• 대한두개안면성형외과학회지
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• 제14권2호
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• pp.119-123
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• 2013

Except for special situations, it is generally agreed that best results in the treatment of facial fractures is expected if reduction is done within the first 2 or 3 weeks after injury. We reduced facial bone fractures at 4 to 7 weeks after trauma. A 44-year-old female patient underwent open reduction for her right zygomaticomaxillary complex fracture at 7 weeks after injury. A 59-year-old female patient underwent surgery for the right mandible body and left parasymphysis fractures at 4 weeks after injury. Using traditional approaches, granulation tissue and callus were removed from the fracture sites, and malunited fracture lines were separated by a small osteotome. We reduced the displaced fractured zygoma and mandible to their normal anatomical positions and fixed them using titanium plates. No complications such as asymmetry, malunion, malocclusion, or trismus were seen. Unfavorable asymmetric facial contours were corrected, and we obtained good occlusion with favorable bony alignment. The functional and aesthetic outcomes were satisfactory. Through removal the callus and limited osteotomy, a successful approach to the previously fractured line was possible, and an exact correction with symmetry was obtained. This method can be a good option for obtaining good mobility and clinical results in treating delayed facial bone fractures.

• Archives of Plastic Surgery
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• 제50권1호
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• pp.37-41
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• 2023

Background The coronavirus disease 2019 (COVID-19) outbreak has had a major impact worldwide. Several countries have implemented restrictions on social interaction ("social distancing"). Several studies have reported that the epidemiology of trauma patients, such as those with facial bone fractures, has changed after COVID-19 pandemic. This study aimed to further explore these specific changes. Methods This was a retrospective study of patients who presented to a single institution with facial bone fractures between January 1, 2016, and December 31, 2020. Baseline patient demographics, clinical information, type of fracture, etiology, and operative management were compared before and after COVID-19. Results Of all cases, 3,409 occurred before COVID-19, and 602 occurred after COVID-19. Since the outbreak of COVID-19, the number of patients with facial fractures has not decreased significantly. A significant increase was noted in fractures that occurred outdoors (p < 0.001). However, a decrease was observed in operative management between the groups (p < 0.001). There was no significant difference in the proportion of assault, fall-down, industrial accident, or roll-down. In contrast, the proportion of traffic accidents and slip-down categories increased significantly (p < 0.05). Moreover, a significant decrease was found in the proportion of the sports category (p = 0.001) Conclusions It was confirmed through this study that COVID-19 pandemic also affected epidemiology of facial fractures. Focusing on these changes, it is necessary to develop safety measures to reduce facial fractures.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.96-101
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• 2011

Purpose: In treatment of facial bone fracture, occurred in children, we generally use wires, miniplate, absorbable plate or their combination. These foreign bodies can be palpable, and sometimes may cause infections, and need reoperation for removing. When bone fragments are multiple, small or thin, they are hard to handle and make accurate reduction of all fragments. In these cases, a biodegradable tissue adhesive, Histoacryl$^{(R)}$ (n-butyl-2-cyanoacrylate), can be used as fixation technique for small, multiple, and thin fracture fragments. Methods: 3 years old and 6 years old children, who has comminuted fracture on frontal sinus, we used Histoacryl$^{(R)}$ for fixation of multiple bone fragments. After approaching by coronal incision, we pulled out all bone fragments and reconstructed bone fragments by Histoacryl$^{(R)}$ and fixed those on frontal sinus by absorbable plates. Results: Photographs and 3-dimensional CT obtained preoperatively and postoperatively. And we compared them each other in terms of accuracy of reconstructed bony contour. We could reconstruct almost all bone fragments easily along 3-dimensional structure and get excellent aesthetic results. There was no complication such as infection. Conclusion: In treatment of comminuted facial bone fracture, occurred in children, Histoacryl$^{(R)}$ is an excellent method for accurate reconstruction in small and thin bone fragments which cannot be fixed by wire, miniplate or absorbable plate without complication.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.461-465
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• 2007

