• Journal of Trauma and Injury
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• 제23권1호
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• pp.38-42
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• 2010

Purpose: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. Methods: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. Results: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. Conclusion: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.150-158
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• 2006

Purpose: There are two theories about the relationships between facial fractures and cranial injuries. One is that facial bones act as a protective cushion for the brain, and the other is that facial fractures are the marker for increased risk of cranial injury. They have been debated on for many years. The purpose of this study is to identify the relationship between facial fractures and cranial injuries. Methods: A retrospective study was performed on 242 patients with facial fractures. The data were analyzed based on the medical records of the patients: age, gender, cause of injury, Injury Severity Score (ISS), alcohol intake, type of facial fractures, and type of cranial injury. The patients were divided into two groups: facial fractures with cranial injury and facial fractures without cranial injury. We compared the general characteristics between the two groups and evaluated the relationship between each type of facial fracture and each type of cranial injury. Results: Among the 242 patients with facial bone fractures, 96 (39.7%) patients had a combination of facial fractures and cranial injuries. Gender predilection was demonstrated to favor males: the ratio was 3:1. The mean age was $36.51{\pm}19.63$. As to the injury mechanism, traffic accidents (in car, out of car, motorcycle) were statistically significant in the group of facial fractures with cranial injury (p=0.038, p=0.000, p=0.003). The ISS was significant, but alcohol intake was not significant. No significant relationship between facial fractures and skull fractures was found. Only maxilla fractures, zygoma fractures, and cerebral concussion had a significant difference in cranial injury (p=0.039, p=0.025). Conclusion: There is a no correlation between facial fractures and skull fractures, which suggests that the cushion effect is the predominent relationship between facial fractures and cranial injuries.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.18-23
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• 2009

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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.42.1-42.5
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• 2018

Background: Fractures of the orbital wall are mainly caused by traffic accidents, assaults, and falls and generally occur in men aged between 20 and 40 years. Complications that may occur after an orbital fracture include diplopia and decreased visual acuity due to changes in orbital volume, ocular depression due to changes in orbital floor height, and exophthalmos. If surgery is delayed too long, tissue adhesion will occur, making it difficult to improve ophthalmologic symptoms. Thus, early diagnosis and treatment are important. Fractures of the superior orbital wall are often accompanied by skull fractures. Most of these patients are unable to perform an early ocular evaluation due to neurosurgery and treatment. These patients are more likely to show tissue adhesion, making it difficult to properly dissect the tissue for wall reconstruction during surgery. Case presentation: This report details a case of superior orbital wall reconstruction using superior orbital rim osteotomy in a patient with a superior orbital wall fracture involving severe tissue adhesion. Three months after reconstruction, there were no significant complications. Conclusion: In a patient with a superior orbital wall fracture, our procedure is helpful in securing the visual field and in delamination of the surrounding tissue.

• Journal of Korean Neurosurgical Society
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• 제37권3호
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• pp.213-216
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• 2005

Objective: We report six patients with traumatic intracerebellar hematomas between 1997 and 2003 at our hospitals. Methods: Each data about patients' clinicoradiologic findings, management, and outcomes, which were retrospectively reviewed. Results: All patients had skull fracture on occiput and five patients with large hematomas(three cm or greater) were operated on. In the results of surgery, three patients were good outcome but two patients were fatal due to compression of brain stem. One patient with small hematoma (1.5cm) was treated conservatively and recovered. Conclusion: In our cases, the clinical course and prognosis of traumatic intracerebellar hematoma were grave. The results of this study support that early diagnosis based on strict observation in patients with occipital fracture will lead to best results.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.423-427
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• 2014

Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare phenomenon, which are usually associated with head trauma such as an underlying skull fracture. They were usually known to cause acute or delayed epidural hematomas but can be associated with subdural, subarachnoid, or even intracerebral hemorrhage. Sometimes, a high mortality rate was reported in these circumferences. But the natural course of these pseudoaneurysms is not well recognized. The indication and guideline of treatment for pseudoaneurysm are also unclear. This report describes a rare case of angiographically progressive change of traumatic pseudoaneurysm of the middle meningeal artery for one week, which was treated with endovascular embolization.

• Journal of Korean Neurosurgical Society
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• 제42권5호
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• pp.403-405
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• 2007

Most posttraumatic cerebrospinal fluid (CSF) leakage is noticed by the patients with the first symptom, rhinorrhea. A 38-year-old woman presented with frequent clear continuous rhinorrhea and otorrhea for 5 years after basilar skull fracture. After this, meningitis was developed with subsequent CSF fistula. Her clinical symptom was improved by medical treatment. The dural defect and CSF leakage were not detected by computerized tomography (CT) cistemography. We report a rare case of persistent posttraumatic CSF fistula that continued for five years.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.272-274
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• 2007

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. This report describes a 50year-old man with bilateral basal ganglia hemorrhage with occipital fracture of the skull after head trauma. The mechanism of development of traumatic hemorrhage of the basal ganglia has been not clear. But, it is presumed to be secondary to rupture of the lenticulostriate or anterior choroidal artery by shearing as a result of acceleration/deceleration forces. We briefly summarize our uncommon case and discuss its possible mechanisms.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.53-57
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• 2011

We reported a unique case of posttraumatic giant infratentorial extradural intradiploic epidermoid cyst. A 54-year-old male, with a previous history of an open scalp injury and underlying linear skull fracture in the left occipital region in childhood, presented with a painful subcutaneous swelling, which had been developed gradually in the same region and moderate headache, nausea, vomiting and cerebellar ataxia. The duration of symptoms on admission was 3 months. Imaging studies revealed occipital bone destruction and giant extradural intradiploic lesion. The preoperative diagnosis was giant infratentorial extradural intradiploic epidermoid cyst. Surgery achieved total removal of the lesion, which was histologically confirmed and the postoperative course was uneventful. To our knowledge, this is the first case of giant infratentorial extradural intradiploic epidermoid cyst with a traumatic etiology described in the literature.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.188-191
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• 2010

A postoperative contralateral supra- and infratentorial epidural hematoma after decompressive surgery is an extremely rare event. We describe a 38-year-old male with a contralateral supra- and infratentorial acute epidural hematoma just after decompressive surgery for an acute subdural hematoma. A contralateral skull fracture involving a lambdoidal suture and an intraoperative brain protrusion may be warning signs. The mechanisms, along with relevant literature, are discussed.