Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
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J Craniomaxillofac Surg · Dec 2012
Management of penetrating medial and retro-bulbar orbital shrapnel/bullet injuries.
The presence of shrapnel or a bullet lying in the medial orbital and retrobulbar area is rare. A review of the literature revealed only a few reports. Recently eye/orbital penetrating trauma has increased dramatically, mainly due to IEDs or conventional weaponry in civilian and military casualties. ⋯ Practical techniques for correctly determining the location of retained projectiles in the orbit are described. Surgical techniques for treatment are presented, based on safe and successful practices used in the missile retrievals. Six shrapnel and three bullet injuries, mostly in the medial orbital region, were removed without increasing morbidity and with limited orbital tissue injury.
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J Craniomaxillofac Surg · Dec 2012
Randomized Controlled Trial Comparative StudyComparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery.
The aim of this randomized, double-blind clinical trial was to investigate the effect of preemptive analgesia with a combination of tramadol+dexamethasone or tramadol+diclofenac sodium. The study included 30 patients (age range: 16-30 years), who were randomly assigned to 2 groups by the split-mouth method. Postoperative pain was assessed with a visual analogue scale at 4, 6, 12, 24, and 48 h postoperatively (p.o.h.). ⋯ Significant differences in postoperative pain intensity were detected between the drug combinations at 4, 6, and 12p.o.h., suggesting the importance of preemptive analgesia. Patients treated with tramadol+dexamethasone showed lower pain scores compared to the tramadol+diclofenac sodium combination, larger postoperative mouth opening, and less swelling. The tramadol+dexamethasone combination also was more effective than tramadol+diclofenac sodium at reducing inflammation.
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J Craniomaxillofac Surg · Dec 2012
Multicenter StudyNeurosensory disturbances one year after bilateral sagittal split osteotomy of the mandibula performed with separators: a multi-centre prospective study.
Bilateral sagittal split osteotomy (BSSO) is an effective and commonly used treatment to correct mandibular hypo- and hyperplasia. Hypoesthesia of the inferior alveolar nerve (IAN) is a common complication of this surgical procedure. This prospective multi-centre study aimed to determine the incidence of neurosensory disturbances of the IAN after BSSO procedures performed without the use of chisels. ⋯ The concomitant genioplasty in combination with BSSO was significantly associated with hypoesthesia. Peri-operative removal of the wisdom tooth or a Le Fort I procedure did not influence post-operative hypoesthesia. We believe that the use of splitting forceps and elevators without chisels leads to a lower incidence of persistent post-operative hypoesthesia 1 year after BSSO of the mandible, without increasing the risk of a bad split.
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J Craniomaxillofac Surg · Dec 2012
Case ReportsEndoscopic abdominoplasty providing a perforator fat flap for treatment of hemi-facial microsomia.
A patient with a history of an extended unilateral hemifacial cleft desired the restoration of the buccal fat on the hollow cheeked side and also wished to reduce an abdominal bulge at the same time. The amount of tissue volume needed exceeded the possibilities of free autologous fat grafting, lipofilling and allogenic implants. Therefore a free fat flap with microvascular anastomoses harvested as part of a minimal invasive abdominoplastic procedure using an incision well hidden within the bikini zone was the most attractive surgical option. This is the first case reported, where the standard free deep inferior epigastric artery (DIEA) perforator flap was utilised.
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J Craniomaxillofac Surg · Dec 2012
Ethical questions raised by the first allotransplantations of the face: a survey of French surgeons.
More than any other allograft, the allotransplantation of the face has a symbolic character, which raises a large number of questions. The objective of this article is to make an analysis through a survey carried out among French surgeons. ⋯ Over two thirds of the surgeons attached importance to ethical issues regarding the donor and recipient of a facial allograft. Some of the principal questions facing facial transplantation is of an ethical nature as it is an unprecedented procedure that is challenged by the axiom to first do no harm and the need of modern medicine to limit risk to as close to zero as possible. For the non-specialist, accepting psychologically the face of another individual appears to be a real issue. Contrary to that, the main demand expressed by the facial transplant recipients appears to be related to facial functions rather than appearance.