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Lumbar puncture
254
INJURY: THE BRITISH JOURNAL OF ACCIDENT SURGERY
Injury Jan. 1970
ABSTRACTS MAXILLOFACIAL
AND HEAD INJURIES
Fractures of the Orbit Orbital fractures may involve the floor, medial wall, roof, lateral wall, or optic canal. Diagnosis of these fractures may be impossible without a knowledge of the clinical findings and correlation with radiological signs. The examination includes occipitomental with horizontal beam and exaggerated tube tilt, lateral, and oblique (optic foramen) views plus tomograms if necessary. Orbital floor fractures often result in diplopia, opacity of the maxillary antrum, depression of the floor, and, at times, orbital emphysema. Surgical intervention is necessary to elevate the orbital floor. Medial wall fractures may show ethmoid sinus clouding and supportive measures and antibiotics are usually adequate treatment. Fractures of the roof and lateral wall are commonly part of multiple fractures in the skull. An optic canal fracture may produce partial or total blindness although similar findings can result from ischaemia or haemorrhage without fracture. A visual deficit with optic canal fracture, however, calls for surgical decompression. Management of these injuries may require a multidiscipline approach that crosses many fields including radiology, neurosurgery, and orthopaedic surgery. THORWARTH, W. T., BARDEN, R. P., and GRAHAM, T. F. (1968), 'Recognition and Management of Fractures of the Orbit ', Am. J. Roentg., 102, 840. Replacement of Avulsed Scalp Although the reported results of re-attaching completely avulsed portions of scalp are usually poor, the occasional success continues to make the attempt worth while. In the case reported, about four-fifths of the total hair-bearing area was avulsed and was sutured back in place 1½ hours later. No special techniques were used but the author emphasizes the prevention of drying of the inside of the detached scalp and the wound on the head, and also the avoidance of irritation of either raw surface by chemicals, physical means, or otherwise. Lu, M. M. (1969), 'Successful Replacement of Avulsed Scalp. Case Report ', Plast. reconstr. Surg., 43, 231. Bone Plating for Mandibular Fractures In 101 cases of fractured mandible, 136 plates have been used for fixation. The plates are about 1 inch long and made of vitallium, with four holes. In 5 cases the plates were removed for infection and 2 had to be removed later to prevent ulceration into the mouth. The plates are screwed to the lateral surface of the mandible; if attached to the inferior border, they may bend. The authors feel that this is an excellent method of mandibular fracture fixation but the reviewer wonders if it is justifiable any longer to make a wound and a
subsequent scar on one or both sides of the neck an intra-oral approach will achieve as much by techniques. SNELL, A., and DOTT, W. A. (1969), ' Internal tion of Certain Fractures of the Mandible by Plating ', Plast. reconstr. Surg., 43, 281.
when other FixaBone
Early Traumatic Epilepsy By early, Professor Jennett means within 1 week of injury and he regards early epilepsy as being different in a number of important ways from epilepsy of later onset. His conclusions are based on 549 patients that had suffered closed injury of the head. Epilepsy starts during the first week after injury nearly thirty times more frequently than in any subsequent week and when of this early onset it is often focal. Recurrent attacks are three times more likely to follow a first fit occurring after the first week than one occurring during it. Nevertheless, a higher proportion of patients that developed late epilepsy had had the onset in the first week than later. He suggests that when fits occur several weeks after early epilepsy they should be regarded as being late epilepsy and not recurrences of the original attack(s). JENNEa-r, W. B. (1969),' Early Traumatic Epilepsy ', Lancet, 1, 1023. Lumbar Puncture Thirty patients with raised intracranial pressure became worse after lumbar puncture; the deterioration occurred with dramatic rapidity in half the patients, in the other half it came on within 12 hours. Radiographic films showed displacement of the pineal gland in a quarter of the cases and erosion of the clinoid processes in nearly a third of them. Although all the patients in this series were the victims of intracranial disease, the lessons for doctors treating patients with head injuries are clear. DUFFV, G. P. (1969), ' L u m b a r Punctures in the Presence of Raised Intracranial Pressure ', Br. reed. J., 1, 407. Cerebral Embolus A man had his arm 6rawn into a tyre-shredding machine and suffered complete paralysis of the brachial plexus and rupture of the subclavian artery. In the course of amputation a clot was removed from the subclavian artery, which was ligated ' well proximally '. Forty-eight hours later he developed left homonymous hemianopia without any other sign of neurological disorder. This was attributed to occlus;on of the calcarine branch of the posterior cerebral artery, which was thought to originate in turn from the retrograde spread of thrombns from the subclavian to the vertebral artery. EDGAR, M. A., and JOYCE, M. (1969), 'Cerebral Embolus after Traction Injury of the Arm ', Br. med. J., 2, 805.
