phenylephrine-hydrochloride and Facial-Injuries

The nose is one of the most common sites of facial injury due to its prominence and anatomical placement. Given its intricate anatomy, function, and high visibility, it also proves to be one of the most complex regions for repair. We provide a review of the management of soft tissue injuries to the nose, including the various reconstructive tools available and adjunctive wound care measures. We also discuss special considerations based on mechanism of injury and treatment of this condition in the pediatric population. The main goals of reconstruction should be to preserve function while achieving optimal cosmetic results in this highly visible region of the face.

Topics: Child; Facial Injuries; Humans; Nose; Plastic Surgery Procedures; Soft Tissue Injuries

Facial trauma can have long-lasting physical and mental consequences. Trauma to the nose is commonly seen in the emergency department. Nasal lacerations account for 7% of all facial lacerations. Thorough examination and documentation including photographs is important for documentation and creating a reconstruction plan. Underlying damage to cartilage or bone must be reconstructed initially or in a delayed fashion to recreate the pretrauma anatomy and function. There are several options for soft tissue nasal reconstruction, including local flaps, skin grafts, pedicle flaps, and free flaps. At present there is no standard of care for postoperative facial trauma wound care.

Topics: Facial Injuries; Free Tissue Flaps; Humans; Nose; Rhinoplasty; Skin Transplantation

The athletic training room is filled with a multitude of conditions encompassing many different specialties of medicine. When it comes to traumatic injuries in the training room, many of them are not musculoskeletal in nature. Ultrasound in the training room can help identify serious and subtle solid-organ injury and small pneumothoraces. The discussion of these conditions follows a simple outline that helps identify injury/conditions through a proper history and physical. Evidence-based treatment/management/return to play guidelines are discussed.

Topics: Abdominal Injuries; Athletic Injuries; Facial Injuries; Humans; Mouth; Neck Injuries; Nose; Physical Examination; Return to Sport; Thoracic Injuries

Bite wounds in the nose region may lead to serious esthetic problems and functional losses. The authors describe a dog bite to his nose, resulting in a defect involving the entire tip of the nose and a part of the surrounding subunits. He was repaired with forehead flap and auricular conchal cartilage acutely. To the authors' knowledge, there are very few cases of acute repair in the literature. The authors also made a literature review on this subject.

Topics: Animals; Bites and Stings; Dogs; Ear Cartilage; Facial Injuries; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Surgical Flaps

The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing grotesque facial disfigurement. As this disfigurement is visible on frontal and profile views, the patient suffers both socially and psychologically. The nose is a three-dimensional organ. Reconstruction is therefore more difficult and needs to be more precise than in other parts of the face. Maintaining symmetry, contour and function are essential for successful nasal reconstruction. Multiple factors determine the optimal method of reconstruction, including the size of the defect, its depth and its site. Satisfactory social life is recovered only after multiple surgical procedures and long-term rehabilitation and physiotherapy.

Topics: Burns; Burns, Chemical; Facial Injuries; Humans; Nose; Nose Deformities, Acquired; Patient Satisfaction; Plastic Surgery Procedures; Reoperation; Rhinoplasty; Surgical Flaps; Treatment Outcome

The double "S" principle should be followed for facial reconstruction: the "similarity" of the donor site to the defect area and the reconstruction should be based on the different "subunits" of the face. In this article the pre-expanded, bipedicled supratrochlear perforator flap method is described, which is used for the resurfacing of both nasal and upper lip defects. This method can provide 2 independent flaps with sufficient tissue from 1 single donor site, resurfacing the nasal and upper lip units separately and providing an unparalleled color and texture match and ideal reconstructive result.

Topics: Adult; Burns, Chemical; Face; Facial Injuries; Female; Forehead; Humans; Lip; Male; Nose; Perforator Flap; Surgical Flaps; Tissue Expansion

Impairment of smell may occur following injury to any portion of the olfactory tract, from nasal cavity to brain. A thorough understanding of the anatomy and pathophysiology combined with comprehensively obtained history, physical exam, olfactory testing, and neuroimaging may help to identify the mechanism of dysfunction and suggest possible treatments. Although most olfactory deficits are neuronal mediated and therefore currently unable to be corrected, promising technology may provide novel treatment options for those most affected. Until that day, patient counseling with compensatory strategies and reassurance is essential for the maintenance of safety and QoL in this unique and challenging patient population.

Topics: Activities of Daily Living; Brain Contusion; Brain Injuries, Traumatic; Cerebral Cortex; Facial Bones; Facial Injuries; Fractures, Bone; Humans; Magnetic Resonance Imaging; Nose; Olfaction Disorders; Olfactory Nerve Injuries; Paranasal Sinuses; Positron-Emission Tomography; Quality of Life; Tomography, Emission-Computed, Single-Photon

Correct treatment of traumatic facial lacerations is essential to achieve the best cosmetic and functional outcome. This article discusses wound management, anatomy and techniques to repair lacerations of scalp, eyelid, nose, lip and ear. Scalp lacerations should be sutured in layers. Injury to the eyelid mandates a careful examination of the eye. Accurate adaptation of the lid margin is required. Nasal septum haematoma must be drained and the nares and alar margins aligned. The key to proper repair of lip laceration is alignment of the vermillion border. Injury to the ear can often be closed in one layer.

Topics: Ear; Eyelids; Facial Injuries; Facial Nerve Injuries; Humans; Lacerations; Lip; Nose; Scalp; Sutures

Regional nerve blocks of the face are important skills every emergency physician ought to know. Facial anesthesia improves cosmetic outcomes, reduces pain, and improves patient satisfaction. Understanding the anatomy of the head and face is essential to the application of regional anesthesia, and this anatomy will be reviewed in depth. By completion of this article, physicians should appreciate the basics of the various nerve blocks of the head and face to repair any laceration.

Topics: Ear, External; Emergencies; Emergency Service, Hospital; Face; Facial Injuries; Facial Nerve; Humans; Lip; Mandibular Injuries; Nerve Block; Nose; Scalp

This article presents an overview of facial wound management, beginning with a brief review of basic anatomy of the head and face as it relates to wound care. Basic wound management is discussed, and techniques for repairing specific cosmetically high-risk areas of the face, particularly the eyes, lips, and ears, are reviewed. Also described are the proper techniques for the management of an auricular hematoma.

Topics: Emergencies; Emergency Service, Hospital; Eyelids; Facial Injuries; Forehead; Humans; Lacerations; Lip; Nose; Scalp

Nasal injuries coupled with midface fractures of the orbit and ethmoids constitute a nasoorbitoethmoid (NOE) fracture pattern, which is typically the most challenging facial fracture to repair. Hard and soft tissue defects of this region may require advanced reconstruction techniques, including local rotational flaps, free tissue transfer, and even prosthetics. The restoration of form and function dictates treatment, and the success of primary repair is paramount, because secondary correction is challenging in this area of the midface. Because of the complex nature of this region, this discussion is divided into hard tissue defects, with a focus on trauma, and soft tissue defects, with a focus on oncology.

Topics: Bone Transplantation; Ethmoid Bone; Facial Injuries; Humans; Nose; Orbit; Plastic Surgery Procedures; Rhinoplasty; Skull Fractures; Surgical Flaps

The development of nasal reconstruction concepts such as the three-layered (lining, structure, and covering) repair has led to remarkable esthetic and functional improvements. The authors present a variety of techniques for providing nasal structure and internal lining and discuss the application of these methods to specific nasal defects.

