• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.103-110
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• 2016

Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.128-131
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• 2017

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.

• The Journal of Advanced Prosthodontics
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• v.6 no.1
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• pp.53-59
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• 2014

PURPOSE. The aim of this study was to obtain statistical data on the residual bone height at different natural tooth positions by panoramic radiography in edentulous Korean patients aged 60-90 years. MATERIALS AND METHODS. The study included the diagnostic panoramic radiographs of 180 randomly selected edentulous patients without systemic diseases affecting bone. The radiographic selection criteria included absence of obvious facial asymmetry, clearly visible anatomic structures, and no surgical and fracture history. The panoramic radiographs of 79 patients met these criteria and were used in the analysis. The same researcher processed all the radiographs by using a standardized method. The height of the residual bone was measured at 18 predetermined sites (7 in the maxilla and 11 in the mandible) on digitized and printed radiographs by using a Digimatic caliper, triangle, and ruler. Gender- and age-related differences were statistically analyzed by using the t-test and rank-sum test (${\alpha}=0.05$). RESULTS. The maxillary residual bone height did not show significant gender-related differences, but male patients had significantly higher residual bone in the mandible(P<.05). No significant height differences at the measured sites were noted among the 60s, 70s, and 80s age groups. CONCLUSION. Dentists should pay greater attention to older female edentulous patients because they are more prone to rapid residual bone resorption. Residual bone resorption may not be affected by age.

• Archives of Plastic Surgery
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• v.39 no.3
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• pp.209-215
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• 2012

Background : Among all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone. Methods : A retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty. Results : According to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes. Conclusions : IOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

• The Journal of Korean Academy of Prosthodontics
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• v.60 no.4
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• pp.395-403
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• 2022

In the fracture operation of pan facial fracture, there are many cases where the shape and position of the occlusal and oral structures are abnormally changed because the index for repositioning to the original position is insufficient. And trismus and gag reflex in patients with pan facial fractures increase the difficulty of dental treatment, and the difference in the position of the jaw bone makes it difficult to restore aesthetically and functionally. In this case, digital workflows for minimal intraoral work could be selected to reduce patient discomfort and the difficulty of dental treatment. This case is using a digital workflow from implant planning to final prosthesis production in a patient with acquired skeletal grade III, trismus, and gag reflex due to pan facial fracture 15 years ago. In this case report, the use of digital workflow in a patient who has difficulty in dental treatment was able to minimize patient discomfort and obtain esthetic and functionally appropriate results.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.5
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• pp.382-387
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• 2021

Objectives: Zygomatic complex (ZMC) fractures comprise up to 40% of all facial fractures. Misaligned bone fragments and misplaced fixation hardware traditionally detected postoperatively on plain radiographs of the skull might require re-operation. The intraoperative O-Arm (Medtronic, USA) is a three-dimensional (3D) computed tomographic imaging system. Materials and Methods: This retrospective single-center study evaluated the utility of O-Arm scanning during corrective surgeries for ZMC and zygomatic arch (ZA) fractures from 2018 to 2020. Three females and 16 males (mean age, 31.52 years; range, 22-48 years) were included. Fracture instability (n=6) and facial deformity (n=15) were the most frequent indications for intraoperative 3D O-Arm scan. Results: The images demonstrated that all fracture lines were properly reduced and fixed. Another scan performed at the end of the fixation or reduction stage, however, revealed suboptimal results in five of the 19 cases, and further reduction and fixation of the fracture lines were required. Conclusion: Implementation of an intraoperative O-Arm system in ZMC and ZA fracture surgeries assists in obtaining predictable and accurate results and obviates the need for revision surgeries. The device should be considered for precise operations such as ZMC fracture repairs.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.1
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• pp.54-59
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• 1999

This study was based on a series of 164 patients with zygomatic bone fracture treated at Department of Oral and Maxillofacial Surgery of Chonnam University Hospital from January 1992 to December 1996. The male-to-female ratio was 7:1. Their ages ranged from 8 to 78 years, with a median age of 35.6 years. The age frequency was highest in the second decade (30.5%), and third decade (23.8%), fifth decade (16.5%) in orders. The monthly distrbution of incidence showed October to be the month in which the greatest percentage occured (14.0%). The major cause of zygomatic bone fracture was alleged traffic accidents (53.7%). The incidence of concomitant facial bone fractures was 69,5%, and maxilla fracture (52.4%) was most frequently combined. The admission route was through emergency room (72.3%) and through outpatient department (26.8%). The incidence of associated injuries was 37.2%. The intraoral approach was the major method of treatment in zygomatic bone fracture (57.1%). The most frequent type of zygoma fracture was class IV (33.5%), and class III (25.6%) was next in order of frequency. Complications were enophthalmos (7.3%), facial asymmetry (6.7%), paresthesia (6.1%), and diplopia (2.4%) These results suggest that correct diagnosis and treatment of severity of fracture, concomitant fracture, and associated injuries are necessary, and co-operative treatment with medical department should be performed to reduce postoperative complication.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.599-604
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• 2007