INJURY: THE BRITISH JOURNAL OF ACCIDENT SURGERY
Injury Jan. 1970
ABSTRACTS MAXILLOFACIAL
AND HEAD INJURIES
Fractures of the Orbit Orbital fractures may involve the floor, medial wall, roof, lateral wall, or optic canal. Diagnosis of these fractures may be impossible without a knowledge of the clinical findings and correlation with radiological signs. The examination includes occipitomental with horizontal beam and exaggerated tube tilt, lateral, and oblique (optic foramen) views plus tomograms if necessary. Orbital floor fractures often result in diplopia, opacity of the maxillary antrum, depression of the floor, and, at times, orbital emphysema. Surgical intervention is necessary to elevate the orbital floor. Medial wall fractures may show ethmoid sinus clouding and supportive measures and antibiotics are usually adequate treatment. Fractures of the roof and lateral wall are commonly part of multiple fractures in the skull. An optic canal fracture may produce partial or total blindness although similar findings can result from ischaemia or haemorrhage without fracture. A visual deficit with optic canal fracture, however, calls for surgical decompression. Management of these injuries may require a multidiscipline approach that crosses many fields including radiology, neurosurgery, and orthopaedic surgery. THORWARTH, W. T., BARDEN, R. P., and GRAHAM, T. F. (1968), 'Recognition and Management of Fractures of the Orbit ', Am. J. Roentg., 102, 840. Replacement of Avulsed Scalp Although the reported results of re-attaching completely avulsed portions of scalp are usually poor, the occasional success continues to make the attempt worth while. In the case reported, about four-fifths of the total hair-bearing area was avulsed and was sutured back in place 1½ hours later. No special techniques were used but the author emphasizes the prevention of drying of the inside of the detached scalp and the wound on the head, and also the avoidance of irritation of either raw surface by chemicals, physical means, or otherwise. Lu, M. M. (1969), 'Successful Replacement of Avulsed Scalp. Case Report ', Plast. reconstr. Surg., 43, 231. Bone Plating for Mandibular Fractures In 101 cases of fractured mandible, 136 plates have been used for fixation. The plates are about 1 inch long and made of vitallium, with four holes. In 5 cases the plates were removed for infection and 2 had to be removed later to prevent ulceration into the mouth. The plates are screwed to the lateral surface of the mandible; if attached to the inferior border, they may bend. The authors feel that this is an excellent method of mandibular fracture fixation but the reviewer wonders if it is justifiable any longer to make a wound and a
subsequent scar on one or both sides of the neck an intra-oral approach will achieve as much by techniques. SNELL, A., and DOTT, W. A. (1969), ' Internal tion of Certain Fractures of the Mandible by Plating ', Plast. reconstr. Surg., 43, 281.
when other FixaBone
Early Traumatic Epilepsy By early, Professor Jennett means within 1 week of injury and he regards early epilepsy as being different in a number of important ways from epilepsy of later onset. His conclusions are based on 549 patients that had suffered closed injury of the head. Epilepsy starts during the first week after injury nearly thirty times more frequently than in any subsequent week and when of this early onset it is often focal. Recurrent attacks are three times more likely to follow a first fit occurring after the first week than one occurring during it. Nevertheless, a higher proportion of patients that developed late epilepsy had had the onset in the first week than later. He suggests that when fits occur several weeks after early epilepsy they should be regarded as being late epilepsy and not recurrences of the original attack(s). JENNEa-r, W. B. (1969),' Early Traumatic Epilepsy ', Lancet, 1, 1023. Lumbar Puncture Thirty patients with raised intracranial pressure became worse after lumbar puncture; the deterioration occurred with dramatic rapidity in half the patients, in the other half it came on within 12 hours. Radiographic films showed displacement of the pineal gland in a quarter of the cases and erosion of the clinoid processes in nearly a third of them. Although all the patients in this series were the victims of intracranial disease, the lessons for doctors treating patients with head injuries are clear. DUFFV, G. P. (1969), ' L u m b a r Punctures in the Presence of Raised Intracranial Pressure ', Br. reed. J., 1, 407. Cerebral Embolus A man had his arm 6rawn into a tyre-shredding machine and suffered complete paralysis of the brachial plexus and rupture of the subclavian artery. In the course of amputation a clot was removed from the subclavian artery, which was ligated ' well proximally '. Forty-eight hours later he developed left homonymous hemianopia without any other sign of neurological disorder. This was attributed to occlus;on of the calcarine branch of the posterior cerebral artery, which was thought to originate in turn from the retrograde spread of thrombns from the subclavian to the vertebral artery. EDGAR, M. A., and JOYCE, M. (1969), 'Cerebral Embolus after Traction Injury of the Arm ', Br. med. J., 2, 805.