Topics: Bone Transplantation; Facial Injuries; Humans; Nasal Mucosa; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps

In Germany about 8500 dog-bite injuries in the face occur every year; more than 50% of the victims are infants and schoolchildren. Besides dogs, other animals such as cats or horses may be responsible for these accidents. Even human bites are reported. The predominant areas are the nose and the auricles. The tissue defects may be superficial, but they can even cause amputations, including severe vascular and nerve or bony destruction. Systemic antibiotic therapy is needed when the wound is infected. The surgical approach to bite injuries includes local wound cleansing, careful excision of necrotic tissue and primary closure of the wound whenever possible. Regarding the importance of surgery in the head and neck area plastic-reconstructive techniques including autologous transplantations and various local or regional flaps should be used at the time the wound is first repaired.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bites and Stings; Bites, Human; Cats; Child; Child, Preschool; Dogs; Ear; Facial Injuries; Germany; Horses; Humans; Nose; Rabies Vaccines; Tetanus Toxoid; Wound Infection

Topics: Facial Injuries; Humans; Infections; Mohs Surgery; Nose; Nose Deformities, Acquired; Nose Neoplasms; Rhinoplasty

Postsurgical infection has always been a cause for major concern in ENT surgery. Papers on the topic allowed to identify indications for antibiotic prophylaxis. In ear surgery, in the absence of prior infection (stapes surgery, medium dry ear surgery), studies' results are not in favour of antibiotic prophylaxis. On the other hand, however, when the ear is inflamed or infected, the use of antibiotics is indicated, if possible after having first taken a sample. For nose and sinus surgery, antibiotic prophylaxis seems to be worthless in the absence of a prolonged packing. If a packing has to be maintained or if a transplant is used, an antibiotic administration has to be considered; the most appropriate antibiotic and its mode of use still have to be specified. In case of facial trauma, antibiotic prophylaxis using cefazolin reduces the risk of infection of paraymphysis fractures and angle fractures. The postoperative course after tonsillectomy is simplified by a prolonged antibiotic administration based on ampicillin. In clean cervico-facial surgery, without buccopharyngeal opening, the antibiotic prophylaxis seems to be worthless. In the opposite, antibiotherapy is required in case of buccopharyngeal opening. Indeed the presence of potential pathogenic bacteria in the buccopharyngeal cavity, the difficulties of mucosa closing, the importance of the tumoral extension, the length of the procedure, radiotherapy and use of myocutaneous flaps may all be the cause of a high infection rate (80%) in the absence of antibiotic prophylaxis. Two types of antibiotics seem to be suitable, cefazolin and clindamycin. Antibiotics active against Gram negative bacteria seem to be useless. There is a disagreement concerning the duration of antibiotic administration. The populations studied are too small to obtain significant results. Both points of view (prolonged antibiotic administration or true antibiotic prophylaxis) can be considered. Only large scale prospective studies with an adequate methodology will provide credible data for this debate.

Topics: Anti-Bacterial Agents; Ear; Facial Injuries; Humans; Jaw Fractures; Mouth; Nose; Pharynx; Surgical Wound Infection

Topics: Amputation, Traumatic; Bites and Stings; Facial Injuries; Humans; Nose; Rhinoplasty; Skin Transplantation; Wounds, Penetrating

Topics: Endoscopy; Facial Injuries; Humans; Maxillary Diseases; Nasopharyngeal Neoplasms; Nose; Nose Deformities, Acquired; Paranasal Sinus Neoplasms; Penicillins; Rhinoplasty; Sinusitis; Surgery, Plastic

Topics: Facial Injuries; Fractures, Bone; Humans; Mandibular Fractures; Maxillofacial Injuries; Nose; Orbit; Zygoma

Reliable securement of nasally inserted enteral tubes is a problem in patients with facial burns that make use of traditional adhesive tape ineffective.. To implement the nasal bridle as a way to decrease inadvertent removal of nasally inserted enteral tubes and improve subsequent patient outcomes.. The nasal bridle was implemented in the burn unit of the University of Kansas Hospital, Kansas City, Kansas, as a quality improvement project. Outcomes for the calendar year 2010 were measured in patients treated before use of the bridle (prebridle control group) and in patients for whom the bridle was used. The groups were compared on measures of tube insertions per tube day, abdominal radiographs per tube day, and a number of complications.. A total of 50 patients were studied: 33 in the control group and 17 in the bridle group. Baseline characteristics of age and sex did not differ between the groups. The bridle group had significantly fewer tube insertions and abdominal radiographs per tube day than the control group. Although complications were generally less common in the bridle group, the differences were not statistically significant.. In burn patients, use of a nasal bridle to secure nasally inserted tubes had clinical advantages over securement with traditional adhesive tape.

Topics: Burn Units; Burns; Enteral Nutrition; Facial Injuries; Female; Humans; Intubation, Gastrointestinal; Kansas; Length of Stay; Male; Middle Aged; Nose; Outcome Assessment, Health Care; Personnel, Hospital; Quality Improvement; Staff Development; Surgical Tape; Trauma Severity Indices

Topics: Adolescent; Adult; Burns; Clinical Trials as Topic; Ear; Facial Injuries; Hearing Disorders; Humans; Male; Nose; Pharynx

Nasal trauma is the most common facial injury worldwide. Prompt assessment allows for recognition of injuries requiring surgical intervention in the form of nasal bone manipulation. The literature is unclear to what extent patients undergoing conservative management subsequently require surgical intervention.. A retrospective chart review of all patients presenting with nasal injury between July 2017 and July 2018 who underwent conservative and surgical management was undertaken. Re-referral and subsequent surgical intervention were documented.. In a cohort of 390 patients with nasal injury 229 patients underwent conservative management. Average age was 29 years. Males comprised 60% of our conservative cohort and 81% of the manipulated cohort. 8.3% of patients managed conservatively and 12% of those undergoing manipulation were re-referred.. Nasal trauma assessment is a significant workload for an ENT unit. Conservative management is appropriate following clinical assessment and does not lead to increased intervention compared with those who are surgically manipulated.

Topics: Facial Injuries; Female; Humans; Male; Nose; Retrospective Studies; Sex Factors; Treatment Outcome

Topics: Adult; Facial Injuries; Female; Follow-Up Studies; Forehead; Humans; Lip; Male; Nose; Patient Satisfaction; Plastic Surgery Procedures; Surgical Flaps; Tissue Expansion; Treatment Outcome

Topics: Facial Injuries; Female; Foreign Bodies; Humans; Lacerations; Nose; Soft Tissue Injuries

Suicidal gunshot wounds to the nasal bridge are rare, particularly at close range (defined as muzzle of the weapon not touching the skin surface, but near enough to deposit soot and stippling). Previously reported suicidal gunshot wounds to the nose have been through the left nostril (Forensic Sci Int 1995;71(1):25-31; J Forensic Radiol Imag 2013;1(2):63-7). The death of a 26-year-old man with a close-range gunshot wound to the bridge of the nose was deemed suicide due to history, scene, and autopsy findings. These findings included previous suicidal ideation, texted and written notes, the decedent's cross-legged position seated on the floor, the trajectory of the bullet through his head and into the ceiling fan and roof above him, and acute alcohol intoxication. This decedent may have been intending a hard contact forehead location but inadvertently fired the gun into the bridge of his nose while bending forward, prior to contact.

