Plastic surgeons who perform reconstructive surgery of facial injuries have a dual responsibility: repair of the aesthetic defect and restoration of the function. The third goal is to minimize the period of disability. although emergent situations are limited in facial injuries, I would like to emphasize the advantages of prompt definitive reconstruction of the injuries and the contribution of early operative intervention to the superior aesthetic and functional outcomes. Socioeconomic and psychological factors make it imperative that an aggressive, expedient, and wellplanned surgical program be outlined, operated, and maintained to rehabilitate the patient to return to his or her active and productive life as soon as possible while minimizing aesthetic and functional disabilities. Teaching points: the techniques of extended open reduction and immediate repair or replacement of bone and microvascular tissue transfer of bone or soft tissue have made extensive and challenging injuries manageable. The principle of immediate skeletal stabilization in anatomic position has been enhanced by the use of rigid fixation and the application of craniofacial techniques that is safer and less traumatic for facial bone exposure. In this article, I will present mandibular fracture, orbital wall fracture and maxillar fracture, which are commonly encountered facial bone injuries. We can improve both the functional and aesthetic outcomes of facial fracture treatment when we manage the patients with the current concept of craniofacial techniques based on precise anatomic knowledge.
Facial Bones* ; Facial Injuries ; Humans ; Mandibular Fractures ; Orbit ; Orbital Fractures ; Psychology

This report is based on a statistical analysis of the records of 116 cases of perforating eye injuries among 39,721 patients who visited the eye department of the National Medical Center from 1971 to 1981. The results were as follows: 1. The incidence of perforating eye injuries was 0.3% of 39,721 patients and 8.7% of the ocular trauma. 2. Of patients with perforating eye injuries, 76.7% were male and 23.3% female. Perforated injuries peaked in the age group 10-19 years, with about 50% of the perforations incurred by patients in the age group 10-29 years. 3. Of perforating eye injuries, 51.7% were found in the right eye, whereas 43.1% were in the left eye. 5.2% had injuries in both eyes. 4. The corneal perforations were 60.3% of the injuries, while the scleral were 25%, and the corneoscleral 14.7%. 5. Of perforating injuries, 16.4% were caused by intraocular foreign bodies, 78.9% of which were magnetic 89.5% of the patients were males. 6. Of perforating eye injuries, 32.8% occurred in the fall and 13.8% in September. 7. The most common material(23.3%) which caused perforating injuries was metal or iron particles. 15.5% of perforating injuries were caused by broken glass, 9.5% by explosives, and 7.8% by wood splinters. 8. Associated ocular manifestations were as follows: subconjunctival hemorrhage 42.2%, prolapse of uveal tissue 37.9%, conjunctival laceration 29.3%, traumatic hyphema 27.6%, tra umatic cataract 25.9% and traumatic uveitis 17.2%. 9. Of perforating eye injuries, 57.4% were treated by surgical procedure, such as primary closure, iridectomy, replacement of the prolapsed iris, lens extraction and removal of intraocular foreign bodies. In 13.9% of injured eyes removal of the eye-ball was performed. 10. Only 19.8% of the injuries were restored to 0.6 or better and 64.0% to 0.1 or less. 11. The location of the perforation was not correlated with visual prognosis. Relatively good vision was restored in scleral perforation cases, while corneal perforations resulted in the worst vision(statistically not significant). 12. The restored visual acuity was better in occupational injuries than in nonoccupational ones(statistically not significant). 13. Better results were obtained in the cases involving magnetic intraocular foreign bodies than in those with non-magnetic ones(statistically not significant). 14. The more complications occurred, the worse vision became. 15. The cases(38) of restoration of visual acuity considered to be poor(< or =0.1) breakdown as fo llows(by cause): phthisis bulbi(18.6%), traumatic cataract(10.5%), corneal opacity(81.0%), and vitreous opacity(3.5%).
Cataract ; Corneal Perforation ; Explosive Agents ; Eye Injuries* ; Female ; Foreign Bodies ; Glass ; Hemorrhage ; Humans ; Hyphema ; Incidence ; Iridectomy ; Iris ; Iron ; Lacerations ; Male ; Occupational Injuries ; Prognosis ; Prolapse ; Uveitis ; Visual Acuity ; Wood

