Surgical elevation of the depressed bone is known to be the conventional treatment usually recommended for a simple depressed skull fracture in the adult or pediatric age. The authors introduce, however, a case of depressed skull fracture in an infant which was elevated by means of a cup of breast pump and a suction generator without surgical elevation. In our case, without surgery, a 'cup-shaped' depressed skull fracture in an infant was safely elevated with no neurological signs. This method is considered a simple, effective, safe, and alternative procedure in an infant with simple depressed skull fracture.
Adult ; Breast* ; Humans ; Infant ; Skull Fracture, Depressed* ; Skull Fractures ; Suction*

OBJECTIVE: In the pediatric population the skull has not yet undergone ossification and it is assumed that the diagnostic rate of skull fractures by simple X-rays are lower than that of adults. It has been recently proposed that the diagnostic rates of skull fractures by 3-dimensional computer tomography (3D-CT) are higher than simple X-rays. The authors therefore attempted to compare the diagnostic rates of pediatric skull fractures by simple X-rays and 3D-CTs with respect to the type of fracture. METHODS: One-hundred patients aged less than 12 years who visited the Emergency Center for cranial injury were subject to simple X-rays and 3D-CTs. The type and location of the fractures were compared and Kappa statistical analysis and the t-test were conducted. RESULTS: Among the 100 pediatric patients, 65 were male and 35 were female. The mean age was 50+/-45 months. 63 patients had simple skull fractures and 22 had complex fractures, and the types of fractures were linear fractures in 74, diastatic fractures 15, depressed fractures in 10, penetrating fracture in 1, and greenstick fractures in 3 patients. Statistical difference was observed for the predictive value of simple skull fractures' diagnostic rate depending on the method for diagnosis. A significant difference of the Kappa value was noted in the diagnosis of depressed skull fractures and diastatic skull fractures. CONCLUSION: In the majority of pediatric skull fractures, 3D-CT showed superior diagnosis rates compared to simple skull X-rays and therefore 3D-CT is recommended whenever skull fractures are suspected. This is especially true for depressed skull fractures and diastatic skull fractures.
Adult ; Aged ; Child ; Emergencies ; Female ; Humans ; Male ; Skull ; Skull Fracture, Depressed ; Skull Fractures

It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text.
Dental Occlusion ; Humans ; Intubation* ; Jaw Fractures ; Maxilla ; Skull ; Tracheotomy

PURPOSE: In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries. METHODS: Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs. RESULTS: Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures. CONCLUSION: Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.
Brain Injuries ; Contusions ; Hematoma, Subdural ; Hemorrhage ; Humans ; Incidence ; Mandibular Fractures ; Maxilla ; Maxillary Fractures ; Medical Records ; Motor Vehicles ; Orbit ; Retrospective Studies ; Skull Fractures ; Subarachnoid Hemorrhage, Traumatic ; Zygoma

Ethmoid Bone ; injuries ; Humans ; Orbital Fractures ; surgery ; Skull Fractures ; surgery

OBJECTIVEIn order to improve the diagnosis and treatment of the complex fracture of the orbit region and adjacent cranio-maxillofacial fracture.

METHODS73 cases with blowout fracture of the orbit and adjacent cranio-maxillofacial fracture in recent years were retrospectively analyzed and comparied with different methods of treatment. All cases had undertaken CT examinations.

RESULTSThe positive rate of the CT examinations with blowout fracture of the orbit and adjacent cranio-maxillofacial region were 100%. Operating repositioning, rigid fixation and artificial material placement were used to treat this kind of deformities.

CONCLUSIONSWith the progress of modern photographic methods, blowout fracture of the orbit and adjacent cranio-maxillofacial fracture can be diagnosed clearly and help the operation procedure. Operations with reduction, rigid fixation and filling materials can be used to restore this kind of fracture and appearance.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Maxillary Fractures ; surgery ; Maxillofacial Injuries ; surgery ; Middle Aged ; Orbital Fractures ; surgery ; Reconstructive Surgical Procedures ; Skull Fractures ; surgery

OBJECTIVETo analyze the epidemiological characters of fresh maxillofacial fractures in hospitalized patients by the retrospective study.

