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The coronal flap approach in craniofacial trauma
Trauma magnitude of facial bone fractures and their concomitant injuries in the course of our lifetime. Material and methods: Between 2001 and 2003, 3028 patients with 8955 cranio-maxillofacial trauma were registered. Epidemiological data of patients were split up statistically into three different group based on age. Results: Age 0–19: n = 234; female:male = 27%:73%; 425 patients (181%) with facial bone fractures; 40.6% sport accidents. Concomitant injuries: lacerations (32.2%), haematoma (24,6%), lateral luxation of teeth (28.7%), craniocerebral injuries (28.7%), injuries of extremities (4.7%). Age 20–59: n = 639; female:male = 23%:77%; 1596 cases (249%) with facial bone fractures. Concomitant injuries: haematoma (32.9%), crown fractures (32.0%), fractures of the skull (10.3%). Age > 60: n = 213; female:male = 49%:51%; 496 patients (232%) with facial bone fractures. Household accidents (52.6%). Compared to young patients the elderly are more prone for facial bone fractures and concomitant injuries (fractures of the zygomatic arch increase of 204%/year of age, fractures of the orbital floor increase of 150%/ year of age); Concomitant injuries: haematoma (42.4%), dentoalveolar avulsions (26.5%), injuries of extremities (11.3%). Discussion: In the course of our lifetime, the risk for facial bone fractures and their concomitant injuries increases. For children and young adults, the highest rate of bone fractures is during the playing of sports and for seniors it is unreasonably dangerous at home. doi:10.1016/j.ijom.2007.08.460
O17.54 Maxillofacial trauma in subconventional warfare N. K. Sahoo Corps Dental Advisor, 15 Core, 56 APO, India Insurgency, terrorism and proxy war has been the most prevalent form of conflict in the modern world. It presents a serious threat and crucial challenge to the international community, governments and military establishments. The net outcomes are loss of life and destruction of properties. The Armed Forces Medical Services is dedicatedly engaged to provide the highest
standard of medical care not only to the injured soldiers of military and paramilitary establishments but also to the civilian population in India and abroad. The incidence of ballistic inflicted maxillo-facial trauma is about 14%. Maxillofacial injuries vary from soft tissue laceration to loss of hard & soft tissue. Mandible is most commonly involved followed by zygomatic complex. The etiological factors are GSW, IED blast, grenade attack and road traffic accidents associated with militancy. Management of these cases is essentially a team approach to the clinical challenge. The casualties reported to our trauma centre were treated in a comprehensive manner. The cases were treated with ORIF, reconstruction and by grafting. Various complications are also discussed. Adequate care was taken during the post-hospital phase for the oral and maxillo-facial rehabilitation of these cases. doi:10.1016/j.ijom.2007.08.461
O17.55 Life threatening haemorrhage following maxillofacial trauma I. Mohammed*, N. V. Reddy Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, India The medical literature regarding facial trauma supports the hypothesis that maxillofacial trauma alone is rarely life threatening unless associated with airway compromise or undiagnosed cervical spine injury. However, there are some situations that may cause irreversible damage unless immediate operation is undertaken. In few situations of haemorrhage associated with facial bone injuries, the conventional haemostatic measures might fail to stop bleeding and which may lead to haemorrhagic shock leading to fatality. The aim of this presentation is to review few cases of such life threatening haemorrhage encountered by us in our unit and successful management of these patients with prompt medical and emergency surgical intervention to arrest haemorrhage along with definitive management of facial bone fractures. doi:10.1016/j.ijom.2007.08.462
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O17.56 Post-trauma psychiatric disturbances in craniomaxillofacial patients M. S. Dewan*, C. Gupta Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India Psychic disturbances are well known in patients after polytrauma. We accessed the prevalence of acute symptoms of stress in patients who underwent craniomaxillofacial trauma. One hundred patients between the age group of 16–60 years were evaluated irrespective of caste and religion. Injury severity score (ISS) was used in reference to time, Davidson trauma scale was used for assessment of post-traumatic symptoms and Zung’s self-rating depression scale (ZSRDS) for assessment of depressive symptoms. Females and young patients aged between 16 and 30 years had a significant association between demographic variations. Twenty-three patients had positive DTS results at 3 months. There was a significant relation between the psychopathological variables and trauma specific symptoms. Thus, psychiatrists must play an important role in the trauma team to help the victim of facial trauma return to normal life. doi:10.1016/j.ijom.2007.08.463