Topics: Adult; Alcoholic Intoxication; Correspondence as Topic; Facial Injuries; Forensic Ballistics; Forensic Pathology; Head Injuries, Penetrating; Humans; Male; Nose; Posture; Suicidal Ideation; Suicide, Completed; Wounds, Gunshot

Nasal trauma due to nasal CPAP (nCPAP) use is a commonly reported complication in infants under 1500 g of birth weight and 32 weeks of gestation. With the rise of nCPAP as the gold standard for non-invasive respiratory support, preventive measures should be considered.. To assess the prevalence and risk factors of nasal injury in very low birth weight (VLBW) preterm infants with nCPAP.. We retrospectively analyzed neonates hospitalized between 2012 and 2017, with less than 1500 g and 32 weeks of gestational age who received more than 12 hours of nCPAP. Demographic, antenatal and clinical data, along with information regarding respiratory support and nCPAP complications, were collected. We used Fischer's classification to grade nasal trauma.. A total of 135 infants were evaluated. Mean gestational age was 28 weeks (SD 2) and mean birth weight 1072 g (SD 239). Nasal trauma was reported in 65% of patients and it was of stage I, II and III in 49%, 16% and 1% of patients, respectively. The multivariate logistic regression revealed that the risk of trauma was greater in neonates with a longer duration of nCPAP ventilation (OR = 1.098, 95% CI: 1.055-1.142; p < 0.001) and in patients submitted to oxygen therapy (OR = 3.174, 95% CI: 1.014-9.929, p = 0.004). The median of days after nCPAP administration until the onset of an identifiable lesion was 4.. Nasal trauma is a frequent complication in VLBW preterm infants using nCPAP for long periods. Preventive measures in patients who are at greater risk of skin breakdown are of major clinical importance for a better outcome.

Topics: Cannula; Continuous Positive Airway Pressure; Facial Injuries; Female; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Logistic Models; Male; Masks; Multivariate Analysis; Nose; Prevalence; Retrospective Studies; Risk Factors

Topics: Adult; Betacoronavirus; Coronavirus Infections; COVID-19; Facial Injuries; Humans; Male; Nose; Occupational Injuries; Pandemics; Physicians; Pneumonia, Viral; Pressure Ulcer; Respiratory Protective Devices; SARS-CoV-2

Topics: Cheek; Coronavirus Infections; COVID-19; Facial Injuries; Humans; Infectious Disease Transmission, Patient-to-Professional; Masks; Nose; Pandemics; Personal Protective Equipment; Pneumonia, Viral; Skin

Coronavirus disease 2019 is an international pandemic. One of the cardinal features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face.. This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy.. The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients.

Topics: Betacoronavirus; Coronavirus Infections; COVID-19; Equipment Design; Facial Injuries; Humans; Nose; Pandemics; Patient Positioning; Pneumonia, Viral; Pressure; Prone Position; Respiration, Artificial; SARS-CoV-2; Surgical Sponges

Significant evolution has been made concerning resuscitation and emergency management of severely burned patients, and nowadays most patients will survive and deal with burns sequelae. They constitute a reconstructive challenge, mainly because options and donor areas are frequently compromised, results are often limited, and other options should then be considered. A 27-year-old male patient with 55% total burn surface area, presented with severe facial disfigurement including ectropion, upper/lower lip retraction, and partial loss of the nose. In order to improve the patient's condition, autologous reconstruction was considered. The only unburned area in the body was the left dorsal region, and a three-stage reconstruction was planned using a paraescapular flap. In a first stage, an elective surgery was performed to identify and tag the recipient vessels in the neck. After 3 months, the prelamination process was initiated with the drawing of a facial model, and a nose and lips were opened inside the flap. This was based on a three-dimensional latex model as a print of the patient's face, which allowed us to calculate distances and estimate the length of the vascular pedicles. After 3 months, the flap (18 × 8 cm) was transferred and microvascular anastomoses were performed. No major complications were seen after surgeries, and after 28 months, an extremely important functional gain was obtained. Despite the number of surgeries required and less than optimal aesthetic results, this method may offer a satisfactory solution for complex acquired facial burn sequelae when other local or distant flap options are not available.

Topics: Adult; Burns; Esthetics; Facial Injuries; Free Tissue Flaps; Humans; Male; Nose; Plastic Surgery Procedures

The clinical challenge in blunt nasal trauma in children, is to identify cases requiring specialized care among frequently encountered banalities, whilst trying to minimize the exposure to diagnostic procedures. We aim to evaluate the related diagnostic and therapeutic pathways and its outcome during follow-up.. This retrospective cohort study includes children up to 16 years presenting at the emergency department with blunt nasal trauma of our tertiary reference center.. The incidence of blunt nasal injuries was estimated 1750 cases in 7 years. A total of 459 consecutive cases with suspected complications were enrolled. Univariate comparison between age groups revealed a statistically significant diminution of downfall related injuries with growing up, whereas blows (including violence) significantly increased with age (p < 0.001 each). The logistic regression model identified male sex as an independent risk factor for soft tissue lesions (OR 1.699, p = 0.017) and for frontobasal fractures (OR 2.415, p = 0.050). Age was not identified to play a significant role regarding localization of injuries. Delayed septorhinoplasties became necessary in 2 cases only (0.4%). The logistic regression model identified nasal bone fracture (OR 17.038, p < 0.001) and mandibular fracture (OR 4.753, p = 0.004) as independent risk factor for a surgical intervention.. Blunt trauma to the nose is frequent in children. Trauma mechanisms differ significantly between age groups, whereas localization and concomitant injuries do not. Male sex was identified as an independent risk factor for soft tissue lesions and frontobasal fractures. In our experience, initial triage by the pediatric department with consecutive involvement of the ENT specialists in case of suspected complications is safe and effective and may help to reduce unnecessary diagnostic procedures/irradiation to the young patients.

Topics: Adolescent; Age Distribution; Child; Child, Preschool; Facial Injuries; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Nose; Retrospective Studies; Risk Factors; Sex Distribution; Switzerland; Trauma Severity Indices; Wounds, Nonpenetrating

Upper airway injuries can be fatal in burn patients if not recognized, a scenario that causes a significant amount of anxiety for physicians providing initial assessment of burn patients. Early elective intubation is often performed; sometimes unnecessarily. However, some providers employ nasolaryngoscopy for patients presenting with facial burns or signs/symptoms of upper airway injury in order to assess the need for intubation, but this practice is not considered standard of care and may also be unnecessary. Evidence is currently lacking about the utility of nasolaryngoscopy as an adjuvant assessment during evaluation of potential upper airway burn injuries. The objective of this study was to determine if nasolaryngoscopy provides additional information to the history and physical in making the decision to electively intubate patients with facial burns.. This study was a retrospective analysis of all patients who underwent fiberoptic nasolaryngoscopy after facial burn injury to evaluate for upper airway injury associated with burns over a 2 year period at a regional burn center. During this time period, all patients who presented with facial burns, soot, or carbonaceous sputum underwent nasolaryngoscopy to look for upper airway injury regardless of mechanism of injury. Patients intubated prior to arrival were excluded from the study. Patients were considered to have signs/symptoms of airway injury (symptomatic) if they presented with dyspnea, tachypnea, hypoxia, or significant burns to buccal mucosa. Procedure notes were used to determine if supraglottic/glottic injury (erythema or edema) was present on nasolaryngoscopy. Presence of pathologic changes and whether they led to intubation were evaluated in the asymptomatic and the symptomatic groups of patients. Select individual records were inspected further to help determine if the nasolaryngoscopy findings altered management plans and if intubation was ultimately necessary based upon the presence or absence of a cuff leak and the duration of intubation.. Twenty-two patients were symptomatic upon presentation, 14 of which had positive findings on laryngoscopy and 7 (50%) were intubated. One-hundred and eighty-eight patients were asymptomatic, 58 (31%) of which had either erythema or edema or carbonaceous debris on nasolaryngoscopy, and only 2 (1%) were intubated. These patients were both extubated within two days. None of the 130 asymptomatic patients with negative nasolaryngoscopy were intubated.. This study showed disparity between signs and symptoms of airway injury and nasolaryngoscopy findings. Asymptomatic patients showed pathologic changes in 30% of scopes, but this finding only changed management 1% of the time. Furthermore, the two patients in this group were extubated quickly, suggesting they may have been suitable for observation without intubation. These results indicate that the presence of erythema or edema is of questionable clinical significance in asymptomatic patients and nasolaryngoscopy is of limited benefit in this group. Only 50% of the symptomatic patients with airway injury evident on nasolaryngoscopy were actually intubated, also bringing into question the significance of the pathologic changes in this group. However, negative nasolaryngoscopy may have had some benefit in preventing intubation in a few, select symptomatic patients. This study suggests that a thorough history and physical is the best tool to identify patients at higher risk of upper airway injury who need intubation, but this should be further studied in prospective trials to determine the definitive role of nasolaryngoscopy.

