The Journal of craniofacial surgery
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Case Reports
Traumatic unilateral temporomandibular joint dislocation overlooked for more than two decades.
Forward dislocation of the temporomandibular joint commonly can be easily diagnosed and successfully reduced by manual repositioning. In this report, we discuss a rare case of prolonged temporomandibular dislocation that had persisted for more than 20 years because the otolaryngologist and dentist had missed the dislocation. ⋯ It is possible that strong pain and mouth-closing disability may gradually remit and only deviated mandibular prognathism like malocclusion may persist. Therefore, abnormal occlusion warrants careful attention to temporomandibular joint dislocation.
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The aim of this study is to elucidate the nerve passage over the iliac crest shifted by skin retraction in harvesting iliac bone graft. A total of 44 iliac crests obtained of 22 nonembalmed Korean fresh cadavers were dissected (six males and 16 females; age range, 57-91 years). In A group (22) of "reposed skin," a skin incision was made from the anterior superior iliac spine (ASIS) to the highest level of iliac crest (HLIC). ⋯ An injuring rate of ilioinguinal nerve was almost the same between A group (13 branches, 59.1%) and B group (14 branches, 63.61%). P value is 0.760. In the procedure of harvesting iliac bone graft, it is suggested to make an incision on the skin retracted medially and on the anterior half site of ASIS to HLIC to avert an injury of superficial sensory nerves.
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Although cervical spine injury is rarely associated with maxillofacial trauma, it should be suspected when injuries above the clavicle occur, as suggested in the Advanced Trauma Life Support Manual. A retrospective study of 2482 patients with maxillofacial trauma, who were admitted to the Maxillofacial Surgical Division of Turin University between 1996 and 2006, conducted to identify concomitant fractures of the cervical spine and establish a treatment protocol. Twenty-one patients (0.8%), consisting of 17 males and four females ranging in age from 15 to 70 years, had amyelic cervical spine fractures. ⋯ Cervical spine immobilization should never be removed until cervical spine injury has been excluded using a lateral x-ray of the cervical spine. In males with significant blunt craniomaxillofacial trauma caused by high-energy impact accidents such as car and motorcycle accidents, computed tomography is the radiologic examination of first choice to exclude cervical spine injuries. Lastly, the presence of a cervical spine injury did not result in modified or delayed treatment of maxillofacial fractures, with the exception of one patient who had a fracture of the odontoid process.
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Several transcranial surgical approaches such as frontoorbital, lateral, medial, central, inferolateral, and transmaxillary orbitotomy have been used for exposure of lesions within the orbit. During surgical approaches, detailed anatomic knowledge regarding neural, muscular, and neighboring structures for preservation of the neurovascular structures is important in avoiding traumatic retraction of the nerves of the extraocular muscles. For this study, a total of 22 formalin-fixed cadavers were dissected. ⋯ Areas nervosa of the nerves were located in the middle one third of the muscles. In this study, detailed knowledge regarding the innervation features of extraocular muscles was attained. An understanding of the innervation features of extraocular muscles is important for the preservation of neural structures during intraorbital procedures.