O17.57 The coronal flap approach in craniofacial trauma J. Naveen*, G. Krishnan SDM College of Dental Sciences and Hospital, Dharwad, India The utilisation of the coronal scalp flap in craniofacial trauma has proved indispensable in the management of severe craniofacial injuries. It provides vast exposure of such critical structures as the cranium, frontal sinus, orbit and upper midface compared with that for previous techniques of facial fracture reduction. Although the flap has great utility severe complications such as facial nerve injury, diplopia, telecanthus and scalp necrosis can occur. This paper discusses the surgical anatomy, technique, complications and indications for the safe utilisation of the coronal scalp flap approach in the management of craniofacial trauma along with our experience in relation to the same. doi:10.1016/j.ijom.2007.08.464
O17.54 Maxillofacial trauma in subconventional warfare N. K. Sahoo Corps Dental Advisor, 15 Core, 56 APO, India Insurgency, terrorism and proxy war has been the most prevalent form of conflict in the modern world. It presents a serious threat and crucial challenge to the international community, governments and military establishments. The net outcomes are loss of life and destruction of properties. The Armed Forces Medical Services is dedicatedly engaged to provide the highest
standard of medical care not only to the injured soldiers of military and paramilitary establishments but also to the civilian population in India and abroad. The incidence of ballistic inflicted maxillo-facial trauma is about 14%. Maxillofacial injuries vary from soft tissue laceration to loss of hard & soft tissue. Mandible is most commonly involved followed by zygomatic complex. The etiological factors are GSW, IED blast, grenade attack and road traffic accidents associated with militancy. Management of these cases is essentially a team approach to the clinical challenge. The casualties reported to our trauma centre were treated in a comprehensive manner. The cases were treated with ORIF, reconstruction and by grafting. Various complications are also discussed. Adequate care was taken during the post-hospital phase for the oral and maxillo-facial rehabilitation of these cases. doi:10.1016/j.ijom.2007.08.461
O17.55 Life threatening haemorrhage following maxillofacial trauma I. Mohammed*, N. V. Reddy Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, India The medical literature regarding facial trauma supports the hypothesis that maxillofacial trauma alone is rarely life threatening unless associated with airway compromise or undiagnosed cervical spine injury. However, there are some situations that may cause irreversible damage unless immediate operation is undertaken. In few situations of haemorrhage associated with facial bone injuries, the conventional haemostatic measures might fail to stop bleeding and which may lead to haemorrhagic shock leading to fatality. The aim of this presentation is to review few cases of such life threatening haemorrhage encountered by us in our unit and successful management of these patients with prompt medical and emergency surgical intervention to arrest haemorrhage along with definitive management of facial bone fractures. doi:10.1016/j.ijom.2007.08.462
1083
O17.56 Post-trauma psychiatric disturbances in craniomaxillofacial patients M. S. Dewan*, C. Gupta Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India Psychic disturbances are well known in patients after polytrauma. We accessed the prevalence of acute symptoms of stress in patients who underwent craniomaxillofacial trauma. One hundred patients between the age group of 16–60 years were evaluated irrespective of caste and religion. Injury severity score (ISS) was used in reference to time, Davidson trauma scale was used for assessment of post-traumatic symptoms and Zung’s self-rating depression scale (ZSRDS) for assessment of depressive symptoms. Females and young patients aged between 16 and 30 years had a significant association between demographic variations. Twenty-three patients had positive DTS results at 3 months. There was a significant relation between the psychopathological variables and trauma specific symptoms. Thus, psychiatrists must play an important role in the trauma team to help the victim of facial trauma return to normal life. doi:10.1016/j.ijom.2007.08.463
O17.57 The coronal flap approach in craniofacial trauma J. Naveen*, G. Krishnan SDM College of Dental Sciences and Hospital, Dharwad, India The utilisation of the coronal scalp flap in craniofacial trauma has proved indispensable in the management of severe craniofacial injuries. It provides vast exposure of such critical structures as the cranium, frontal sinus, orbit and upper midface compared with that for previous techniques of facial fracture reduction. Although the flap has great utility severe complications such as facial nerve injury, diplopia, telecanthus and scalp necrosis can occur. This paper discusses the surgical anatomy, technique, complications and indications for the safe utilisation of the coronal scalp flap approach in the management of craniofacial trauma along with our experience in relation to the same. doi:10.1016/j.ijom.2007.08.464