Topics: Adult; Burn Units; Burns; Burns, Inhalation; Diagnostic Techniques, Respiratory System; Dyspnea; Facial Injuries; Female; Humans; Hypoxia; Laryngoscopy; Larynx; Logistic Models; Male; Nose; Pharynx; Retrospective Studies; Smoke Inhalation Injury; Tachypnea

While various forms of facial trauma, bruising, burns, and fractures are frequently seen in cases of child abuse, purposeful nasal erosion has rarely been identified as a form of abusive injury. Progressive destruction of nasal tissue in children provokes a wide differential diagnosis crossing multiple subspecialties: infectious, primary immunodeficiencies, inflammatory conditions, malignancy, and genetic disorders. Progressive nasal erosion also can be a manifestation of child abuse. The proposed mechanism is repetitive mechanical denudation of the soft tissue and cartilage resulting in chronic inflammation, bleeding, and ultimately destruction of the insulted tissue. We report 6 cases of child abuse manifesting as overt nasal destruction.

Topics: Child; Child Abuse; Child, Preschool; Contusions; Diagnosis, Differential; Facial Injuries; Female; Fractures, Bone; Humans; Infant; Male; Nose; Tomography, X-Ray Computed

Reconstruction of the nasal lining has traditionally been performed using the folded radial forearm free flap, given its reliable blood supply, pliability, and familiarity to surgeons with respect to its harvest. More recently, the free ulnar forearm flap has been proposed as an alternative reconstructive option for the nasal lining, with safe and reliable outcomes, and improved donor-site morbidity compared with its radial counterpart. In this article, the authors provide educational video footage with accompanying text description of the senior author's (E.D.R) approach to design and elevation of the free ulnar forearm flap for the purpose of reconstructing a composite nasal defect. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

Topics: Adult; Anatomic Landmarks; Composite Tissue Allografts; Facial Injuries; Forearm; Free Tissue Flaps; Humans; Male; Nasal Mucosa; Nose; Postoperative Care; Transplant Donor Site; Vascularized Composite Allotransplantation; Wounds, Penetrating

The nose has a robust blood supply derived from both internal and external carotid arteries. The main blood supply of the nasal tip and skin is derived primarily from the lateral nasal arteries, with a variable contribution from the columellar arteries. We present a patient with cut nose resulting from a homicidal attack in which the lower two-thirds of the nose was severed starting at the bony-cartilaginous junction of the dorsum of the nose down to the tip of the nose. The skin-cartilage flap was attached only to the columella and to the caudalmost 3 mm of the left ala nasi. The detached skin-cartilage flap was replaced and sutured anatomically, and the flap completely survived in spite of cutting of both lateral and dorsal nasal arteries.

Topics: Aged; Cartilage; Facial Injuries; Graft Survival; Humans; Male; Nose; Rhinoplasty; Surgical Flaps

Topics: Facial Injuries; Hematoma; Humans; Male; Middle Aged; Nasal Septum; Nose

Foreign bodies (FBs) in the paranasal sinuses are rare, whether iatrogenic or traumatic. One of the most common causes of such traumatic injuries is gunshot wounds from the bullets. Removing FBs from the paranasal sinuses usually needs endoscopic or open surgery. We present the case of a 22-year-old male soldier who sustained a penetrating injury of his nose and maxillary sinus with an iron rod that was a part of his gun, which was removed without either endoscopic or open paranasal sinus surgery.

Topics: Facial Injuries; Foreign Bodies; Humans; Male; Maxillary Sinus; Military Personnel; Nose; Tomography, X-Ray Computed; Wounds, Penetrating; Young Adult

Maxillofacial traumas with long-barreled guns may sometimes cause catastrophic results by means of smashing in facial structures. In these patients, reconstruction strategies of both fragmented/lost soft and hard tissues still remain controversial. In their clinic, the authors treated 5 patients with severely injured face after failed suicide attempt between 2008 and 2013. In this study, the authors aimed to present their clinical experiences on these severely injured maxillofacial gunshot traumas and offer a treatment algorithm to gain a result as possible as satisfactory in terms of functionality and appearance.

Topics: Adolescent; Adult; Biocompatible Materials; Bone Transplantation; Eyelids; Facial Injuries; Female; Firearms; Humans; Lip; Male; Mandibular Fractures; Mandibular Injuries; Maxilla; Maxillofacial Injuries; Middle Aged; Myocutaneous Flap; Nose; Orbit; Palate, Hard; Plastic Surgery Procedures; Rectus Abdominis; Suicide, Attempted; Wounds, Gunshot

Topics: Adult; Canada; Facial Injuries; Foot Injuries; Frostbite; Hand Injuries; Humans; Iloprost; Male; Middle Aged; Nose; Severity of Illness Index; Vasodilator Agents

Background Reconstruction of the central facial subunits is a complex and challenging task. In cases in which both the nasal and upper lip subunits are involved, a technique that can reconstruct both aesthetic units with tissue of similar color and texture from a single donor site will be ideal. In this article we present our experience with the bipedicled preexpanded forehead flap for simultaneous nasal and upper lip resurfacing. Patients and Methods Between January 2012 and January 2015 we used this technique in the simultaneous reconstruction of total nasal and upper lip subunits in five patients. All cases were for burns scar resurfacing. Results Good aesthetic results were achieved in each of our five cases to date and no complications were encountered. All donor sites closed primarily with aesthetically pleasing well-concealed linear scars. In all cases small modifications such as philtral shaping and further flap thinning were performed under local anesthesia between 6 and 12 months postoperatively Conclusion The preexpanded forehead flap provides an unparalleled color and texture match when it comes to facial resurfacing. When both total nasal and upper lip resurfacings are required, it is possible to achieve this in a single sitting from a single donor site by using a bipedicled preexpanded forehead flap.

Topics: Adolescent; Adult; Burns; Cicatrix; Esthetics; Facial Injuries; Female; Forehead; Humans; Lip; Male; Middle Aged; Nose; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome; Young Adult

Traumatic injuries, especially in maxillofacial region, not only lead to physical debilitation but also cause severe psychological distress in the affected individuals. Complete cosmetic and functional rehabilitation of such patients is a challenging task and thus requires a strategic treatment planning and a multidisciplinary team to execute the treatment. This patient report presents a patient who suffered with a severe glass cut injury leading to massive avulsion of face involving forehead, nose, upper lip, and anterior teeth. Patient was rehabilitated with a combined surgical and prosthetic approach, which involved flap repositioning in forehead, nasal and lip regions and an implant-supported nasal prosthesis to replace missing nose. Missing anterior teeth were replaced with fixed dental prostheses.