METHODSFrom Jan. 2008 to Dec. 2013, a total of 1 009 patients with fresh maxillofacial fractures treated at Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were investigated. The data were statistically analyzed by SPSS 21.0.

RESULTSThe male and female ratio was 2.94:1 and 33.5% of the patients aged from 20 to 30 years. The most common cause of the fresh fracture was road traffic accidents (424 cases, 42.0%), followed by tumblings (250 cases, 24.8%) and violence (128 cases, 12.7%). The number of new fracture was increasing gradually in recent years. The patients were at peak of 20-29 years old. The mandibular fracture was the most frequently seen (536 cases, 53.1%), followed by zygomatic complex fractures (233 cases, 23.1%). The simple maxillary fracture was rare and usually combined with other fractures. Infraorbital nerve injury was the most common one in nerve injuries (144 cases). The most common associated injury was extremity injuries (77 cases), followed by thoracic injury (65 cases) and craniocerebral injury (57 cases). Associated injuries were mostly caused by car accidents (127 sites), followed by fall (32 sites). Logictic regression analysis showed that fall and tumbling were risk factors of mandibular and condylar fracture (OR > 1, P < 0.05), while age was a protective factor (OR > 1, P < 0.05).

CONCLUSIONSOral and maxillofacial fresh fractures most commonly occurred in young people, and the most common cause of fractures was road traffic accidents. Infraorbital nerve was involved frequently. The most common associated injuries was extremity injuries.

Accidental Falls ; statistics & numerical data ; Accidents, Traffic ; statistics & numerical data ; Adult ; Beijing ; epidemiology ; Female ; Hospitalization ; statistics & numerical data ; Humans ; Male ; Mandibular Fractures ; epidemiology ; etiology ; Maxillary Fractures ; epidemiology ; etiology ; Maxillofacial Injuries ; epidemiology ; etiology ; Regression Analysis ; Retrospective Studies ; Risk Factors ; Sex Distribution ; Skull Fractures ; Violence ; statistics & numerical data ; Young Adult ; Zygomatic Fractures ; epidemiology ; etiology

OBJECTIVETo study the reconstructive effect of the dissociate bone flap to repair the macrosis depressed skull fracture on the frontal and orbit part.

METHODSThe coronal scalp flap was elevated and dissociate bone flap was expanding to the 2cm width beside the edge of depressed skull fracture. The first step was to extract the dissociate bone flap and make there is an area for operating . Then extract free bone fragments, and elevate the depressed orbital lamina and use the biological glue to stick it to its position. The free fragments extracted were stacked into a whole one and it to its position in use of the biological glue on the dissociate bone flap. The uneven inner table should was smoother with bon-wax. The prosthetic dissociate bone flap was put back on its position and fixation.

RESULTSFrom January 2000 to December 2004, 17 cases of the macrosis depressed skull fracture on the frontal and orbit part undertaken plastic surgery by the dissociate bone flap to treat the macrosis depressed skull fracture and obtained excellent curative effect.

CONCLUSIONSUsing dissociate bone flap to treat the mocrosis depressed skull fracture on the frontal and orbit part can avoid the complication of the traditional operation, and make the method become a plastic surgical operation.

Adult ; Bone Transplantation ; methods ; Female ; Humans ; Male ; Orbit ; Orbital Fractures ; surgery ; Reconstructive Surgical Procedures ; methods ; Skull Fracture, Depressed ; surgery ; Surgical Flaps ; Young Adult