PURPOSE: To research about maxillofacial traumatic injuries of children in aspects of gender difference, various incidence rates between age, trauma type, cause, monthly and daily incidence rate, type of tooth damage, gingival damage, soft tissue damage, and type of facial bone fracture. MATERIALS AND METHODS: Study group consisted of children under 15 years of age who visited Dental Hospital, School of Dentistry, Kyung Hee University from 2004/7/1 to 2007/6/30 with chief complaint of oral and maxillofacial traumatic injuries. 1,559 cases of traumatic injuries were studied from 1,556 (1,004 male, 552 female) children. CONCLUSION: 1. There were slightly more boys than girls, giving a male-to-female ratio of 1.82:1.0. The 1-3 year old boys and girls had the highest number of traumatic injuries. 2. Of the 1,556 patients, 68.63% had soft tissue injuries, 50.22% had periodontal injuries, 29.89% had teeth injuries, and 3.85% had maxillofacial bone fractures. 3. Falling down was the most common cause of injury in both sexes. 4. The months with the highest incidence rates were in order May (12.12%), June (11.74%), and October (11.13%). Most of the injuries occurred on weekends. 5. The most common tooth injury was uncomplicated crown fracture, and the most common periodontal injury was subluxation. The majority of traumatizes teeth were the upper central incisors. 6. The most common soft tissue injury was intraoral lacerations. 7. Mandibular fractures were most frequent in facial bone fractures; symphysis, condylar head, and angle fractures were most frequent in mandibular fractures; maxillary and nasal bone fractures were most frequent in midfacial bone fractures.
Child ; Crowns ; Dentistry ; Facial Bones ; Fractures, Bone ; Head ; Humans ; Incidence ; Male ; Mandibular Fractures ; Maxillofacial Injuries ; Nasal Bone ; Soft Tissue Injuries ; Tooth ; Tooth Injuries

maxillofacial trauma were increased. Because of the mandible relatively protruded among the facial bone, the most frequent associated oral and maxillofacial injuries was mandible fracture in the trauma center setting. A clinical study on 411 patients with mandibular fracture who visited in Department of Oral and Maxillofacial Surgery, Chun-chon Sacred Heart Hospital during 10 years(1997-2006) was done by analysing sex, age, mode, fracture site and treatment method]]>
Accidents, Occupational ; Facial Bones ; Heart ; Humans ; Mandible ; Mandibular Fractures ; Maxillofacial Injuries ; Motor Vehicles ; Sports ; Surgery, Oral ; Trauma Centers ; Urbanization

We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS(R) solution at -70degrees C for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis.
Aged, 80 and over ; Cornea/injuries/*surgery ; Corneal Perforation/pathology/physiopathology/*surgery ; Corneal Transplantation/*methods ; *Cryopreservation ; Eye Injuries, Penetrating/pathology/physiopathology/*surgery ; Female ; Follow-Up Studies ; Humans ; *Tissue Donors ; Visual Acuity

The surgical reconstruction of complex facial injuries have focused on the following; early one-stage repair, exposure of all fracture fragments, precise anatomic rigid fixation, immediate bone grafting, and definite soft tissue management were the main surgical procedures, as in other facial bone injuries. Complex facial bone fractures involving dentition should be managed by the same principles. However, conventional methods can not achieve accurate preinjury occlusion when there are unstable fracture segments, edentulous state, or complex palatal/maxillary and mandibular fractures. Seventeen patients were surgically reconstructed in conjunction with dental impression, model surgery, and fabrication of dental splints to establish better occlusion. Among the facial fractures that had the occlusal problem, maxillary/palatal fractures and complex mandibular fractures, were the major indications for fabrication of acrylic splints. During operation, fracture segments were reduced and repositioned according to dental wear facets of the prefabricated occlusal splint and then temporary intermaxillary fixations were performed. This allowed us to accomplish precise anatomical reduction and rigid intrenal fixations. The postoperative occlusions were acceptible and no complication occurred as direct effects of dental splint. We suggest that fabrication of an acrylic occlusal splint is necessary for the management of complex facial injuries involving dentition.
Bone Transplantation ; Dentition ; Facial Bones ; Facial Injuries* ; Humans ; Mandibular Fractures ; Occlusal Splints ; Splints* ; Tooth Wear

