The Journal of craniofacial surgery
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Inadequate treatment of complex midfacial fractures involving the orbit and zygomatic arch can result in important functional and aesthetic deformity. Accurate repair of fractures at the zygomatic arch and orbital floor has traditionally necessitated coronal scalp and lower eyelid incisions respectively. ⋯ The endoscopic-assisted technique facilitated the anatomic repair of associated zygomatic arch and orbital floor fractures. The technique minimized ocular globe manipulation and eliminated the need for coronal scalp and lower eyelid incisions.
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Case Reports
Late diagnosis and removal of a large wooden foreign body in the cranio-orbital region.
The rare case of a large wooden foreign body impaled in the cranio-orbital region, and its late diagnosis and successful removal, is presented. A 26-year-old man was admitted to a regional hospital after suffering a severe penetrating craniocerebral injury from a motorcycle accident. Two months after the accident, computed tomographic examination at Burdenko Neurosurgical Institute revealed a large foreign body located in the cranio-orbital region and penetrating the right temporal lobe, with surrounding abscess development. Radiological examination, including three-dimensional computed tomography, enables one to choose the optimal surgical approach and to remove the foreign body, thereby avoiding purulent, inflammatory complications.
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Sixty-seven surgeons, members of the International Craniofacial Surgery Society, responded to a questionnaire focused on assessing the incidence and risk of cranial plate and screw translocation intracranially in infants undergoing cranial surgery. Despite screws, plates, and wires being evident intracranially in individual cases, no apparent increase in seizure frequency or susceptibility to head trauma was noted in this preliminary study.
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Foreign body removal in blind, penetrating craniocerebral injuries, especially those involving craniobasal localization, could entail additional brain trauma risk. Under such conditions one can use surgical approaches for tumor removal or clipping of intracranial aneurysms. In this report, we present a case of blind, penetrating craniofacial injury in which a supraorbital-pterion approach for foreign body removal was used. Craniography, carotid angiography, and computed tomography data, including three-dimensional imaging, were taken into consideration while planning the operation.
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Growing skull fractures occur most commonly after head injury; however, their "craniofacial equivalents" may occur after neurosurgical or craniofacial operations in pediatric patients. Experience with five separate cases is reviewed, including one case that involved the anterior cranial base and presented with vertical dystopia and proptosis. ⋯ Prompt recognition and the diagnosis of the problem are essential to prevent the development of progressive neurological complications. The pathophysiology and principles of surgical management of these complex problems are explored in detail.