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Radical reconstruction of comminuted zygomatic complex fractures: A retrospective analysis of 10 cases
0 2 5 F : Trauma management O25F - Trauma m a n a g e m e n t
1. The Transoral/Transfacial Approach to the Anterior Skull Base
Holton, J. Department of Oral and Maxillofacial Surgery, East Texas Medical Center, Tyler, Texas Access to the midline of the anterior skull base from the sphenoid sinus though the clivus and upper cervical spine presents a challenge to the skull base surgeon. A LeFort I osteotomy with midline split of the palate allows wide field exposure of this most difficult anatomic zone. The Oral and Maxillofacial Surgeon is uniquely qualified to participate in access procedures of skull base surgery. His experience with power equipment, plating systems, and anatomy makes him a valuable part of the skull base team. Our experience with 30 transoral / transfacial approaches to the anterior skull base will be presented. Preoperative evaluation, instrumentation, intraoperative retraction and postoperative care will be discussed.
2. Battle Injuries to the Face: Sri Lankan Experience
Muthumala, M., Ekanayake, If., Wickramasuriya, G. Ministry of Health, Colombo, Sri Lanka Sri Lanka is a small island with a population little over 17 million. Since 1983 Northern & Eastern provinces have been involved in a bitter sectarian conflict or what the medi~t describe as "Guerrilla Warfare". Every conceivable type of weapon has been used, which has resulted in the full spectrurn of violent injuries. Casualties have varied from isolated cases to disaster situations. The patients admitted to General HosPital Anuradhapura from April 1992 to January 1997 and patients admitted to Military Hospital, Colombo from March 1997 to August 1998 with maxillofacial injuries sustained in war, were included in this study. Five hundred thirty-two (532) piitients have been included in this review of whom 524 (98.5%) were males, with ages ranging from 16 to 50 years. The majority ofwfiom 448 (84.2%) were in the age group of 20 to 30 years. It is generally the experience in wartime, that maxillofacial injuries constitute 10% to 20% of all casualties, but in our experience it is around 6.5%. The chief objective in the management of maxillofacial injuries is preservation of life. Tracheostomy is a procedure which saves lives, the use of which is a very important technique for maintaining the death rate at zero for this type of wound. In- our study, incidents of tracheostomies carried out was 24.2~ but for severe max, illofacial trauma, the percentage of tracheostomies performed reached a percentage of 52%. One hundred sixty eight (168) cases required intensive care. Standard bone grafting procedures were used to recon-
39
struct the mandible and the maxilla (Orbit). One hundred thirty six (22.3%) cases required bone grafting. The soft tissue reconstruction was carried out by standard plastic techniques including deltopectoral, pectoralis major and other local flaps. Only one patient died due to severe head injury. All the other patients have survived in spite of devastating injuries. The higher survival rate was achieved due to rapid evacuation, permitting resuscitation of patients whom in previous wars could not have survived. The purpose of this paper is to highlight the methods used and the experience gained by the author in the management of the missile injuries to the face.
3. Radical Reconstruction of Comminuted Zygomatic Complex Fractures: A Retrospective Analysis of 10 Cases
Van, 5.1, Chow~ T.2 aOral and Maxillofaeial Surgery and Dental Unit, Queen Mary Hospital, Hong Kong SAR, P.R. China, 2Department of Oral and Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR, P.R. China
Comminuted Zygomatic Complex Fracture (ZGC #) is not a common category of Malar Fracture. The involvement of the body of the Zygoma and significant displacement of the comminuted arch fragments indicates open reduction and internal fixation. With the advent in the craniofacial application of micro-fixation and innovative surgical access, radical reconstruction of these fractures could restore both the pre-injured anatomy precisely and function immediately. The aim of this analysis is to review the experience of open reduction and internal fixation of 10 comminuted ZGC#s in the United Christian Hospital from July 96 to September 98. The data analysis wilfinclude age, sex, etiology, location and severity of injuries which could be reflected by the concomitant fractures e.g. 2 coronoid#s, 3 zygomatic root#s, 3 cganio-bone#s, etc. All the ZGC#s were fully exposed by modified Coronal Incisign adjunct with either Transconjunctival or subcillary incisions. This enabled access for direct fixation with reinforced micro-Titanium plates. In the cases of severe comminuti0n of malar body and localization of displaced arch fragments, 3-dimensional C.T. was deployed for pre-operative assessment. The analysis will be concluded by auditing the outcome of this radical surgical approach in the aspect of minimal morbidity of the Coronal/Transconjecrival incisions, MIO, eye function, surgical blood loss and cosmetic result. The design of the modified Coronal incision and the supra-temporal fat pad dissection for full exposure of the ZGC will be highlighted.
