Trauma

Submental intubation to facilitate the management of maxillofacial trauma

September 20, 2011     Robert T. Adelson, MD
article

Characteristics of nasal injuries incurred during sports activities: Analysis of 91 patients

August 15, 2011     C. Ron Cannon, MD, Rob Cannon, BS, Kevin Young, MD, William Replogle, PhD, Scott Stringer, MD, and Elizabeth Gasson, RN, MSN
article

Abstract

Nasal injuries are among the most common sports injuries. We conducted a prospective, observational study of 91 patients, aged 7 to 60 years (mean: 18.3), who had sustained a nasal injury while engaging in a sport, exercise, or other recreational physical activity. We found that a substantial proportion of these injuries occurred in females (29.7% of cases). A high percentage of injuries (86.8%) occurred in those who had been participating in a noncontact sport; the sport most often implicated was basketball (26.4%). Also, injuries were more common during organized competition as opposed to recreational play (59.3 vs. 40.7%). Of the 91 nasal injuries, 59 (64.8%) were fractures, most of which were treated with a closed reduction. Almost all of the patients in this study (92.3%) were able to return to their sport. We conclude that most sports-related nasal fractures are not preventable.

An unusual presentation of an asymptomatic neck mass

August 15, 2011     Rapahel Nach, MD, Lorraine M. Smith, MD, MPH, and Hootan Zandifar, MD
article

Self-induced subcutaneous facial emphysema in a prisoner: Report of a case

June 13, 2011     Mahmoud Goudarzi, MD and Jafar Navabi, MD
article

Abstract

Subcutaneous cervicofacial emphysema is a rare condition that results from various causes. Initially it might be misdiagnosed and managed as other clinical entities, such as angioedema. We report a case of self-induced subcutaneous facial emphysema in a prisoner who sought better living conditions by simulating an emergency.

Nasal septal abscess

March 31, 2011     Jordan Cain, MD and Soham Roy, MD, FACS, FAAP
article

Postaural inflammatory pseudotumor: An extremely unusual complication of trauma in a child

March 1, 2011     Ashwani Sethi, MS, Vikas Malhotra, MS, Deepika Sethi, MS, and Sonu Nigam, MD
article

Abstract

We report the case of a 12-year-old boy who presented with a rapidly enlarging, painless mass behind the ear following trauma to the area. The mass was excised, and histopathologic and immunohistochemical evaluations revealed it to be an inflammatory pseudotumor. At 1 year postoperatively, the child exhibited no evidence of recurrence.

Traumatic hemorrhage and rapid expansion of a cervical lymphatic malformation

January 1, 2011     Nishant Bhatt, MD, Helen Perakis, MD, Tammara L. Watts, MD, PhD, and Jack C. Borders, MD
article

Aspiration of radiolucent dentures in facial trauma: Case report

December 17, 2010     Jon B. Chadwell, MD, Joshua R. Mitchell, MD, Michael Donnino, MD, Charles Peterson, MD, Paul Guentert, MD, Cliff Arnold, BA, and Mark Walsh, MD
article

Abstract

Foreign body aspiration is a serious problem that may lead to complications or even death. People who sustain major maxillofacial trauma can often damage their teeth or oral prostheses, and aspiration can occur. Detection of this type of aspiration can be difficult, especially in elderly people wearing dental appliances, since many dental prostheses are not radiopaque and the aspiration is not always recognized at the time of injury. We report a specific case of extensive maxillofacial trauma from a self-inflicted gunshot wound leading to aspiration of large, radiolucent denture fragments, delayed diagnosis, and complications. The possibility of denture fragment aspiration must always be part of the differential diagnosis in an elderly trauma patient presenting with dyspnea, hypoxia or, eventually, pneumonia. This is especially so when radiologic evaluation does not reveal a foreign body, since much dental prosthesis material is radiolucent. Delayed complications of radiolucent dental prosthesis aspiration could be avoided by the inclusion of some radiopaque material within the acrylic material of the prosthesis.