Purpose: Nasal bone fracture may be the most common fracture among facial trauma. However, diagnosis and treatment tend to be overlooked while the reduction and maintenance of fragments remain complicated. Thus, the results are plagued with high rate of nasal deformity which leads cosmetic and functional discomfort. We took advantage of the fact that the nasal bone is one of the thinnest facial bone while at the same time being located close to the skin and utilized ultrasound in performing reduction of nasal bone. Methods:This method was performed on 25 patients with nasal bone fracture. The CL 15-7 linear array transducer (10-15MHz) ultrasound which provides a total of 7 views (3 axial views and 4 transverse views) of the elevator under the bony fragments was enough for the surgeon to accurately perform the reduction. Results: In our class, an accurate and precise reduction has been made possible by real time images before, during, and after the procedure with the help of ultrasound while reducing the exposure to radiation. Conclusion: Compared to previous methods, satisfaction of patients has increased in the nasal tip, minimal fracture of the side wall and secondary reduction cases. Therefore, the incorporation of ultrasound in the closed reduction of nasal bone may prove to be a useful method.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권2호
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• pp.171-176
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• 2005

Although there have been many clinical studies about the facial trauma in the recent as well as in the past, severity and frequency of facial trauma are reported multifarious. It seemed to be because of variety of social, cultural, and environmental factors, and the view point of investigators. In this study, we investigated about the patients visiting emergency room during recent 5 years(1999-2003), and compared with retrospective study during former 5 years(1992-1996) in Dept. OMS Pusan Univ-Hospital. We are assessed the cause, type, demographic ect. And analyzed alterations of facial bone fractures during past 2 periods. the results were as follows. The total number of patients was increased slightly. 429 patients treated for maxillofacial fractures between January 1992 and December 1996 and 466 patients treated between January 1992 and December 1996. The male-to-female ratio reduced in the second period by a factor of 0.7. Patients in the age groups of 10-19 years and 20-29 years increased by a factor of 4.2 and 7.9 in the second period. Assaults and falls in the second period decreased by a factor of 15.4 and 7.9. But, traffic accidents and slip downs in the second period increased by a factor of 6 and 6.6. The mandibular fractures(70.6%) showed the highest incidence, followed by zygomatic bone and arch fractures(7.5%), maxillary bone fractures(4.0%), and nasal bone fractures(4.0%). In the second period, the mid-face fracture was increased slightly. So, the mandibular fractures(69.0%) followed by maxillary bone fractures(12.9%), zygomatic bone and arch fractures(8.0%), nasal bone fractures(7.0%). Ramus fractures and body fractures of mandible was increased slightly in the second period.

• 대한두개안면성형외과학회지
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• 제19권1호
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• pp.1-2
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• 2018

Theoretically, panfacial bone fractures involve all three areas of the face: frontal bone, midface, and mandible. In practice, when two out of these three areas are involved, the term "panfacial bone fracture" has been applied. We can use physical examination, simple radiologic examination, and computed tomography study for diagnosis. Linear fracture are treated by conservative treatment. But, most of panfacial bone fracture patients need to be treated by open reduction and internal fixation. Facial width is most important thing that we need to care during operation. There are many ways about sequence like "top to bottom," "bottom to top," "outside to inside," or "inside to outside" and the authors prefer "top to bottom" and "outside to inside" ways. The authors apply arch bar from the first of surgery and then, set frontal bone fracture, midface fracture and mandible fracture in sequence. Usually, we remove the stitches for 5 days after surgery and the intraoral stitch removed after 2 weeks. Usually arch bar is going to be removed 4 weeks after surgery. We could get acceptable results with the above way.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권6호
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• pp.306-316
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• 2015

Objectives: The facial bones are the most noticeable area in the human body, and facial injuries can cause significant functional, aesthetic, and psychological complications. Continuous study of the patterns of facial bone fractures and changes in trends is helpful in the prevention and treatment of maxillofacial fractures. The purpose of the current clinico-statistical study is to investigate the pattern of facial fractures over a 4-year period. Materials and Methods: A retrospective analysis of 1,824 fracture sites was carried out in 1,284 patients admitted to SMG-SNU Boramae Medical Center for facial bone fracture from January 2010 to December 2013. We evaluated the distributions of age/gender/season, fracture site, cause of injury, duration from injury to treatment, hospitalization period, and postoperative complications. Results: The ratio of men to women was 3.2:1. Most fractures occurred in individuals aged between teens to 40s and were most prevalent at the middle and end of the month. Fractures occurred in the nasal bone (65.0%), orbital wall (29.2%), maxillary wall (15.3%), zygomatic arch (13.2%), zygomaticomaxillary complex (9.8%), mandibular symphysis (6.5%), mandibular angle (5.9%), mandibular condyle (4.9%), and mandibular body (1.9%). The most common etiologies were fall (32.5%) and assault (26.0%). The average duration of injury to treatment was 6 days, and the average hospitalization period was 5 days. Eighteen postoperative complications were observed in 17 patients, mainly infection and malocclusion in the mandible. Conclusion: This study reflects the tendency for trauma in the Seoul metropolitan region because it analyzes all facial fracture patients who visited our hospital regardless of the specific department. Distinctively, in this study, midfacial fractures had a much higher incidence than mandible fractures.

