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Hypoglobus in the acute setting; causes from above
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Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e1–e34
implications on how the acutely proptosed eye should be managed. doi:10.1016/j.bjoms.2009.06.216 P 92 Preserving the skin in necrotising fasciitis of the head and neck James Morrison ∗ , V. Sood, A.T.M. Carton, I.S. Holland Monklands Hospital, Airdire and Southern General Hospital, Glasgow, United Kingdom Introduction/aim: Necrotising fasciitis of the head and neck carries a significant mortality of 25–30%. It is usually preceded by relatively trivial trauma. The management of this condition is aggressive pre-operative resuscitation, wide surgical debridement of the necrotic tissue, organ support as required and appropriate antibiotic therapy. The surgical management of these cases often leads to significant loss of integument. This results in significant disfigurement and functional morbidity. It can often require complex reconstructive surgery. The aim of this poster is to present a review of the management of necrotising fasciitis of the head and neck and to propose a modification in the management which preserves the integument. Materials/method: We present several illustrated cases in which the integument was preserved. A literature review of the management of necrotising fasciitis was undertaken and is presented. Results: We suggest that preservation of the skin in necrotising fasciitis may be possible without compromising the outcome for the patient. Conclusions/clinical relevance: The wide surgical debridement of necrotic tissue is imperative if the patient is to survive. However, if the integument can be preserved it leads to a significant reduction in morbidity for these patients. doi:10.1016/j.bjoms.2009.06.217 P 94 Hypoglobus in the acute setting; causes from above Mohammed Al-Gholmy ∗ , M. Ethunandan, N.J. Baker, A.A. Webb Southampton University Hospitals NHS Trust, United Kingdom Hypoglobus in the acute setting is usually associated with disruption of the inferior orbital rim or floor. The resulting hypoglobus may occur in isolation or associated with enophthalmos.
While orbital floor disruption is the most common cause, surgeons must be mindful of the causes arising from above the orbital equator. Inferior displacement of the orbital contents from above may also be caused by: 1. 2. 3. 4. 5. 6. 7.
Bone Blood Cerebro-spinal fluid Air Brain Foreign bodies Combination(s) of the above
The management of hypoglobus in the above setting needs to be tailored to the specific cause. Illustrative cases will be presented along with the appropriate investigations and their management. doi:10.1016/j.bjoms.2009.06.218 P 95 3D CT scans allow imporved surgical planning in ballistic injuries Colin MacIver ∗ , Andrew Monaghan West of Scotland Regional Maxillofacial Unit, United Kingdom Background: Ballistic injuries to the head and neck are routinely treated in the military environment but are still a rare presentation in the civilian setting. With recent terrorist attacks and an increased risk of attack a knowledge of the assessment and treatment of these patients is an essential part of not only the military maxillofacial surgeons armamentarium but also their civilian counterparts. Tissue loss and comminution of hard tissues are commonly seen with ballistic injuries modern imaging techniques allow accurate surgical planning. Aim: To show that 3D reformatted CT scans improve surgical planning. Methods: Retrospective review of maxillofacial trauma patients sustaining ballistic injuries during a deployment in Afghanistan. Results/conclusion: Maxillofacial ballistic wounds cause both direct injury to the soft and hard tissues and also distant injury due to a damaging blast wave. This indirect injury is evident in vascular structures with no obvious trauma but thromboses within the vesels. The surgical planning of treatment of head and neck ballistic injuries can be complex due to the degree of tissue loss, comminution and disruption of tissue planes. The use of 3D CT scans allows accurate visualisation of hard tissues that
Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e1–e34
implications on how the acutely proptosed eye should be managed. doi:10.1016/j.bjoms.2009.06.216 P 92 Preserving the skin in necrotising fasciitis of the head and neck James Morrison ∗ , V. Sood, A.T.M. Carton, I.S. Holland Monklands Hospital, Airdire and Southern General Hospital, Glasgow, United Kingdom Introduction/aim: Necrotising fasciitis of the head and neck carries a significant mortality of 25–30%. It is usually preceded by relatively trivial trauma. The management of this condition is aggressive pre-operative resuscitation, wide surgical debridement of the necrotic tissue, organ support as required and appropriate antibiotic therapy. The surgical management of these cases often leads to significant loss of integument. This results in significant disfigurement and functional morbidity. It can often require complex reconstructive surgery. The aim of this poster is to present a review of the management of necrotising fasciitis of the head and neck and to propose a modification in the management which preserves the integument. Materials/method: We present several illustrated cases in which the integument was preserved. A literature review of the management of necrotising fasciitis was undertaken and is presented. Results: We suggest that preservation of the skin in necrotising fasciitis may be possible without compromising the outcome for the patient. Conclusions/clinical relevance: The wide surgical debridement of necrotic tissue is imperative if the patient is to survive. However, if the integument can be preserved it leads to a significant reduction in morbidity for these patients. doi:10.1016/j.bjoms.2009.06.217 P 94 Hypoglobus in the acute setting; causes from above Mohammed Al-Gholmy ∗ , M. Ethunandan, N.J. Baker, A.A. Webb Southampton University Hospitals NHS Trust, United Kingdom Hypoglobus in the acute setting is usually associated with disruption of the inferior orbital rim or floor. The resulting hypoglobus may occur in isolation or associated with enophthalmos.
While orbital floor disruption is the most common cause, surgeons must be mindful of the causes arising from above the orbital equator. Inferior displacement of the orbital contents from above may also be caused by: 1. 2. 3. 4. 5. 6. 7.
Bone Blood Cerebro-spinal fluid Air Brain Foreign bodies Combination(s) of the above
The management of hypoglobus in the above setting needs to be tailored to the specific cause. Illustrative cases will be presented along with the appropriate investigations and their management. doi:10.1016/j.bjoms.2009.06.218 P 95 3D CT scans allow imporved surgical planning in ballistic injuries Colin MacIver ∗ , Andrew Monaghan West of Scotland Regional Maxillofacial Unit, United Kingdom Background: Ballistic injuries to the head and neck are routinely treated in the military environment but are still a rare presentation in the civilian setting. With recent terrorist attacks and an increased risk of attack a knowledge of the assessment and treatment of these patients is an essential part of not only the military maxillofacial surgeons armamentarium but also their civilian counterparts. Tissue loss and comminution of hard tissues are commonly seen with ballistic injuries modern imaging techniques allow accurate surgical planning. Aim: To show that 3D reformatted CT scans improve surgical planning. Methods: Retrospective review of maxillofacial trauma patients sustaining ballistic injuries during a deployment in Afghanistan. Results/conclusion: Maxillofacial ballistic wounds cause both direct injury to the soft and hard tissues and also distant injury due to a damaging blast wave. This indirect injury is evident in vascular structures with no obvious trauma but thromboses within the vesels. The surgical planning of treatment of head and neck ballistic injuries can be complex due to the degree of tissue loss, comminution and disruption of tissue planes. The use of 3D CT scans allows accurate visualisation of hard tissues that