Topics: Adult; Facial Injuries; Forehead; Humans; Lip; Male; Maxillofacial Prosthesis; Nose; Surgical Flaps

Soccer participation continues to increase among all ages in the US. Our objective was to analyze trends in soccer-related facial injury epidemiology, demographics, and mechanisms of injury.. The National Electronic Injury Surveillance System was evaluated for soccer-related facial injuries from 2010 through 2014. Results for product code "soccer" were filtered for injures to the face. Number of injuries was extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and mechanisms.. In all, 2054 soccer-related facial trauma entries were analyzed. During this time, the number of injures remained relatively stable. Lacerations were the most common diagnosis (44.2%), followed by contusions and fractures. The most common sites of fracture were the nose (75.1%). Of fractures with a reported mechanism of injury, the most common was head-to-head collisions (39.0%). Patients <19 years accounted for 66.9% of injuries, and athletes over 18 years old had a higher risk of fractures.. The incidence of soccer-related facial trauma has remained stable, but the severity of such injuries remain a danger. Facial protection in soccer is virtually absent, and our findings reinforce the need to educate athletes, families, and physicians on injury awareness and prevention.

Topics: Adolescent; Adult; Age Distribution; Child; Contusions; Databases, Factual; Facial Bones; Facial Injuries; Female; Fractures, Bone; Humans; Incidence; Jaw Fractures; Lacerations; Male; Nose; Orbital Fractures; Sex Distribution; Soccer; United States; Young Adult

Topics: Cartilage; Chondroitin Sulfates; Collagen; Esthetics; Facial Injuries; Free Tissue Flaps; Humans; Middle Aged; Nose; Plastic Surgery Procedures; Reoperation; Rhinoplasty; Skin, Artificial; Surgical Flaps; Tissue and Organ Harvesting; Wounds, Gunshot

The wearing of eye protection by United Kingdom soldiers in Afghanistan has reduced the morbidity caused by explosive fragments. However, the remaining face remains uncovered because there is a lack of evidence to substantiate the procurement of methods to protect it. Using a new computerised tool we entered details of the entry sites of surface wounds caused by explosive fragments in all UK soldiers who were injured in the face between 1 January 2010 and 31 December 2011. We compared clinical and predicted immediate and long term outcomes (as defined by the Abbreviated Injury Score (AIS) and the Functional Capacity Index (pFCI), respectively). We also used the tool to predict how additional protection in the form of a visor and mandible guard would affect outcomes. A soldier wearing eye protection was 9 times (1.03/0.12) less likely to sustain an eye injury than one without. However, 38% of soldiers in this series were not wearing eye protection at the time of injury. There was no significant difference between the AIS and pFCI scores predicted by the tool and those found clinically. There is limited evidence to support the use of a mandible guard; its greatest asset is better protection of the nose, but a visor would be expected to reduce long-term morbidity more than eye protection alone, and we recommend future trials to assess its acceptability to users. We think that use of this novel tool can help in the selection of future methods of ballistic facial protection.

Topics: Abbreviated Injury Scale; Blast Injuries; Computer-Aided Design; Equipment Design; Explosions; Eye Injuries, Penetrating; Eye Protective Devices; Facial Injuries; Forecasting; Head Protective Devices; Humans; Imaging, Three-Dimensional; Lasers; Male; Mandibular Injuries; Military Personnel; Nose; Personal Protective Equipment; Prospective Studies; Registries; Treatment Outcome; United Kingdom

The number of injuries caused by dog bites is increasing in the United Kingdom. We review patients admitted with dog bites to a single maxillofacial department in a district general hospital over a 21-month period. Data include patients' characteristics, and the site and severity of injury. The relationship of the victim to the animal and its breed and classification were added where possible. In total, 65 patients, mean age 22 years (range 1-71, median 14) were included. There were 84 wounds, and their site and severity were recorded according to the Lackmann classification. Twelve different breeds of dog were responsible for the bites. An appreciable proportion of those injured were young children. Educational strategies should aim to reduce the incidence of all dog bites, particularly in young children, as their needs after initial treatment are complex. We propose specific strategies to reduce the number of these injuries.

Topics: Adolescent; Adult; Aged; Animals; Bites and Stings; Cheek; Child; Child, Preschool; Dogs; Facial Injuries; Humans; Infant; Length of Stay; Lip; Middle Aged; Muscle, Skeletal; Nose; Pets; Retrospective Studies; Skin; Soft Tissue Injuries; United Kingdom; Young Adult

Topics: Facial Injuries; Fractures, Bone; Humans; Incisor; Male; Mandible; Nose; Tomography, X-Ray Computed; Young Adult

The central face is the dominant feature of humans. A complex central facial defect can severely affect a person's appearance and function and can pose significant challenges for reconstructive surgeons. The aims and principles of central facial reconstruction are to achieve adequate function and esthetics. This report describes the case of a 45-year-old man who was bitten in the central face by a wild boar. A free radial forearm flap was designed as a multiple-folding flap that was divided into several portions. The folded portions of the flap were used to reconstruct the nasal mucosa, oral mucosa, and upper lip defects and provided the lining for an eventual staged nasal reconstruction. The patient achieved good functional recovery and had a good esthetic outcome.

Topics: Animals; Bites and Stings; Cheek; Esthetics; Facial Injuries; Forearm; Free Tissue Flaps; Humans; Lip; Male; Middle Aged; Mouth Mucosa; Nasal Mucosa; Nose; Plastic Surgery Procedures; Skin Transplantation; Sus scrofa; Tissue and Organ Harvesting

Topics: Adult; Facial Injuries; Female; Fracture Fixation; Fractures, Bone; Humans; Incidence; Male; Northern Ireland; Nose; Retrospective Studies; Rhinoplasty

Topics: Animals; Arteriovenous Shunt, Surgical; Bites and Stings; Child; Dogs; Facial Injuries; Female; Follow-Up Studies; Humans; Lip; Nose; Replantation

To describe a technique for reconstruction of the rostral aspect of the muzzle of a dog after traumatic amputation.. Clinical report.. Adult female dog.. A 6-year-old, intact, female, mixed-breed dog was admitted for facial reconstructive surgery after traumatic amputation of the rostral aspect of the muzzle. The nasal planum and the rostral portion of the upper lips were missing. A hard palate mucoperiosteal flap and lateral labial advancement flaps were used to reconstruct the nasal philtrum and borders of the nares.. This reconstructive technique resulted in adequate nostril function and an acceptable cosmetic outcome. One naris developed partial obstruction with granulation tissue that may have occurred because of a lack of circumferential nasal mucosa to appose the skin on that side.. The mucoperiosteum of the hard palate can be used to reconstruct the rostral aspect of the muzzle after traumatic amputation, resulting in an acceptable cosmetic outcome.

Topics: Animals; Dogs; Face; Facial Injuries; Female; Lip; Nose; Palate; Periosteum; Plastic Surgery Procedures; Surgical Flaps

Successful microvascular replantation of amputated facial tissues has been sporadically reported in the literature, although most of these reports have concerned the reattachment of relatively small and segmental portions of the nose or nasal tip. We report the successful replantation of a traumatically amputated composite piece of tissue comprising the entire nose, most of the upper and lower lips, and the nasal boney and cartilaginous complex based on microvascular repair of the labial arteries and glabellar veins and discuss the results and implications of this experience.

