do Crânio com Afundamento/cirurgia
16.
BMJ Case Rep ; 20152015 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-25694629

RESUMO

This is a case study describing the finding of a depressed skull fracture in a neonate who was delivered without instrumentation and with no history of trauma. Depressed skull fractures are described as being associated with forceps delivery both vaginally and with caesarean section but are much rarer without instrumentation. This obvious abnormality was very concerning for the parents as it was not picked up on antenatal scans and there was no clear cause. There were both cosmetic and neurological concerns and we found no clear consensus on appropriate treatment and prognosis in the literature we had available.


Assuntos
Fratura do Crânio com Afundamento/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Recém-Nascido , Radiografia
17.
J Forensic Sci ; 60(1): 219-25, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25039407

RESUMO

Modern ballistic helmets defeat penetrating bullets by energy transfer from the projectile to the helmet, producing helmet deformation. This deformation may cause severe injuries without completely perforating the helmet, termed "behind armor blunt trauma" (BABT). As helmets become lighter, the likelihood of larger helmet backface deformation under ballistic impact increases. To characterize the potential for BABT, seven postmortem human head/neck specimens wearing a ballistic protective helmet were exposed to nonperforating impact, using a 9 mm, full metal jacket, 124 grain bullet with velocities of 400-460 m/s. An increasing trend of injury severity was observed, ranging from simple linear fractures to combinations of linear and depressed fractures. Overall, the ability to identify skull fractures resulting from BABT can be used in forensic investigations. Our results demonstrate a high risk of skull fracture due to BABT and necessitate the prevention of BABT as a design factor in future generations of protective gear.


Assuntos
Dispositivos de Proteção da Cabeça , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/patologia , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/patologia , Ferimentos por Arma de Fogo/patologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Contusões/patologia , Desenho de Equipamento , Balística Forense , Patologia Legal , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia
18.
Biomed Res Int ; 2014: 879286, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25197666

RESUMO

INTRODUCTION: There has been much debate about the ideal timing of surgery of frontal depressed skull fractures (DSF). In this paper, we assess whether timing of surgery may have influenced outcome. METHODS: Retrospective cohort of 40 consecutive patients with frontal DSF who underwent surgical treatment over a 36-month period. The patients were divided into early surgery group (ESG) which were operated within 24 h and delayed surgery group (DSG). RESULTS: The population comprised 39 (97.50%) men and the mean age was 27.9 years (range, 2-81 yr). There was no difference of age (P = 0.53), gender male (P = 1.00), presence of focal lesion on head CT (P = 0.89), hypotension (P = 0.28), and hypoxia (P = 0.15). Mean Glasgow Coma Scale (GCS) was significantly lower in patients of ESG than DSG (8.75 and 11.7, resp., P = 0.02). There was no difference between the groups in relation to death (P = 0.13), unfavourable outcome (P = 0.41), late posttraumatic epilepsy (P = 0.64), and smell-and-taste disturbances (P = 1.00). Only one patient (3.5%) evolved meningitis during follow-up. CONCLUSION: We found no difference between the ESG and DSG in respect to death, unfavourable outcome, LPE, and STD.


Assuntos
Fratura do Crânio com Afundamento/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Cabeça/diagnóstico por imagem , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , Fratura do Crânio com Afundamento/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
20.
J Craniofac Surg ; 24(2): 589-91, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23524750

RESUMO

OBJECTIVE: Depressed skull fractures (DSF) with operation indications should be paid with enough attention because they have several complications and can influence esthetics. The optimal surgical method for DSF remains unclear. We explored the merits of dissociate bone flap cranioplasty. PATIENTS AND METHODS: From July 2006 to August 2012, we performed 30 craniotomies on patients with DSF, which were divided into 2 groups: 1 group, which consisted of 18 patients, underwent dissociate bone cranioplasty; the other 12 patients underwent lever-up cranioplasty. A helical computed tomographic scan was routinely obtained after the operation and a 3-dimensional technique was performed on some patients to evaluate the postoperative condition of the flap. RESULTS: Dissociate bone flap cranioplasty was performed on the 18 patients [11 men, 7 women: age, 26-70 (41) y]. No complications were observed in these patients. Lever-up cranioplasty was applied in the 12 patients [8 men, 4 women: age, 19-60 (41.8) y]; 2 patients had wound infection and 2 emerged with epidural hematoma. Obvious statistical significance of stability (P = 0.013) and position (P = 0.015) was found between the 2 methods. CONCLUSIONS: Dissociate bone flap cranioplasty is safer, more flexible, has less complications, and has better plasticity. We advocate the use of bone flap cranioplasty in dealing with DSF.


Assuntos
Craniotomia/métodos , Fratura do Crânio com Afundamento/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fratura do Crânio com Afundamento/diagnóstico por imagem , Tomografia Computadorizada Espiral , Resultado do Tratamento
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