International journal of oral and maxillofacial surgery
-
Int J Oral Maxillofac Surg · Jul 2008
Agreement between Research Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patient population.
The aim of this work was to evaluate the agreement between the clinical Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) examination and magnetic resonance (MR) findings of temporomandibular joint (TMJ) disc position abnormalities in a sample of clinically symptomatic patients, recruited from a population seeking TMD treatment. Two-hundred and thirty-two TMJs of 116 patients were evaluated to detect disc position abnormalities by means of a standardized clinical assessment according to RDC/TMD guidelines and MR performed blind by a radiologist. ⋯ The kappa values for the agreement between RDC/TMD and MR diagnosis of disc displacement with reduction (DDR), disc displacement without reduction (DDNR) and normal disk position were 0.69, 0.57, and 0.61, respectively. The observation that clinically predicted cases of DDR and DDNR show good to excellent agreement with MR findings, and the potential MR over-diagnosis of DDR and DDNR in the absence of clinical symptoms, support the usefulness of a standardized examination conducted by a trained investigator in the evaluation of patients with TMD.
-
Int J Oral Maxillofac Surg · Jun 2008
ReviewAdvanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 4: 'can the patient see?' Timely diagnosis, dilemmas and pitfalls in the multiply injured, poorly responsive/unresponsive patient.
Assessment of the eyes and visual pathways in the multiply injured patient with co-existing craniofacial injuries can be very difficult. Although ocular injury is common in facial trauma, vision-threatening injuries and severe visual impairment are less frequently seen and may be associated with specific injury patterns. Some vision-threatening injuries require early diagnosis and treatment if useful sight is to be preserved, but at the same time this must not interfere with any ongoing investigations and resuscitation. ⋯ More detailed ophthalmic examination can be performed later, when the patient is in a better condition. The management of the severely proptosed eye in the multiply injured unconscious patient is also a very difficult area, particularly if the precise cause is unknown. A number of causes exist and these may require different therapeutic strategies, which are discussed.
-
Int J Oral Maxillofac Surg · May 2008
ReviewAdvanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 3: Hypovolaemia and facial injuries in the multiply injured patient.
Hypovolaemic shock is a common cause of morbidity and mortality following trauma, accounting for approximately 30% to 40% of trauma deaths. Life-threatening blood loss from the maxillofacial region is uncommon, but represents one of a number of possible sites which must be rapidly identified and controlled. Bleeding from the face may not be obvious especially in awake, supine patients and it poses an obvious threat to the unprotected airway. ⋯ The concepts of the 'lethal triad' and 'biologic first hit' have resulted in new strategies in managing the profoundly shocked patient, although some of these remain controversial. Debate continues over the optimal blood pressure, fluid administration and role of surgical intervention in the actively bleeding patient. These may have an impact on the timing and extent of any proposed maxillofacial repairs, and are discussed.
-
A new technique of surgical tracheostomy is described. Prior to performing the tracheostomy, the endotracheal tube (ETT) is advanced further down the trachea so that the end of the tube is positioned just above the carina. Using the flexible endoscope within the ETT the positioning can be done with precision. ⋯ Following the creation of an opening in the trachea, the patient continues to have a definitive airway. In this controlled environment, time is taken to obtain haemostasis at the tracheostomy site, place a rescue stitch and also suction above the cuff of the ETT. A study was carried out in a series of 15 patients by recording various measurements during the procedure to confirm the accuracy of this technique.
-
Int J Oral Maxillofac Surg · Apr 2008
ReviewAdvanced trauma life support (ATLS) and facial trauma: can one size fit all? Part 2: ATLS, maxillofacial injuries and airway management dilemmas.
Maxillofacial trauma poses an obvious threat to the patient's airway, which may not be immediately evident. In the multiply injured patient, the co-existence of actual or potential injuries elsewhere may complicate airway management, notably in the presence of full spinal immobilization. Following high-velocity trauma, injuries to the cervical spine must be assumed to be present. ⋯ Prolonged immobilization is associated with significant morbidity and mortality. A number of protocols currently exist for 'clearing' the spine. Imaging now plays a greater role, especially in the obtunded, unconscious or intubated patient, and this is discussed.