The Journal of craniofacial surgery
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The facial nerve branches are vulnerable during manipulation of the buccal fat pad. The aim of this study is to describe the precise anatomical interrelation among the buccal fat pad, buccal branches of the facial nerve, and parotid duct. Nineteen hemifaces of Korean cadavers (11 male and 8 female) fixed in 10% formaldehyde solution were dissected. ⋯ An interrelation of parotid duct and buccal fat pad is as follows: parotid duct crossing superficial to the buccal extension of buccal fat pad in 8 of 19 (42.1%) specimens, crossing deep to the buccal extension of buccal fat pad in 5 of 19 (26.3%) specimens and crossing along the superior border of the buccal extension of buccal fat pad in 6 of 19 (31.6%) specimens. There is a 26.3% chance of injury to the buccal branch during total removal of buccal fat pad. The parotid duct runs deep to the buccal extension of buccal fat pad in 26.3% of cases.
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Case Reports
A patient of severe cervicofacial subcutaneous emphysema associated with Munchausen's syndrome.
Subcutaneous cervicofacial emphysema is an entity with the presence of air within the fascial planes of the head and neck, which results from various causes. A case of severe subcutaneous cervicofacial emphysema associated with Munchausen's syndrome is presented. ⋯ Episodes of facial swelling were prevented by psychiatric support. Munchausen's syndrome should be kept in mind among the etiological factors of subcutaneous cervicofacial emphysema cases, in whom no organic causes can be found out.
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Perioperative management of the airway in complex craniomaxillofacial trauma can be difficult. As described by Altemir in 1986, submental intubation is a useful technique as an alternative to tracheostomy in selected trauma patients. The authors reports patients with craniomaxillofacial trauma who successfully underwent submental intubation and describe the straightforward technique in detail.
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Zygomatic fractures can be associated with functional and esthetic problems. Recent improvements in surgical techniques and materials have enabled stable fixation of zygmomatic fractures. Multiple-point fixation is most commonly used for internal fixation. ⋯ The status of inferior orbital rim reduction is confirmed by palpitation. Inferior orbital rim fixation with mini- or microplates is recommended for reduction of comminuted fractures and orbital floor fractures with herniation of internal orbit components. Patients who did not undergo inferior orbital rim fixation were free of inferior orbital rim deformity, diplopia, and postreduction rotation.
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Interest in the psychiatric consequences of trauma and the subsequent surgical intervention has been increasing steadily; therefore, the authors assessed the prevalence of acute symptoms of stress in patients who experienced a craniomaxillofacial injury. Fifty patients between the ages of 18 and 65 years were evaluated and assigned a score using the Injury Severity Scale (ISS). Within 48 hours of surgery (T0) and at 3 months after surgery (T1), the authors administered the Davidson Trauma Scale (DTS) to assess post-traumatic symptoms, Spielberger's State-Trait Anxiety Inventory (STAI) to assess symptoms of anxiety, and Zung's Self-rating Depression Scale (SDS) to assess depressive symptoms. ⋯ There was a significant correlation between the psychopathologic variables and trauma-specific symptoms at both T0 and T1; the same was true for the ISS at T0. Eight of the 13 patients with positive DTS results at 3 months had aesthetic and functional sequelae that might have served as reminders of the traumatic event. It is not only necessary to restitutio ad integrum the anatomy and function, but also to provide psychiatric support for patients experiencing psychiatric symptoms caused by traumatic events.