Topics: Adult; Amputation, Traumatic; Facial Injuries; Humans; Lip; Male; Nose; Replantation

By definition, degloving is skin and subcutaneous tissue detachment, most often affecting the limbs and extremities and occasionally the scalp. Degloving generally stems from high-energy trauma, but can also be intentional, such as in the case of planned surgical access in the anterior region of the mandible in oral-maxillofacial surgery. This paper describes an extreme case of complete traumatic maxillofacial degloving that caused partial avulsion of the soft tissues and maxilla. This is an extremely rare condition that has not previously been described in the literature, as the patient survived despite the risk of imminent death. This case report addresses the decisions made regarding the prevention of necrosis and infection that guided the emergency care and subsequent elective steps.

Topics: Adult; Facial Bones; Facial Injuries; Facial Muscles; Female; Frontal Sinus; Humans; Maxillary Fractures; Maxillofacial Injuries; Nose; Patient Care Planning; Plastic Surgery Procedures; Skull Fractures; Soft Tissue Injuries; Zygomatic Fractures

Most nasal reconstructions previously repaired with regional flaps require a revision to improve appearance and function. Many local flaps also create significant landmark and contour distortions, such as alar crease obliteration or nostril margin malposition.. Over 400 nasal reconstructions with regional tissues, primarily forehead flaps, and 100 local flap repairs were evaluated to identify the causes of failure of the primary repair, to classify late deformities, and to develop an approach to the late revision of a nasal reconstruction. Surgical timing, staging, incisional approaches, and operative technique were defined with the goal of restoring normal dimension, volume, position, projection, symmetry, skin quality, border outline, and contour.. Deformities can be classified as "minor," when overall dimension, volume, and position are satisfactory but nasal landmarks are imperfect, nostril margins are asymmetric, or the nostrils are small; or "major," when there is a significant failure to restore the basic fundamental character of the nose. It is bulky, shapeless, malpositioned and without landmarks. These characteristics determine incision sites, the extent of required flap reelevation, soft tissue excision and cartilage grafting, the number of stages, the use of secondary local flaps, surgical delay, and the need for reoperation with a second regional flap.. Revision is accomplished through new direct incisions and old peripheral border scars. Soft tissue excision and secondary cartilage grafts can effectively reestablish contour. Lining deficiencies are addressed by transferring discardable local excess skin from the nostril margin, columella, cheek, or upper lip to open the airway. If local tissues are inadequate, a second regional flap must be transferred to resurface or line the nose.

Topics: Bone Transplantation; Burns; Cartilage; Constriction, Pathologic; Facial Injuries; Humans; Lip; Nasal Cavity; Nose; Plastic Surgery Procedures; Reoperation; Surgical Flaps; Time Factors; Treatment Failure

Asymmetry of the nasal tip is a common finding in the setting of primary and revision rhinoplasty. Careful preoperative analysis is imperative to identify the anatomic etiology of the asymmetry to develop an appropriate surgical plan to correct it. This article describes the anatomic structures that affect the overall appearance of the nasal tip, explains how intrinsic asymmetries can alter nasal tip appearance, and offers a menu of surgical techniques that can be used to correct these asymmetries.

Topics: Cartilage; Facial Asymmetry; Facial Injuries; Humans; Nasal Bone; Nasal Cartilages; Nasal Septum; Nose; Nose Deformities, Acquired; Rhinoplasty; Suture Techniques

Topics: Education, Medical, Continuing; Facial Injuries; Female; Humans; Lacerations; Middle Aged; Nose; Paresthesia; Skin Ulcer; Trigeminal Nerve Diseases

Surgical reconstruction of the nasal tip is a very delicate procedure, as it must rebuild three different anatomical planes: mucosa, cartilage and skin with functional and aesthetic requirements. This procedure is even more difficult in burns patients, due to more limited donor sites and poor skin quality. Numerous flap options are available to reconstruct defects of the tip of the nose. The authors report their experience of nasal alar reconstruction by a scar tissue remodelling technique using a rolled dermal flap with overlying full-thickness skin graft.. The medical charts of seven patients (five women and two men with a mean age of 30) treated between 1991 and 2006 were retrospectively reviewed. Six patients presented sequelae of a facial burn and one patient had congenital facial hemiagenesis.. Reconstruction was bilateral for all burns patients and unilateral for the patient with facial hemiagenesis. The skin graft was raised from the medial aspect of the forearm in four cases, the retroauricular region in two cases and the groin in one case. One patient required a second surgical procedure for necrosis of the nasal tip. No nasal obstruction was reported with a mean follow-up of five years (range: six months to 15 years).. The rolled dermal flap with overlying full-thickness skin graft is a simple and reliable procedure for reconstruction of the nasal alae. Filling of the nasal alae defect and reconstruction of all anatomical planes are achieved in a single surgical procedure. The aesthetic and functional results were satisfactory, with minimal scarring of the donor site. This technique is very suitable for the treatment of burn sequelae and can also be used to treat nasal hemiagenesis and nasal mutilation by biting or facial trauma.

Topics: Adolescent; Adult; Burns; Burns, Chemical; Child; Cicatrix; Face; Facial Injuries; Female; Humans; Male; Middle Aged; Nose; Postoperative Complications; Reoperation; Retrospective Studies; Rhinoplasty; Skin Transplantation; Surgical Flaps; Tissue and Organ Harvesting

Several approaches exist for the treatment of animal attacks targeting the head and neck region. The treatment options and timing vary depending on the animal species, the nature of the defect, and the experience of the surgeon. In this study, early surgical treatment options used in head-neck injuries caused by domesticated or wild animal attacks are presented.We consider 12 patients who were admitted to our clinic between June 2006 and May 2010 with head-neck injuries caused by animal attacks. Tissue defect had developed in 10 patients due to half-wild dog bite and in 2 patients due to wolf bite. The ages of the patients ranged from 3 to 45 years (mean, 21.3 years). Among the patients included in the study, 4 had facial injury, 3 had ear, 3 had scalp, 1 had eye, and 2 had nose injuries. In all patients, early surgical reconstruction was performed after irrigation, antisepsis, and debridement. Concurrent rabies and tetanus prophylactic antibiotherapy program was started.Infection or surgical complications were not observed in any of the patients. Rabies symptoms were determined in one of the quarantined dogs under surveillance. There were no positive findings in the patient bitten by the dog. The surgical treatment results from all patients were at satisfactory levels.As a result, it is observed that, in the treatment of head and neck injuries resulting from animal bites, early acute approach has replaced the traditional long-term treatment. We believe that debridement and early surgical reconstruction used in combination with medical support and prophylactic treatment are the best treatment method.

Topics: Adolescent; Adult; Animals; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bites and Stings; Child; Child, Preschool; Craniocerebral Trauma; Debridement; Dogs; Ear, External; Eye Injuries, Penetrating; Facial Injuries; Female; Follow-Up Studies; Humans; Lacerations; Male; Middle Aged; Neck Injuries; Nose; Plastic Surgery Procedures; Povidone-Iodine; Rabies Vaccines; Scalp; Surgical Flaps; Tetanus Toxoid; Wolves

Topics: Accidental Falls; Aged; Biopsy; Facial Dermatoses; Facial Injuries; Female; Humans; Immunocompetence; Mycobacterium tuberculosis; Nose; Skin Ulcer; Tuberculosis, Cutaneous; Wound Infection

To investigate the nature of surgical revision procedures necessitated by cicatricial complications of facial injury.. All patients who had facial trauma in a period of approximately 5 years managed by a single surgeon were reviewed. Of these, 36 were found to have undergone secondary revision procedures arising specifically from scar-related complications.. The average age of patients undergoing revision surgery was 34 years; 27 of the 36 patients (75%) were men, and 9 of the 36 (25%) required multiple revision surgical visits. The most common cause of injury was motor vehicle collision; the interval between the initial trauma and the first revision surgery was most commonly 6 to 12 months. Scar-related complications were categorized on the face by anatomic subsite; they occurred most frequently on the forehead/cheeks/chin area, with the eyes/periorbital area the second most frequent location. One hundred twelve discrete surgical procedures (as per current procedural terminology) were performed on these 36 patients to address the cicatricial sequelae of their initial injuries.. Facial trauma can frequently entail secondary morbidity in the form of facial scar deposition, which itself can necessitate surgical repair. This represents a substantial but as yet underappreciated health care burden attendant to maxillofacial injury.

