Facial plastic surgery : FPS
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Optimal management of patients with traumatic brain injury (TBI) remains a challenge, despite significant improvements in pathophysiologic understanding and treatment strategies in recent decades. Because primary brain injury sustained at the time of trauma is irreversible, the TBI management mainly aims for early detection and treatment of secondary brain injury such as space-occupying intracerebral hematomas and brain edema. Prevention of secondary brain injury requires a high standard of care and understanding of both medical and surgical treatment modalities. This review focuses on practical recommendations for neurosurgical and intensive care management in patients with severe TBI.
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Airway management in craniofacial trauma patients is a challenge for an anesthetist. Treating these patients requires a close interdisciplinary communication and cooperation. Maintaining the airway and oxygenation of the patient is the initial challenge in craniofacial trauma patients. ⋯ It is important to be familiar with different techniques and to change the approach after two unsuccessful attempts with one technique. Once the airway is established, all available preventive measures should be used to avoid losing the airway. A tracheotomy has its place in a significant number of patients in whom an immediate postoperative or a delayed extubation appears unfeasible.
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Corrective rhinoplasty after significant nasal trauma is a much different entity than elective rhinoplasty or rhinoplasty after minor trauma. The more significant the degree of trauma the patient is subjected to, the greater the deleterious effects will be on the soft tissue and skeletal elements of the patient's nose. ⋯ This may be minor and transient or may be lifelong and disabling. In this article, the authors review some of the more long-term aspects of nasal trauma and provide the reader with insights to the use of cartilage grafting techniques that are useful in the management of posttraumatic nasal deformity and airway obstruction.
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Rhinoplasty is arguably one of the most challenging procedures a facial plastic surgeon performs. Numerous techniques have been developed since the inception of rhinoplasty to aid in correction of aesthetic and functional issues. Congenital, iatrogenic, and traumatic etiologies can all lead to a crooked nose. Autologous rib or costal cartilage grafting is a powerful tool that can aid the surgeon in successful correction of the crooked nose.
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The aim of the study is to describe the results of dynamic muscle transfer with an orbicularis oculi muscle flap from the contralateral side to the paralyzed side in patients with House-Brackmann grade 6 facial nerve palsy. This case series included six patients who underwent dynamic muscle transfer with a flap of healthy orbicularis oculi muscle fibers from the contralateral side into the paralyzed orbicularis oculi muscle. All patients had a House-Brackmann grade 6 facial nerve palsy. ⋯ All patients showed a significant improvement of their symptoms and their lagophthalmos reduced postoperatively. Most importantly, the blink occurred involuntarily at the same time as the blink on the normal side. The authors propose that a dynamic muscle transfer using the contralateral orbicularis muscle may be considered to improve the voluntary lid closure and spontaneous blink reflex to improve corneal exposure in patients with grade 6 facial palsy who have not benefited from conventional surgical procedures.