The Journal of craniofacial surgery
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Comparative Study
Comparative analysis of tranexamic acid use in minimally invasive versus open craniosynostosis procedures.
Intraoperatively administered tranexamic acid (TXA) lessens blood loss during orthopedic and cardiovascular surgery. Its use for craniosynostosis surgery warrants investigation. Therefore, we analyzed our use of TXA during minimally invasive (MI) and open craniosynostosis procedures. ⋯ Intraoperative TXA administration is safe with modest benefit suggested, especially in the MI group. Calculated blood loss correlated well with EBL at lower blood loss volumes, implicating it as a potential measurement of true blood loss.
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Randomized Controlled Trial
Effect of rectal diclofenac and acetaminophen alone and in combination on postoperative pain after cleft palate repair in children.
Acetaminophen and diclofenac are prescribed as postoperative analgesic agents in children. However, the efficacy of their combination is not studied sufficiently. We compare the analgesic effects of acetaminophen, diclofenac, and their combination after cleft palate surgery. ⋯ Adverse effects were comparable among groups. Rectal acetaminophen plus diclofenac was found to be the most effective in pain control. However, both rectal acetaminophen and diclofenac were more effective than placebo, whereas diclofenac was more effective than acetaminophen.
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Chordoma is an uncommon tumor of bone that is believed to develop from remnants of the notochord. The chondroid variant of chordomas contains elements possessing both chordoma and cartilaginous tissues. ⋯ Here, we describe a patient with chondroid chordoma with skull base involvement who underwent an expanded endonasal endoscopic approach for complete resection. In conclusion, endonasal endoscopic approach should be kept in mind for the resection of carefully selected chondroid chordomas with skull base involvement because of its minimally invasive characteristics.
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Patients with syndromic craniosynostosis have many problems involving the upper airway, laryngotracheal airway, and tracheobronchial tree. Evaluation of tracheobronchial disorders in syndromic craniosynostosis is very important for accurately diagnosing these problems. We have used three-dimensional computed tomography (CT) imaging of the tracheobronchial tree (three-dimensional tracheal CT imaging) since a multidetector CT was installed in our hospital in 2004. ⋯ Four were confirmed to have abnormalities on either bronchoscopy or three-dimensional tracheal CT imaging, whereas 5 patients were apparently free of abnormalities as determined by both modalities. In conclusion, it was possible to accurately assess the configuration of the tracheobronchial system using both three-dimensional tracheal CT imaging and bronchoscopy. Our results suggest these examinations to be very useful for assessing the optimal timing of decannulation and respiratory function prognosis.
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Case Reports
White-eyed medial wall blowout fracture mimicking head injury due to persistent oculocardiac reflex.
White-eyed medial wall blowout fracture associated with muscle entrapment is rare. It may present with symptoms consistent with an intracranial injury, delaying the diagnosis and putting the patient at risk for permanent damage. ⋯ Patients with white-eyed medial wall blowout fracture with muscle entrapment can present with oculocardiac reflex symptoms, pain, diplopia, and strabismus in the absence of any signs on ocular examination except for abnormal motility. Computed tomography imaging of the orbit should be performed to confirm the diagnosis, followed by immediate surgical intervention to avoid ischemia and permanent injury.