The purpose of this report is to evaluate the validity of the differential diagnosis of epidural and subdural hematomas on the basis of the varied angiographic findings and also to determine the correlation between hematoma shape and the injury-angiogram time interval in subdural hematomas. Conventional cerebral angiograms in 27 cases of epidural and 53 cases of subdural hematoma among surgically proven 155 intracranial hematoma patients, observed at the Department of (Neurosurgery) Seoul National University Hospital, during the past 5 years from August, 1968 to July 1973, were reviewed. 53 subdural hematomas were subdivided into three groups upon the injury-angiogram time interval as follows: acute; within 48 hours ---------- 28 cases, subacute; 3 days to 2 weeks ---------- 14 cases, chronic; over 2 weeks ---------- 11 cases. The results were as follows: 1. In epidural hematoma, the A-P view of angiogram showed typical lentiform (biconvex) avascular zone in 11 cases and crescent-shaped avascular zone in 3 cases among total 27 cases, whereas in acute to subacute subdural hematoma it showed crescent-shaped avascular zone in 15 cases but only 2 cases showed the lentiform appearance. 2. Lentiform avascular zone was also typically seen in 5 cases of chronic subdural hematoma, but it might be differentiated from that of epidural hematoma with more clear inner margin in the former. 3. In epidural hematoma, the following characteristic findings providing excellent diagnostic aids were also noted. 1) medial or inward displacement of middle meningeal artery ---------- 3 cases, 2) extravasation from middle meningeal artery into arterio-venous sheath-4 cases into hematoma ---------- 2 cases, 3) amputation of middle meningeal artery ---------- 2 cases, 4) extravasation from dural sinus ---------- 4 cases, 5) displacement of dural sinus from the inner table of skull ---------- 4 cases, 6) lentiform avascular zone only ---------- 4 cases. In 20 cases of epidural hematoma, one or more of the above findings could be found. Among them, extravasation from middle meningeal artery and dural sinus, amputation of middle meningeal artery and displacement of dural sinus were thought as pathognomonic. In subdural hematoma, none of the above findings was seen. 4. In subdural hematoma, hematoma shape (avascular zone) showed some tendency to change its from according to the injury-angiogram time interval: in the group ranging from 1 to 7 days and over a month, the crescent-shaped hematoma was predominant and in the group between these periods, lentiform hematoma and hematoma with flat inner margin were somewhat predominant. But there was no valid basis for predicting the age of subdural hematoma from its configuration at angiography. 5. There was no direct correlation between the shape of the hematoma and the patients' age. 6. Simple skull roentgenogram provided some aids in the differential diagnosis between epidural and chronic subdural hematoma. 20 cases out of 27 epidural hematomas showed linear or depressed skull fracture, whereas only 1 out of 11 cases of chronic subdural hematoma showed linear skull fracture.
Amputation ; Angiography ; Diagnosis, Differential ; Hematoma ; Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Humans ; Meningeal Arteries ; Seoul ; Skull ; Skull Fracture, Depressed ; Skull Fractures

OBJECTIVE: Forehead deformities are often caused by lack of treatment or incorrect restoration of the frontal buttress, so the underlying frontal buttress should be restored to its previous position to ensure that the previous forehead contour is restored in cases of complex depressed skull fractures. However, since brain injuries from skull fractures could have fatal consequences, the clinical concern in primary surgery has been to save the patient's life, and cosmetic concerns have always been secondary. We retrospectively reviewed fronto-orbital fracture patients who underwent primary restoration with primary bone fragments or an alloplastic implant and compared the surgical outcomes of autologous bone (group 1) and artificial materials (group 2). METHODS: A retrospective review was conducted of 47 patients with fronto-orbital fractures between March 2012 and January 2018. The patients underwent primary reconstruction with primary bone fragments or an alloplastic implant. The surgical results were evaluated by the incidence of infection and cosmetic satisfaction of patients. RESULTS: Infections occurred in one patient (5%) in group 1 and in two patients (15.3%) in group 2, which was not a statistically significant difference. In contrast, at 6 months after surgery, patient satisfaction showed a statistically significant between-group difference (group 1: 4.32 points, group 2: 3.54 points, p=0.001). CONCLUSION: Primary reconstruction using fractured bone fragments is an effective and preferable method that could result in better surgical outcomes than restoration using an alloplastic implant.
Brain Injuries ; Congenital Abnormalities ; Forehead ; Frontal Sinus ; Humans ; Incidence ; Methods ; Patient Satisfaction ; Retrospective Studies ; Skull Fracture, Depressed ; Skull Fractures