Search Results (9)

Study Design: A literature review of relevant publications regarding panfacial fracture sequencing. Objective: To review the current landscape of sequencing of panfacial trauma and propose the utilization of the Major Fragment Theory when conventional sequencing techniques are inadequate. Methods: We conducted a review of existing literature on panfacial fracture management, focusing on sequencing techniques. Additionally, we analyzed unique fracture patterns to identify instances where conventional sequencing may be insufficient. Results: Existing literature emphasizes directional-based sequencing techniques for panfacial fracture reduction. However, unique fracture patterns often necessitate deviation from these sequences. The Major Fragment Theory suggests prioritizing the reduction of larger fragments over conventional sequencing, particularly when dealing with complex fractures. Conclusions: While directional-based sequencing techniques provide a valuable framework for panfacial fracture management and almost any approach can be utilized successfully, the Major Fragment Theory offers a complementary approach for cases where conventional sequencing falls short. Incorporating this theory into practice may enhance outcomes in the treatment of panfacial fractures. Full article

Panfacial fractures are complex fractures involving multiple regions of the facial skeleton and may require multiple surgeries over a relatively short period. They are often associated with polytrauma and other injuries including neurotrauma, which require either immediate (ATLS) airway management, prolonged intubation, or repeated intubations for staged surgeries. The choice of airway for the surgical management of these fractures is difficult, as an assessment of the occlusion is required, and the central nasal complex and/or skull base may be involved, making classical orotracheal or nasotracheal intubation problematic. Submental intubation is increasingly reported as a method of airway management with the aim of avoiding a tracheostomy and its related complications. A review of the different techniques of airway management in the elective treatment of panfacial fractures was performed, focusing on the pros and cons of each method. Most articles were retrospective studies, with only one prospective study comparing submental intubation to tracheostomy in panfacial fractures. An algorithm for the management of the airway in panfacial fractures was presented, based on a sequential assessment of the existing airway, the surgical access required, and the need for prolonged or repeated intubation. Front of neck access, orotracheal and nasotracheal intubation, and submental intubation are all appropriate techniques in different circumstances, and the advantages and disadvantages of each are presented. Full article

Study Design: Submental intubation is and underutilized alternative to traditional techniques of intubation. Complications associated can indeed deter surgeons and anesthesiologist from performing it. Surgeons may opt for submental intubation if they believe that its advantages outweigh the potential risks of the procedure. Identifying the reasons of complications and implementing of proper strategies to address them can help mitigate risks. Objective: This study aims to compare and analyze the complications experienced during and after submental intubation to comment on its safety, efficacy. Revisiting literature, will help us to comment on diagnosis in trauma and associated perioperative and intraoperative complication with it. It will also help us deduce most preferred way of performing submental intubation and various methods to manage complications. Methods: Submental intubation in patients experiencing craniofacial trauma was reviewed retrospectively for 9 years from January 2015 to August 2023. Common diagnosis sites were analyzed for perioperative and postoperative complications. Results: It was found that there were no much complications faced perioperatively and also notes methods used for management of complications. Most commonly encountered postoperative complication was scar. Literature of past years was reviewed, during process we also came out with novel method for safe extubation for which we have got copyright from Government of India. Conclusions: Submental intubation is a safe and efficient intraoperative airway management technique for patients with craniomaxillofacial injuries when there is concurrent facial trauma. This study findings would underscore the safety and efficacy of SEI, making it a promising unparalleled method of airway management worth considering. Full article

