Objective:To compare the outcomes of simultaneous versus staged nasal bone reduction and septoplasty in the treatment of traumatic nasal bone fractures with associated septal fractures. Methods:Patients with traumatic nasal bone fractures, with or without septal fractures, were recruited from two hospitals and divided into three groups. Group A underwent simultaneous nasal bone reduction and septoplasty, Group B underwent staged nasal bone reduction and septoplasty, and Group C underwent nasal bone reduction only. Nasal appearance scores and nasal congestion Visual Analogue Scale （VAS） scores were measured preoperatively, at 2 weeks postoperatively, and at 3 months postoperatively. For Group B, scores were also recorded at 2 weeks and 3 months after the second-stage surgery. Differences were analyzed using statistical software. Results:Two weeks post-surgery, the nasal appearance scores significantly decreased in all three groups compared to preoperative scores （P< 0.01）, with no statistically significant differences between the groups （P= 0.43, 0.71, 0.58）. In Group A, the VAS score for nasal congestion decreased significantly following simultaneous surgery （P<0.01）. In Group B, there were no significant differences in nasal congestion VAS scores between pre-surgery and post-first-stage, nor between three months post-first-stage and two weeks post-first-stage （P= 0.61, 0.13）. However, the VAS scores significantly decreased after the second-stage surgery compared to pre-surgery, and three months post-second-stage surgery compared to three months post-first-stage surgery （P<0.01）. The VAS scores for nasal congestion at two weeks post-surgery in Group A were lower than those in Group B after the first-stage surgery （P<0.01）. The incidence rates of nasal adhesions post-surgery in Groups A, B, and C were 0%, 6.9%, and 4.3%, respectively. Conclusion:For traumatic nasal bone fractures with associated septal fractures, performing simultaneous nasal bone reduction and septoplasty under general anesthesia using endoscopy is more time-efficient compared to staged surgery, and it results in a lower occurrence rate of post-surgical nasal adhesions.
Humans ; Nasal Bone/surgery* ; Nasal Septum/injuries* ; Treatment Outcome ; Rhinoplasty/methods* ; Male ; Female ; Adult ; Skull Fractures/surgery* ; Fractures, Bone/surgery* ; Middle Aged ; Adolescent

OBJECTIVES: This study aims to analyze the biomechanics of three kinds of rigid internal fixation methods for condylar head fractures. METHODS: A three dimensional finite element model of the normal mandible was constructed. It was then used to prepare condylar head fracture finite element model and three kinds of rigid internal fixation finite element model (unilateral tension screw, bilateral tension screw, tension screw+titanium plate). The mechanical characteristics and changes of the mandible condyle under the same mechanical conditions were compared among the three different rigid internal fixation methods. RESULTS: The maximum equivalent stress and displacement of the non-free end of condyle under the rigid internal fixation method of unilateral tension screw were 71.03 MPa and 4.72 mm, respectively. The maximum equivalent stress and displacement of the free end of condyle were 78.45 MPa and 4.50 mm, respectively. The maximum stress of fracture suture was 3.27 MPa. The maximum equivalent stress and displacement of the non-free end of condyle under the rigid internal fixation method of bilateral tension screw were 70.52 MPa and 4.00 mm, respectively. The maximum equivalent stress and displacement of the free end of condyle were 72.49 MPa and 3.85 mm, respectively. The maximum stress of fracture suture was 2.33 MPa. The maximum equivalent stress and maximum displacement of the non-free end of condyle under the rigid internal fixation method of tension screw+titanium plate were 67.26 MPa and 2.66 mm, respectively. The maximum equivalent stress and maximum displacement of the free end of condyle were 69.66 MPa and 2.50 mm, respectively. The maximum stress of fracture suture was 2.18 MPa. CONCLUSIONS The tension screw+titanium plate rigid internal fixation method is the most conducive to biomechanical distribution for condylar head fractures.
Fracture Fixation, Internal/instrumentation* ; Mandibular Condyle/surgery* ; Biomechanical Phenomena ; Bone Screws ; Finite Element Analysis ; Humans ; Mandibular Fractures/surgery* ; Bone Plates ; Titanium ; Stress, Mechanical

Pathological fractures after jaw cyst surgery are rare clinically but are a serious complication. Once a pathological fracture occurs, treatment time and economic costs increase, and doctors face difficulty in handling it. This article reports a case of a patient with mandibular pathological fractures after multiple odontogenic keratocyst surgery of the jaw. Mandibular lesions were located in the bilateral mandibular angles and had macrocystic changes. We adopted a conservative treatment plan, and the treatment effect was good. We also discussed and analyzed relevant literature to provide a reference for clinicians.
Humans ; Odontogenic Cysts/surgery* ; Conservative Treatment ; Postoperative Complications/therapy* ; Mandibular Fractures/etiology* ; Fractures, Spontaneous/etiology* ; Male ; Female