We describe herein a case of an impending corneal perforation with a large descemetocele in a patient with previous penetrating keratoplasty (PKP) that subsequently was treated with an emergent lamellar keratoplasty using frozen preserved cornea. A 76-year-old male patient, who had a PKP, presented with a completely whitish and edematous graft accompanied by large epithelial defects. Although antibiotics and antiviral agents were tried for three days, the corneal stroma abruptly melted, except for the Descemet's membrane and endothelium. Cryopreserved corneal tissue that was kept at -80degrees C was thawed and sutured on top of the remaining Descemet's membrane and endothelium. Pathological and microbiological tests were conducted using the remaining donor and recipient corneal tissues. After tectonic corneal transplantation on top of a large descemetocele, a healthy graft and relatively clear interfaces between graft-host junctions were maintained without serious adverse reactions throughout 6 month follow-up period. Microbiological evaluations of donor tissue at the time of thawing and tissue preparation were done, and the results were all negative. Tissue that was taken intraoperatively from the recipient cornea also showed negative microbiological results. In conclusion, tectonic lamellar keratoplasty, using cryopreserved corneal tissue, only onto the remaining Descemet's membrane and endothelium in an emergent condition, was a safe and effective treatment.
Cornea/*surgery ; Corneal Perforation/pathology/physiopathology/*surgery ; Corneal Transplantation/*methods ; *Cryopreservation ; Eye Injuries, Penetrating/pathology/physiopathology/*surgery ; Female ; Humans ; Keratoplasty, Penetrating ; Male ; Middle Aged ; *Tissue Donors ; Treatment Outcome ; Visual Acuity

BACKGROUND: The number of facial bone fractures are steadily increasing because of increment of traffic volume and expansion of social activity. Also the forms of the fractures show to be more complicated due to increase of traffic vehicles. Facial region has an important role in human aesthetic and functional aspects. Therefore, it it very important to diagnose accurately and treat promptly and appropriately the fracture, to minimize deformity and functional disturbance in the face and enable the patient to socialize normally. OBJECTIVE: Our objective of this study is to elucidate general characteristics of clinical aspect in the facial bone fractures by analyzing the cases with facial bone fractures who diagnosed and treated at Nam Kwang Hospital for recent 2 years. MATERIALS AND METHODS: The authors reviewed retrospectively the medical records of 115 patients among 200 patients with facial bone fractures, excluding 85 patients who had only nasal bone fractures, diagnosed and treated at Nam Kwang Hospital from Jan. 1995 to Dec. 1996. The records of the cases were examined and analyzed according to sex and age distribution, cause of injury, symptoms and signs, associated injuries, frequency and treatment modality in each region, and complications. Results and CONCLUSIONS: The results were as follows; 1) Ninty cases(78.3%) were male and the peak age group was third decade(33.0%). 2) The most common cause of injury was motor vehicle accident(53.0%). 3) The most common symptoms and signs were pain, tenderness and edema(100%). 4) The most common associated injury was soft tissue injury(58.3%). 5) Single facial bone fracture was more common(68.7%) and among them, mandibular fracture was the most common. 6) The incidences of anatomical locations of facial bone fracture were mandible(45.2%), zygoma(39.1%), maxilla(17.4%) and frontal bone(14.8%), in order of frequency. 7) In zygomatic fractures, arch fracture was the most common(46.7%). 8) In maxillary fractures, complete Le Fort fracture type I was the most common(20.0%). 9) In orbital fractures, pure blow-out fracture was the most common(52.9%). 10) In mandibular fractures, symphysis and parasymphysis were the most common anatomical site(48.1%). 11) The cases treated with surgical approach were 70.4%. 12) The most common complication was infraorbital nerve dysfunction(6.1%).
Age Distribution ; Congenital Abnormalities ; Facial Bones* ; Humans ; Incidence ; Male ; Mandibular Fractures ; Maxillary Fractures ; Medical Records ; Motor Vehicles ; Nasal Bone* ; Orbital Fractures ; Retrospective Studies ; Zygomatic Fractures