Botulinum toxin-assisted endoscopic repair of traumatic vocal fold avulsion

August 31, 2010     Rima F. Abraham, MD, Stanley Shapshay, MD, and Lisa Galati, MD
article

Abstract

Blunt traumatic laryngeal injury in children often leads to intralaryngeal soft-tissue damage, which can quickly compromise an already small airway. Injuries requiring operative intervention have historically been repaired via open approaches such as thyrotomy and laryngofissure. These approaches carry significant long-term sequelae that can compromise the airway, deglutition, and voice. We describe a safe and effective alternative to open repair that includes the use of a botulinum toxin chemical myotomy to ensure optimal healing. We used this procedure to treat a 13-year-old boy who had experienced a traumatic avulsion of the true vocal folds. Postoperatively, his voice outcome was satisfactory, as evidenced by a marked improvement in his pediatric Voice Handicap Index score. No complication or compromise of the airway or swallowing occurred, and resolution of the botulinum effect was observed by 6 months postoperatively. The endoscopic approach supplemented by botulinum toxin injection avoids scarring and allows for safe postoperative extubation. Compared with open repair, it is associated with a shorter hospital stay and a lower risk of stenosis and fibrosis.

Expect the unexpected: Two cases of penetrating head and neck trauma from Operation Iraqi Freedom

August 31, 2009     CPT Debjeet Sarkar, MD, CPL Andrew Demma; CPT Dean Stulz, PA-C, and LTC Gunther Hsue, MD
article

Abstract

The protocol for treating penetrating head and neck trauma in a war zone differs from the standard protocol. Rather than first securing an airway, as is standard in civilian trauma cases, the primary emphasis is on assessing and controlling hemorrhage because it is the leading cause of morbidity and mortality in a battlefield setting. Once that has been addressed, we shift to standard advanced-trauma life-support protocols. We describe two cases we encountered at our combined medical clinic in Western Baghdad-one involving a 4-year old Iraqi child with an ammunition round lodged in her neck and one involving a 38-year-old female U.S. soldier with a round lodged in her right superolateral orbit. Both cases were transferred to combat support hospitals for further treatment after our initial assessment and treatment, and both had successful outcomes.

Distal parotid duct pseudocyst as a result of blunt facial trauma

July 31, 2009     Ashkan Monfared, MD, Justin Ortiz, MD, and Carrie Roller, MD
article

Abstract

The sequelae of sharp trauma to the parotid duct, such as sialocele and salivary fistula, are well known. In contrast, complications of blunt trauma to the parotid duct are not as common. A search of the English-language literature revealed 2 cases of parotid pseudocysts caused by blunt trauma. Although no well-known management protocol exists for complications of blunt trauma to the parotid duct, the treatment modalities for sharp trauma complications potentially could be applied. We describe a case of a blunt-trauma-induced distal parotid duct pseudocyst that remained refractory to conservative management, including repeated aspiration and cannulation of the duct. After characterizing and localizing the pseudocyst with sialography and cross-sectional imaging, we performed a surgical repair. This repair involved marsupialization of the parotid duct to the level of the pseudocyst. The edges of the opening of the proximal duct and the pseudocyst were sutured to the oral mucosa, and a small intraoral drain was left in the pseudocyst to prevent collapse and abscess formation. The drain was removed after 5 days, and the patient experienced no further problems during 14 months of follow-up.

Ear trauma caused by a yucca plant leaf spine

May 31, 2009     Yoav P. Talmi, MD, FACS, Michael Wolf, MD, Lela Migirov, MD, and Jona Kronenberg, MD
article

Abstract

Three uncommon cases of ear trauma caused by a yucca plant leaf spine are presented. One patient presented with tympanic perforation and the second with mixed hearing loss after spontaneous closure. The third patient probably had a perilymphatic fistula with subsequent labyrinthitis and hearing loss. Although the yucca is a ubiquitous plant, to the best of our knowledge, such incidents have not been previously reported.

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