Purpose: Blowout fractures of the orbit are common sequelae to blunt facial trauma and now increasing in number due to automobile accidents, violence and industrial disasters. There are some reports of diagnosis and treatment of this fracture, but detailed data provided in overall aspects are very few. We analysed extensive data to provide guide line of blowout fracture patients care. Methods: We retrospectively studied 387 orbital blowout fracture patients who had been followed up at least 3-6 months. Their hospital records were reviewed according to causes, fracture site, operation methods, and follow up results, etc. Results: The ratio of males to females was 7 : 3 and fractures were most often seen in the 20-29 age group. 180(47%) patients had medial orbital wall fractures, 155(40%) patients had floor fractures and 52(13%) patients had a combination of orbital floor and medial wall fractures. The highest associated bone fracture was the nasal bone(37%). The open reduction was done in the 324 patients(83.7%) and insertion materials were used in the 249 patients(77%). Total 45 patients(14%) complained of residual diplopia and 26 patients(8%) kept mild enophthalmos. 24 patients(7%) showed some restriction of extraocular muscle movements. Conclusion: We broadly surveyed the information of blow out fracture patients and believe that this study provides important prognostic information that can be of benefit to both patient and surgeon during preoperative counseling and postoperative analysis of orbital blowout fractures.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.131-138
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• 2013

Purpose: The aim of this study is to present a retrospective review of patients who had a sudden onset of facial palsy after trauma and who underwent facial nerve decompression. Methods: The cases of 25 patients who had traumatic facial palsy were reviewed. Facial nerve function was graded according to the House-Brackmann grading scale. According to facial nerve decompression, patients were categorized into the surgical (decompression) group, with 7 patients in the early decompression subgroup and 2 patients in the late decompression subgroup, and the conservative group(16 patients). Results: The facial nerve decompression group included 8 males and 1 female, aged 2 to 86 years old, with a mean age of 40.8. In early facial nerve decompression subgroup, facial palsy was H-B grade I to III in 6 cases (66.7%); H-B grade IV was observed in 1 case(11.1%). In late facial nerve decompression subgroup, 1 patient (11.1%) had no improvement, and the other patient(11.1%) improved to H-B grade III from H-B grade V. A comparison of patients who underwent surgery within 2 weeks to those who underwent surgery 2 weeks later did not show any significant difference in improvement of H-B grades (p>0.05). The conservative management group included 15 males and 1 female, aged 6 to 66 years old, with a mean age of 36. At the last follow up, 15 patients showed H-B grades of I to III(93.7%), and only 1 patient had an H-B grade of IV(6.3%). Conclusion: Generally, we assume that early facial nerve decompression can lead to some recovery from traumatic facial palsy, but a prospective controlled study should and will be prepared to compare of conservative treatment to late decompression.

• Journal of Trauma and Injury
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• v.32 no.3
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• pp.168-171
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• 2019

The treatment outcome remains poor of severe facial injuries because of the high risk of compromised airway or massive bleeding. We experienced two successful treatment cases of severe facial injury by the chainsaw. A 52-year-male had his face injured by the chainsaw during his work. He was transferred to the Level I trauma center using the Doctor-Helicopter. During his flight, bleeding control was tried and the information was given to the trauma surgeons before his arrival. His consciousness was alert and the vital signs were stable. The crushing wound, mandible open fracture, deep laceration of tongue, lip, neck and arterial bleeding were noted around his mandible. Nasotracheal intubation was performed under the bronchoscope-guided. Emergency operation (open reduction & internal fixation, primary repair with neurorrhaphy) was performed. At 30 hospital days, he was discharged with facial palsy on left mandibular area. A 30-year-male had his face injured by the chainsaw. He was transferred to our Level I trauma center from the local hospital. The deep-mutiple lacerations on right upper eyelid and forehead with the bony exposure were noted. The vital signs were stable and emergency operation was performed. He was discharged at 20 hospital days. Bone loss or tissue loss were not devastating than we expected even though the injury was occurred by the chainsaw. Aggressive treatment including airway manipulation or bleeding control and maximal opportunity of therapy are absolutely needed.