PURPOSE: This study is to analyze the frequency and pattern of associated injuries in patients with facial fractures. METHODS: A retrospective method was used to study facial fracture patients visiting our emergency room from May 2002 to April 2003. The patient's age, sex, injury mechanism, location of facial fracture, and associated injuries, as well as the records of emergency procedures and emergency operations were examined. RESULTS: During the research, a total number of 206 patients with facial fractures were examined. As for the injury mechanism, traffic accidents were the primary cause with 40.3%. Orbital fracture was the most common overall facial fracture (44.7%). Ninety-seven (47.1%) patients had associated injuries. Fifty-nine of those patients had head injuries, 48 had extremity injuries, 17 had chest injuries, 14 had abdominal injuries, and 13 had spine injuries. Among the facial-fracture patients, patients with maxillary fractures had the most associated injuries (95.3%). Of those associated injuries, head injuries were the most commonly reported ones (48.3%). The emergency procedures used were intubations (9) and thoracostomies (4). The emergency operations performed were craniotomies (5) and exploratory laparotomies (2). Four patients died due to brain injuries. CONCILUSION: Associated injuries often occur in patients with facial fractures. Head and extremity injuries are the most common associated injuries. We believe emergency physicians can maximize the effectiveness of their treatment of patients with facial fractures and their associated injuries through a coordinated team approach, while minimizing the complications and sequelae.
Abdominal Injuries ; Accidents, Traffic ; Brain Injuries ; Craniocerebral Trauma ; Craniotomy ; Emergencies ; Emergency Service, Hospital ; Extremities ; Facial Bones ; Head ; Humans ; Intubation ; Laparotomy ; Maxillary Fractures ; Orbital Fractures ; Retrospective Studies ; Spine ; Thoracic Injuries ; Thoracostomy

OBJECTIVETo analyze the injury patterns in pan-facial fractures (PFF) which potentially lead to deficient treatment outcomes and then to propose a clinical classification.

METHODSThirty-nine patients, 31 male and 8 female, with an average age of 33, treated from 1998 to 2007 in the Center of Maxillofacial Trauma, Peking University School and Hospital of Stomatology, were included. Zygomatic complex, maxilla and mandible were involved in the extensive fracture concomitant with nasal-orbital-ethmoid (NOE) fracture or not. All cases experienced a delay of over 4 weeks after injury. An analysis was made to display the relationship between facial architecture demolition and disfigurement and disability. Treatment results were assessed with facial appearance, opening range, occlusion and regional deformities. The associated injury patterns most frequently leading to deficient outcomes were summarized as references to scheme a clinical classification.

RESULTSFacial deformities presented in 90% of the patients and mostly related to condylar fracture/dislocation and zygomatic complex fracture. Limited mouth opening occurred in 59% of patients and were caused most frequently by displacement of zygomatic complex and joint ankylosis. Malocclusion was found in 100% of cases and there were the associated optical signs in 46%. Thirty-nine cases were divided into two types. Zygomatic, maxillary and mandibular fractures all together constituted type I, which accounted for 46% of patients. Type I plus NOE fracture was type II, which accounted for 54% of patients. Furthermore, A, B and C sub-types were recognized in corresponding to involvement of condylar dislocation/fracture and zygomatic complex fracture. In treatment outcomes, a difference between type I and type II fractures remained with NOE fractures. The outcomes of term "moderate" and "worse" in subtype C group were attributed to severe soft tissue injuries and trauma-induced ankylosis.

CONCLUSIONSNOE fracture, condylar fracture and dislocation, and zygomatic complex fracture were closely associated with deficient treatment outcomes. Correspondingly, an clinical classification was proposed for PFF.

Adolescent ; Adult ; Aged ; Child ; Facial Bones ; injuries ; Facial Injuries ; classification ; Female ; Humans ; Male ; Mandibular Fractures ; classification ; Middle Aged ; Retrospective Studies ; Skull Fractures ; classification ; Young Adult