Objective: To report a case of mandibular fracture in a newborn presenting with post-delivery oral cavity bleeding and to discuss its etiology, clinical findings, diagnosis, management and outcome after treatment. Methods: Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One Results: A newborn girl was referred for oral cavity bleeding after partial breech extraction. An intraoral hematoma and symphyseal step deformity on examination corresponded to a complete fracture of the symphysis and downward displacement of the left hemimandible on facial CT scans with 3D reconstruction. An uneventful closed reduction with external fixation using acrylic cap splint with circum-mandibular wiring was performed under general anesthesia and she was discharged feeding well. The cap splint and wires were removed after 4 weeks showing good facial symmetry and bone alignment. There were no complications on follow-up after 1 year. Conclusion Mandibular fracture can result from traumatic delivery and present with oral bleeding and hematoma. A thorough physical examination and workup should be done to assess for the sites involved. A multidisciplinary approach should be undertaken to provide the best possible care with the least invasive technique.
Mandibular Fractures ; Infant, Newborn

OBJECTIVES: This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. METHODS: Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. RESULTS: At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. CONCLUSIONS The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.
Male ; Female ; Humans ; Mandibular Condyle/surgery* ; Cicatrix/surgery* ; Fracture Fixation, Internal/methods* ; Mandibular Fractures/surgery* ; Oral Surgical Procedures/methods* ; Treatment Outcome

Humans ; Mandibular Fractures/etiology* ; Retrospective Studies

Objective: To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient. Methods: Study Design:Surgical Instrumentation Setting:Tertiary Government Training Hospital Patient:One Results: Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted. Conclusion Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.
Human ; Male ; Adult (a Person 19-44 Years Of Age) ; Skull Fracture, Basilar ; Cranial Fossa, Posterior

ABSTRACT The main aim of orbital fracture reconstruction is to restore the functional and aesthetic components of the eye. However, it is known that surgery for complex three-dimensional anatomy of the orbit is always a challenge. With recent advancements in technology, surgical predictability and outcomes have greatly improved. Several methods for orbital reconstruction surgery have been documented such as virtual surgical planning, intraoperative navigation, intraoperative imaging, and the use of patient-specific implant (PSI). PSI made of titanium can be designed by using a computer-aided design process and manufacturing (CAD-CAM) of CT-scan routinely used during diagnostic imaging. With precise analyses in shape and size followed by personalised implant design, the surgical precision can be alleviated further and at the same time, the surgical duration could be reduced with anticipation of better surgical outcomes. However, meticulous planning needs to be done preoperatively, with the timing of the surgery being an important factor. In the present case, pure orbital blowout fracture primarily treated with a personalised-implant solution derived from 3D-printing technology is described. Both pre-surgical and surgical workflow of this computer-assisted surgical method is elaborated. PSI for primary orbital reconstruction can be regarded as a viable alternative surgical solution including its working timeframe and adherence to the surgical protocol or algorithm.
Orbital Fractures--surgery ; Orbital Implants

It is extremely dangerous to treat the posterior third of the superior sagittal sinus (PTSSS) surgically, since it is usually not completely ligated. In this report, the authors described the case of a 27-year-old man with a ruptured and defective PTSSS caused by an open depressed skull fracture, which was treated by ligation of the PTSSS and the patient achieved a positive recovery. The patient's occiput was hit by a height-limiting rod and was in a mild coma. A CT scan showed an open depressed skull fracture overlying the PTSSS and a diffuse brain swelling. He underwent emergency surgery. When the skull fragments were removed, a 4 cm segment of the superior sagittal sinus (SSS) and the adjacent dura mater were removed together with bone fragments. Haemorrhage occurred and blood pressure dropped. We completed the operation by ligating the severed ends of the fractured sagittal sinus. One month after the operation, apart from visual field defects, he recovered well. In our opinion, in primary hospitals, when patients with severely injured PTSSS cannot sustain a long-time and complicated operation, e.g., the bypass using venous graft, and face life-threatening conditions, ligation of the PTSSS is another option, which may unexpectedly achieve good results.
Adult ; Cranial Sinuses ; Humans ; Male ; Skull Fracture, Depressed/surgery* ; Superior Sagittal Sinus/surgery* ; Tomography, X-Ray Computed

PURPOSE: The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture. METHODS: From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0. RESULTS: All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement. CONCLUSION Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.
Humans ; Joint Dislocations/surgery* ; Mandible ; Mandibular Condyle ; Mandibular Fractures/surgery* ; Suture Anchors ; Temporomandibular Joint Disc/surgery*