1. The Transoral/Transfacial Approach to the Anterior Skull Base
Holton, J. Department of Oral and Maxillofacial Surgery, East Texas Medical Center, Tyler, Texas Access to the midline of the anterior skull base from the sphenoid sinus though the clivus and upper cervical spine presents a challenge to the skull base surgeon. A LeFort I osteotomy with midline split of the palate allows wide field exposure of this most difficult anatomic zone. The Oral and Maxillofacial Surgeon is uniquely qualified to participate in access procedures of skull base surgery. His experience with power equipment, plating systems, and anatomy makes him a valuable part of the skull base team. Our experience with 30 transoral / transfacial approaches to the anterior skull base will be presented. Preoperative evaluation, instrumentation, intraoperative retraction and postoperative care will be discussed.
2. Battle Injuries to the Face: Sri Lankan Experience
Muthumala, M., Ekanayake, If., Wickramasuriya, G. Ministry of Health, Colombo, Sri Lanka Sri Lanka is a small island with a population little over 17 million. Since 1983 Northern & Eastern provinces have been involved in a bitter sectarian conflict or what the medi~t describe as "Guerrilla Warfare". Every conceivable type of weapon has been used, which has resulted in the full spectrurn of violent injuries. Casualties have varied from isolated cases to disaster situations. The patients admitted to General HosPital Anuradhapura from April 1992 to January 1997 and patients admitted to Military Hospital, Colombo from March 1997 to August 1998 with maxillofacial injuries sustained in war, were included in this study. Five hundred thirty-two (532) piitients have been included in this review of whom 524 (98.5%) were males, with ages ranging from 16 to 50 years. The majority ofwfiom 448 (84.2%) were in the age group of 20 to 30 years. It is generally the experience in wartime, that maxillofacial injuries constitute 10% to 20% of all casualties, but in our experience it is around 6.5%. The chief objective in the management of maxillofacial injuries is preservation of life. Tracheostomy is a procedure which saves lives, the use of which is a very important technique for maintaining the death rate at zero for this type of wound. In- our study, incidents of tracheostomies carried out was 24.2~ but for severe max, illofacial trauma, the percentage of tracheostomies performed reached a percentage of 52%. One hundred sixty eight (168) cases required intensive care. Standard bone grafting procedures were used to recon-
39
struct the mandible and the maxilla (Orbit). One hundred thirty six (22.3%) cases required bone grafting. The soft tissue reconstruction was carried out by standard plastic techniques including deltopectoral, pectoralis major and other local flaps. Only one patient died due to severe head injury. All the other patients have survived in spite of devastating injuries. The higher survival rate was achieved due to rapid evacuation, permitting resuscitation of patients whom in previous wars could not have survived. The purpose of this paper is to highlight the methods used and the experience gained by the author in the management of the missile injuries to the face.
3. Radical Reconstruction of Comminuted Zygomatic Complex Fractures: A Retrospective Analysis of 10 Cases
Van, 5.1, Chow~ T.2 aOral and Maxillofaeial Surgery and Dental Unit, Queen Mary Hospital, Hong Kong SAR, P.R. China, 2Department of Oral and Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR, P.R. China
Comminuted Zygomatic Complex Fracture (ZGC #) is not a common category of Malar Fracture. The involvement of the body of the Zygoma and significant displacement of the comminuted arch fragments indicates open reduction and internal fixation. With the advent in the craniofacial application of micro-fixation and innovative surgical access, radical reconstruction of these fractures could restore both the pre-injured anatomy precisely and function immediately. The aim of this analysis is to review the experience of open reduction and internal fixation of 10 comminuted ZGC#s in the United Christian Hospital from July 96 to September 98. The data analysis wilfinclude age, sex, etiology, location and severity of injuries which could be reflected by the concomitant fractures e.g. 2 coronoid#s, 3 zygomatic root#s, 3 cganio-bone#s, etc. All the ZGC#s were fully exposed by modified Coronal Incisign adjunct with either Transconjunctival or subcillary incisions. This enabled access for direct fixation with reinforced micro-Titanium plates. In the cases of severe comminuti0n of malar body and localization of displaced arch fragments, 3-dimensional C.T. was deployed for pre-operative assessment. The analysis will be concluded by auditing the outcome of this radical surgical approach in the aspect of minimal morbidity of the Coronal/Transconjecrival incisions, MIO, eye function, surgical blood loss and cosmetic result. The design of the modified Coronal incision and the supra-temporal fat pad dissection for full exposure of the ZGC will be highlighted.