The British journal of oral & maxillofacial surgery
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Br J Oral Maxillofac Surg · Mar 2010
Isolated posterior orbital floor fractures, diplopia and oculocardiac reflexes: a 10-year review.
Isolated fractures of the posterior orbital floor are rarely encountered in facial trauma, but warrant appropriate management to afford optimum recovery from debilitating diplopia and symptoms of activation of the oculocardiac reflex. We reviewed all records of patients with isolated fractures of the orbital floor between 1997 and 2007. Seven of 58 fractures operated on during this time involved the posterior orbit alone (all male, age range: 10-23). ⋯ Diplopia will improve postoperatively, but will persist over months, and patients should be well informed of this. Interestingly none of our patients' injuries were the result of assault, even though this accounted for nearly 75% of all facial fractures treated in our department. Five of the seven patients were adults, and the mechanism of fracture pointed to being crushed by injuries of low velocity and high force.
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Br J Oral Maxillofac Surg · Jan 2010
Case ReportsTapia's syndrome after repair of a fractured mandible.
A 41-year-old gentleman underwent surgical repair of the fractured right parasymphisis and left condyle of his mandible. Post-operatively he developed hoarseness of voice and dyspnoea during speech, with deviation of the tongue on protrusion. After excluding intracranial and surgical causes, a clinical diagnosis of Tapia's syndrome was made.
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Br J Oral Maxillofac Surg · Dec 2009
Blood transfusion in bimaxillary orthognathic operations: need for testing of type and screen.
We prospectively evaluated the incidence of blood transfusion in 105 consecutively treated patients (45 men and 60 women) having bimaxillary orthognathic operations, to find out whether type and screen testing are adequate in clinical practice. All patients had Le Fort I osteotomy combined with bilateral sagittal split osteotomy of the ramus. The preoperative routine was restricted to type and screen testing and verification of ABO/Rhesus (Rh) status. ⋯ No patients had an allogeneic blood transfusion. We found that type and screen testing and verification of ABO/Rh status seems to be an adequate precaution to manage blood loss. As reflected by the low rate of transfusion in the present study, severe haemorrhage that requires transfusion of allogeneic blood has become the exception rather than the rule in bimaxillary orthognathic operations.