Topics: Adolescent; Adult; Aged; Cicatrix; Eyelids; Facial Injuries; Female; Forehead; Humans; Lip; Male; Middle Aged; Nose; Plastic Surgery Procedures; Retrospective Studies; Young Adult

Nasomaxillary depression, which may be seen with major saddle nose deformities, especially as a sequel to childhood nasal trauma, generally is overlooked during management of the saddle nose. To handle both the saddle nose deformity and nasomaxillary depression, the authors used a one-stage intraoral and external open rhinoplasty approach for 12 patients. Lateral nasal osteotomies and correction of midface retrusion with crescent-shaped autogenous rib cartilage grafts were performed through two bilateral intraoral gingivobuccal incisions. The external open rhinoplasty approach was used for the correction of the saddle nose deformities. The mean follow-up period after the surgery was 2 years (range, 1-3.5 years). The correction of nasal tip depression resulting from midface retrusion was evaluated by lateral cephalometric radiographs. The mean movement of the nasal tip anteriorly in the sagittal plane 1 year after the operation was 5.5 mm (range, 4-7 mm). The functional and aesthetic results were satisfactory for all the patients. As the findings show, the intraoral part of the approach provides a route for the placement of cartilage grafts to correct the depressed nasal tip, augment the paranasal area, and provide support to the lateral alar bases and the controlled low-to-low lateral osteotomies. The external part of the approach provides correction of the saddle nose deformity.

Topics: Adolescent; Adult; Cartilage; Cephalometry; Facial Injuries; Female; Humans; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Ribs; Young Adult

Home made siloxan material <> for making external face prosthesis was introduced into clinical practice. Original technique of making external face prosthesis for defects and deformations of middle zone of face based upon making individual prosthetics according to esthetic requirements of the patient was developed. Stable staining of the composition <> by nontoxic pigments of the <> brand with the possibility of repetitive color corrections of the ready external prosthesis let to achieve high esthetic and functional result.

Topics: Adult; Child; Ear, External; Facial Injuries; Humans; Male; Maxillofacial Prosthesis; Middle Aged; Nose; Orbit; Prostheses and Implants; Siloxanes

Topics: Adult; Biocompatible Materials; Biopsy; Collagen; Facial Injuries; Female; Follow-Up Studies; Graft Survival; Humans; Nasal Cartilages; Nose; Nose Deformities, Acquired; Prostheses and Implants; Prosthesis Design; Rhinoplasty

The nose is the most prominent of all facial structures and is susceptible to many types of trauma. All soft tissue injuries of the nose have the potential to distort its appearance and adversely affect the patient's self-image and self-esteem. Once life-threatening injuries are stabilized, a careful history and physical exam should be completed and treatment individualized. The ultimate objective of treatment is to achieve both functional and cosmetic restoration with timely diagnosis and repair. Immediate nasal reconstruction is ideal when medically possible because this decreases long-term sequelae.

Topics: Facial Injuries; Humans; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Soft Tissue Injuries; Surgery, Plastic; Surgical Flaps

We developed the orbicularis oris myomucosal island flap (OOMMIF) to reconstruct the nasal lining in one stage. The OOMMIF blood supply derives from the intramuscular vascular network which communicates with the submucosal vascular plexus via the vascular network formed by the deep ascending branches of the superior labial artery. An oral mucosal flap of approximately 2 x 3cm can be harvested from the upper lip pedicled solely on the orbicularis oris muscle. We transferred this flap to a nasal lining defect located in the ala in four patients, the nasal floor in two patients, and the columella in two patients. The flap donor site was closed primarily. All flaps took completely with satisfactory results. Minor complications included slight asymmetry of the vermilion height due to donor site contracture in one patient and flap drooping in two patients corrected by secondary debulking. Upper lip functional loss was not observed, although upper lip hypoaesthesia occurred in one patient, which disappeared within 6 months. An OOMMIF can be easily elevated with minimal donor site morbidity. Thus, the OOMMIF is a good candidate for one-stage reconstruction of small nasal lining defects.

Topics: Aged; Facial Injuries; Facial Neoplasms; Humans; Male; Middle Aged; Mouth Mucosa; Muscle, Skeletal; Nose; Nose Deformities, Acquired; Surgical Flaps

Nasal injuries are commonly assessed in the accident and emergency (A&E) departments. Where swelling precludes assessment of deformity, patients are often referred to the ear, nose and throat (ENT) outpatients once the swelling has subsided. However, not all of these pateints require referral. Patients with no deformity, or those in whom there is no deformity after any swelling has subsided, do not need further assessment. The purpose of this audit was to assess the impact of a nasal injury management guideline on nasal injury referrals to the ENT department. An audit was made of nasal injury referrals seen in ENT outpatients, before and after the introduction of a guideline. The proportion of patients seen in ENT outpatients not requiring any ENT treatment after the introduction of the guideline was reduced. We suggest that our guideline can reduce unnecessary ENT outpatient appointments for patients with nasal injuries and may prevent delayed ENT input for those with new onset nasal deformity.

Topics: Adult; Emergency Medical Services; Facial Injuries; Female; Humans; Male; Medical Audit; Nose; Practice Guidelines as Topic; Retrospective Studies; Rhinoplasty; Trauma Severity Indices

Little has been written about persistent external nasal pain after injury to the nose in the neurologic or headache literature. In clinical practice, this can be a disabling and treatment refractory condition. The external portion of the nose is highly innervated by branches of the ophthalmic and maxillary divisions of the trigeminal nerve including the nasociliary nerve, external nasal nerve, infratrochlear nerve, anterior ethmoidal nerve, and infraorbital nerve. As these nerves are located on the external portion of the nose just deep enough to the skin they can be easily traumatized with any impact to the nose. Four patients with what is termed the post-traumatic external nasal pain syndrome are reported in this paper, describing the clinical presentation of the disorder and providing treatment options. Post-traumatic external nasal pain syndrome appears to be a novel form of trigeminal-based pain not previously reported in the neurologic literature.

Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Antidepressive Agents, Tricyclic; Facial Injuries; Facial Neuralgia; Female; Ganglia, Parasympathetic; Humans; Male; Maxillary Nerve; Narcotics; Nerve Block; Neurosurgical Procedures; Nose; Nose Diseases; Ophthalmic Nerve; Treatment Outcome; Trigeminal Nerve Diseases; Young Adult

Evaluation of bodily injuries and diminished general vital activity from face and facial bones injuries accompanied by scars and disfiguration ranges from 5 to 50 percent depending on the disfiguration, loss of function and degree of aesthetic marring. They are graded accordingly and they may be: mild (5 to 20%), medium (20 to 35%) and serious when the degree of bodily injury and diminished general vital activity is 35 to 50%. Percentage of bodily injuries and diminished general vital activity from jaw defects ranges from 30 to 80 percent depending on the disfiguration, loss of function and degree of aesthetic marring. Percentage of bodily injuries and diminished general vital activity from nose structure nasal pyramid defects ranges from 10 to 20 percent depending on the disfiguration, loss of function and degree of aesthetic marring. Partial loss of nose structure is estimated at 15%, whereas the complete one may go up to 30%. Diminished general vital activity and percentage of bodily injury with partial laryngectomy ranges from 20 to 40%. In case of subtotal laryngectomy, this is up to 60% and with total one, it reaches 80%.

