RESUMO
The purpose of this study was to evaluate whether orientation of a firearm predicts survival, and to identify risk factors associated with fatality in subjects with self-inflicted craniomaxillofacial gunshot wounds. A retrospective cohort study design was used. The primary predictor variable was orientation of the weapon, defined as in the coronal (lateral) or sagittal (anterior-posterior) trajectory pattern. The primary outcome variable was death for subjects on arrival or during their hospital stay. Other covariates measured include demographic, firearm-related, and psychosocial variables. Risk factors for fatality were identified using multivariate logistic regression. Of the 92 subjects that met study inclusion criteria, 47 (67.2) held the firearm in the coronal position. In the full multivariate model, coronal gun orientation (OR=7.7, 95% CI: 2.0, 30.1, p=0.003) and the absence of a psychiatric diagnosis were associated with an increased risk of fatality (OR=0.1, 95% CI: 0.04, 0.5, p=0.002). Coronal firearm orientation was associated with an increased risk of fatality following self-inflicted craniomaxillofacial gunshot injuries. A patient with a documented psychiatric disorder was not found to be more likely to succumb to this type of injury.
Assuntos
Armas de Fogo , Traumatismos Cranianos Penetrantes/classificação , Traumatismos Maxilofaciais/classificação , Tentativa de Suicídio , Ferimentos por Arma de Fogo/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Etanol/sangue , Feminino , Seguimentos , Humanos , Masculino , Fumar Maconha/sangue , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Detecção do Abuso de Substâncias , Tentativa de Suicídio/classificação , Tentativa de Suicídio/psicologia , Taxa de Sobrevida , Adulto JovemRESUMO
The purpose of this study was to determine whether chemotherapy delivered concurrently with external beam radiation therapy for loco-regionally advanced head and neck cancer affects the rate or severity of postoperative complications in patients who underwent salvage surgery for recurrent or persistent disease with simultaneous microvascular free flap reconstruction. The primary study group consisted of patients with head and neck malignancies that had undergone surgical salvage with microvascular free flap reconstruction for persistent or recurrent disease following definitive radiation or concomitant chemoradiation treatment. A group of demographically matched patients who underwent microvascular free flap reconstruction for non-malignant and malignant conditions who never received radiation were randomly selected to serve as a control group. The study cohort was divided according to radiation treatment. The overall success rate of flap reconstruction was 92%, with an overall complication rate of 23%. Concurrently administered chemotherapy did not appear to affect the type of or the complication rate. The results of this investigation indicate that microvascular free flap reconstruction of head and neck defects is highly predictable, results in relatively few major complications, and suggests that neither radiation alone nor concomitant chemoradiation has a statistically significant effect on overall flap survival or complication rate.
Assuntos
Quimiorradioterapia , Retalhos de Tecido Biológico , Neoplasias Bucais/cirurgia , Neoplasias Orofaríngeas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Terapia de Salvação , Transplante Ósseo , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/terapia , Estudos de Casos e Controles , Estudos de Coortes , Fáscia/transplante , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/terapia , Músculo Esquelético/transplante , Recidiva Local de Neoplasia/cirurgia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/terapia , Complicações Pós-Operatórias , Radioterapia de Alta Energia , Reoperação , Estudos Retrospectivos , Transplante de Pele , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
Primary closure of intraoral wounds can be done up to 24 hours after the injury. A mucosal seal decreases the possibility of infection and allows the wound to heal more rapidly and less painfully than a wound left open to heal by secondary intention. Defects of the lips must be closed with exact alignment of the vermilion-cutaneous margins. Nerve repairs must be done without tension at the repair site. Parotid duct repairs are mandatory to prevent cyst and fistula formation. Anterior permanent teeth may be replanted.
Assuntos
Boca/lesões , Adulto , Criança , Ossos Faciais/lesões , Traumatismos do Nervo Facial , Fraturas Ósseas , Humanos , Lábio/lesões , Glândulas Salivares/lesões , Traumatismos Dentários , Reimplante Dentário , Raiz Dentária/lesões , Traumatismos do Nervo TrigêmeoRESUMO
Surgical intracapsular concylar fractures were initiated on young monkeys followed by prolonged intermaxillary fixation in an effort to create facial asymmetry and induce temporomandibular joint ankylosis. Implanted head positioners and metallic bone markers were used to document developing facial asymmetry in all animals. Vertical opening capabilities were fully recovered and the procedures had no discernible functional impact. Slight limitation of movement persisted only in the translation of the damaged condyles. It was concluded that trauma followed by long term fixation had no effect in promoting ankylosis or significant limitation of jaw movement. It is suggested that when considering the role of trauma in the aetiology of ankylosis, attention be given to those factors which may complicate an existing trauma.