• Journal of Acupuncture Research
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• 제33권1호
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• pp.95-101
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• 2016

Objectives : The aim of this report was to investigate the effects of Korean medical treatment on facial nerve paralysis with sensorineural hearing loss and tinnitus caused by traumatic temporal bone fracture. Methods : We treated a patient with acupuncture, herbal medicine and physiotherapy. The effect of these treatments was evaluated by House-Brackmann facial grading scale, Yanagihara's unweighted grading system and by Digital Infrared Thermographic Image. Results : After 21 days of Korean medical treatment, House-Brackmann facial grading scale changed from III to II and Yanagihara's unweighted grading score increased from 14 to 27. Digital Infrared Thermographic Image also improved. Conclusions : These results suggest that Korean medical treatments were effective in treating facial nerve paralysis with sensorineural hearing loss and tinnitus caused by traumatic temporal bone fracture. We hope that a more efficient application of this treatment will be the result of clinical data accumulated in future studies.

• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.33-36
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• 2009

Purpose: Fractures of the mandibular condylar area are common injuries that account for 29% to 40% of fractures of the facial bones and represent 20% to 62% of all mandibular fractures. Currently 3 main methods are being used in the treatment of mandibular subcondylar fractures: closed reduction; open reduction and internal fixation; Endoscopic reduction and internal fixation. Each method has its proponents and opponent as well as advantages and disadvantages, and indications for each vary among surgeons. There are six approaches of open reduction: submandibular, retromandibular, preaurilcular, postauricular, intraoral, transparotid approach. Among them, transparotid approach has been described for subcondylar exposure with dissection in the direction of facial nerve fibers to expose the bone through the parotid gland. This approach carries the risk of a parotid glandular fistula as well as facial nerve injury but has the advantage of being directly over the fracture site. We report safety and efficacy of surgical treatment using a transparotid approach for direct plating. Methods: A 43-year-old man sustained multiple facial bone fractures by driver traffic accident. Mandibular subcondyle was fractured and dislocated internally. We performed open reduction and internal fixation by transparotid approach. Fractured site was fixed by titanium mini plate & screw. We applicated arch bar for approximately 3 weeks. Results: Follow-up length was about 5months. Scar of surgical incision was indistinct, there was no symptoms and signs of facial nerve and parotid gland injury, and maximal mouth opening was measured 49.5 mm. Conclusion: Transparotid approach has high risks of facial nerve and parotid gland injury, but paradoxically it is the most effective technique in saving facial nerve. Open reduction and internal fixation of mandibular subcondylar fracture by transparotid approach with precise and versed procedure, best outcome can be expected.

• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.97-104
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• 2017

Background: Nasal bone fracture is one of the most common facial bone fracture types, and the surgical results exert a strong influence on the facial contour and patient satisfaction. Preventing secondary deformity and restoring the original bone state are the major goals of surgeons managing nasal bone fracture patients. In this study, a treatment algorithm was established by applying the modified open reduction technique and postoperative care for several years. Methods: This article is a retrospective chart review of 417 patients who had been received surgical treatment from 2014 to 2015. Using prepared questionnaires and visual analogue scale, several components (postoperative nasal contour; degree of pain; minor complications like dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, and headache; and degree of patient satisfaction) were evaluated. Results: The average scores for the postoperative nasal contour given by three experts, and the degree of patient satisfaction, were within the "satisfied" (4) to "very satisfied" (5) range (4.5, 4.6, 4.5, and 4.2, respectively). The postoperative degree of pain was sufficiently low that the patients needed only the minimum dose of painkiller. The scores for the minor complications (dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, headache) were relatively low (36.4, 40.8, 65.2, 32.3, and 34 out of the maximum score of 100, respectively). Conclusion: Satisfactory results were obtained through the algorithm-oriented management of nasal bone fracture. The degree of postoperative pain and minor complications were considerably low, and the degree of satisfaction with the nasal contour was high.