Background: Laser-assisted drug delivery is a promising strategy that enhances topical treatment by increasing cutaneous permeation and reducing side effects. In cosmetic settings, the efficacy and safety profiles of a treatment must meet the need of a painless procedure with fast recovery. In this context, Q-switched laser appears promising as it can open cutaneous pores without creating a carbonisation barrier. Methods: A split-face study on patients presenting for cosmetic procedures at IDI-IRCCS, Rome (30 September–18 October 2023), was conducted. Pan-facial Q-Switched laser was followed by a topical biostimulator applied on half of the face. Post-procedure local reactions were recorded together with patients’ perceptions. Cutaneous elasticity and hydration were assessed at baseline and three-week follow-up. The Skindex17 questionnaire evaluated the procedure’s impact on patients’ life quality. Also, participants and physicians expressed satisfaction with the treatment. Results: The procedure was well tolerated by patients; local reactions include transitory erythema, superficial bleeding, and oedema, none of which had an impact on daily life. An improvement in skin quality was documented objectively and subjectively by patients and physicians. Conclusion: Q-switched lasers emerge as promising devices for drug delivery, especially for cosmetic reasons. Indeed, the low risk of local reactions together with a remarkable increase in cutaneous permeation make this a suitable strategy for cosmetic procedures. Full article

Bone stabilization using osteosynthesis devices is essential in maxillofacial surgery. Owing to numerous disadvantages, bioresorbable materials are preferred over titanium for osteofixation in certain procedures. The biomaterials used for osteosynthesis in maxillofacial surgery have been subdivided into four generations. No study has compared the tissue responses generated by four generations of biomaterials and the feasibility of using these biomaterials in different maxillofacial surgeries. We conducted an in vivo animal study to evaluate host tissue response to four generations of implanted biomaterial sheets, namely, PLLA, PLLA/PGA, u-HA/PLLA, and u-HA/PLLA/PGA. New bone volume and pertinent biomarkers for bone regeneration, such as Runx2, osteocalcin (OCN), and the inflammatory marker CD68, were analyzed, and the expression of each biomarker was correlated with soft tissues outside the biomaterial and toward the host bone at the end of week 2 and week 10. The use of first-generation biomaterials for maxillofacial osteosynthesis is not advantageous over the use of other updated biomaterials. Second-generation biomaterials degrade faster and can be potentially used in non-stress regions, such as the midface. Third and fourth-generation biomaterials possess bioactive/osteoconductivity improved strength. Application of third-generation biomaterials can be considered panfacially. Fourth-generation biomaterials can be worth considering applying at midface due to the shorter degradation period. Full article

Study Design: A retrospective cohort study was conducted using the Kids’ Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective: The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population. Methods: The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures. Results: Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (p < 0.01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (p < 0.01) to result in panfacial fractures while car accidents were over two times more likely (p < 0.01) to result in panfacial fractures. Falls were less likely (OR, 0.39; p < 0.01) to result in panfacial fractures. Conclusions: Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle. Full article

Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years. No episode of oxygen desaturation was noted intraoperatively. Mean time to perform TMI was 6 ± 2 minutes. The mean transmylohyoid ETT withdrawal time/disconnection time from ventilator was approximately 1.5 minutes. Accidental partial extubation of ETT was noted in two patients (0.97%), and three patients (1.45%) developed abscess formations at anterior submandibular site which were managed by incision and drainage. The anterior submandibular approach for TMI was successfully used and provided stable airway in all elective CMF surgery cases, where oral or nasal intubations were not indicated/feasible and long-term ventilation support was not required. It permitted simultaneous dental occlusion-guided reduction and fixation of all the facial fractures without interference from the tube during the surgery with unhindered maintenance of the anesthesia and airway. The advantages include easy, swift, efficient, and reliable approach with a small learning curve. Full article

The carotid-cavernous fistula (CCF) is a rare complication in patients victimized by craniofacial trauma. It involves multidisciplinary medical action. Owing to its potential complications, it is essential that maxillofacial surgery and neurosurgery specialists diagnose this condition so that appropriate treatment can be performed. The authors present a report of a case 11 years after the surgery. Full article

The primary goals in repairing complex craniofacial fractures are restoration of occlusion and mastication, and anatomic reconstruction of a symmetric facial skeleton. Failure to accomplish these goals may result in the need for secondary operations. Recognition of malreduction may not be appreciated until review of a postoperative computed tomographic (CT) scan. Intraoperative CT scanning enables immediate on-table assessment of reduction and fixation, allowing alteration of the surgical plan as needed. We report using intraoperative CT scanning while repairing a panfacial injury in which malreduction was appreciated intraoperatively and corrected. Intraoperative CT can be used to improve outcomes and quality of complex facial fracture repair. Full article