Topics: Ear; Facial Injuries; Forensic Medicine; Humans; Mouth; Nose; Pharynx; Tooth Injuries; Violence

This article reports a longitudinal follow-up of a 15-month-old child with dental trauma resulting from an attack by a dog. The injury consisted of laceration of the facial tissues and loss of the upper central deciduous incisors, in addition to loss of bone tissue in the same area. A malformation of the crown of the right central permanent incisor and complete change of the shape of the left central permanent incisor were observed. The etiological factors of childhood injuries as well as the importance of dental emergency care are discussed and the 14-year clinical and radiographic follow up of the case is presented.

Topics: Animals; Bites and Stings; Dogs; Facial Injuries; Female; Follow-Up Studies; Humans; Incisor; Infant; Lacerations; Lip; Longitudinal Studies; Maxilla; Nose; Tooth Avulsion; Tooth Crown; Tooth Loss; Tooth, Deciduous

Topics: Aged; Burns; Facial Injuries; Humans; Male; Nose; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome

Human bite injuries are both deceptive and challenging in their presentation and management. They remain a frequent presentation to our unit, most often following late night alcohol fuelled aggression.. To audit the management of these wounds, with particular focus on infective complications and outcomes.. A three year retrospective chart review was undertaken on all patients referred to the plastic surgery unit from 1 January 2003 through to 31 December 2005.. A total of 92 patients with 96 human bite wounds were identified. The majority were male (92%). Alcohol consumption was documented in 86% of cases. The majority (70%) occurred over the weekend or on a public holiday. Facial injuries made up 70% of injuries with the remainder being to the upper limb. The ear was the most common target of all facial injuries (65%). Infection was documented in 18 cases (20%), with bite injuries to the upper limb and those presenting late (>12 h) having a higher incidence of infection.. Human bite wounds present a challenge to any emergency department, given the many issues involved in their management. Underestimation of the complexity and potential sequelae of these wounds will result in a suboptimal outcome for the patient.

Topics: Adolescent; Adult; Alcohol Drinking; Bites, Human; Ear; Emergencies; Facial Injuries; Female; Humans; Male; Medical Audit; Middle Aged; Nose; Retrospective Studies; Violence; Wound Infection

Topics: Facial Injuries; Humans; Lip; Nose; Tissue and Organ Procurement

The aim of the trial was evaluation of efficacy of human cultured allofibroblasts transplantation and novel bandage Grasolind neutral (Paul Hartmann, Germany) on the wound with a large defect of nasal soft tissues. Biopsy findings at different stages of healing of the wound confirmed high regenerative properties of human allofibroblasts. The latter promoted reestablishment of full-thickness graft in minimal scarring. After use of allofibroblasts physiological desquamation started 13 days earlier than in the control group. A novel interactive bandage Grasolind (Paul Hartman, Germany) produced a positive effect as it did not damage newly formed epidermal cells which stimulated regeneration.

Topics: Adult; Bandages; Cell Transplantation; Cells, Cultured; Facial Injuries; Fibroblasts; Follow-Up Studies; Humans; Male; Nose; Transplantation, Homologous; Wound Healing

The repair of a craniofacial or nose deformity requires a large volume of reconstructive material. A conventional cartilage graft does not provide a sufficient volume of reconstructive material. Therefore, augmentation of the facial form to the defect shape is quite difficult. The authors developed a new treatment method that provides a sufficiently large volume of reconstructive material and enables an easier reconstruction of the original shape.. Ages of the patients ranged between 9 and 63 years. Approximately 1 cm of auricular cartilage was collected from the auricular concha. Isolated chondrocytes were cultured with autologous serum that accelerates cell proliferation. The cells were subcultured and formed a gel-form mass. This mass, together with autologous serum, was grafted (injected) on the periosteum and into the subcutaneous pocket. The volume of grafted cultured chondrocytes ranged from 1.7 to 40 cc (1 to 5 x 10(7) cells/cc). The lesion changed from soft gel form into hard cartilage tissues within 2 to 3 weeks and stabilized.. Excellent or good satisfactory results were obtained in all patients and have been maintained for periods ranging from 3 to 34 months. No patient experienced absorption of cultured chondrocytes. Biopsy of the newly formed tissues showed that it was an elastic cartilage derived from the original tissue.. A small number of chondrocytes obtained from a 1-cm auricular cartilage are successfully cultured into a large number of cells in a gel form. Those autologous auricular chondrocytes in a gel form allow for the repair of complicated shapes of the defect area. This technique is applicable to various treatments for craniofacial or nose deformity.

Topics: Adolescent; Adult; Biopsy; Cell Culture Techniques; Cells, Cultured; Child; Chin; Chondrocytes; Craniofacial Abnormalities; Device Removal; Ear, External; Elasticity; Facial Injuries; Female; Gels; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Prostheses and Implants; Serum; Skull; Tissue and Organ Harvesting; Transplantation, Autologous; Treatment Outcome

This paper describes the use of a composite graft from the mastoid area consisting of full-thickness skin peripherally and selectively localised fascia-fat tissue underneath the skin centrally for immediate reconstruction of moderate defects of the nasal tip including the columella and soft triangle. Mastoid composite grafting is a simple and safe procedure that avoids partial graft loss and provides adequate augmentation of soft tissue, easy reshaping of the new nostril rim, minimal post-operative shrinkage, and no donor-site morbidity. Then, it results in a satisfactory nasal appearance with adequate tip projection and symmetry. This procedure may represent a preferred method of nasal tip reconstruction.

Topics: Accidental Falls; Accidents, Traffic; Adult; Aged, 80 and over; Crush Syndrome; Debridement; Facial Injuries; Female; Humans; Male; Mastoid; Nose; Nose Deformities, Acquired; Rhinoplasty; Surgical Flaps; Suture Techniques

Currently, various alloplastic materials are being used for reconstruction of three-dimensional structures, and high-density porous polyethylene is so far the best and the most commonly used material. Various indications for high-density porous polyethylene have been defined for closure of craniofacial defects, correction of congenital anomalies, and aesthetic augmentations. A common property of various studies published so far is that after being fixed to the bone or underlying structures, high-density porous polyethylene has been covered primarily or by skin flaps. For reconstruction of complex three-dimensional structures such as the ear and nose, the success of current methods is limited by the thinness and pliability of the skin flap. In this study, the authors' aim was to investigate the graftability of high-density porous polyethylene after prefabrication with an axial pedicle and to explore possible clinical applications in light of the new data obtained. In the experimental study, three-dimensional implants (rectangular prism) carved from high-density porous polyethylene were prefabricated using bilateral superficial epigastric arteries and veins of 25 New Zealand rabbits. After a waiting period of 2 to 6 weeks in five groups, control samples were obtained and the prefabricated implants that had been left in place were directly grafted. The results showed that high-density porous polyethylene was vascularized 75 percent after 4 weeks and 90 percent after 5 weeks, and 95 percent of the grafts had survived after 8 weeks. In the clinical study, three nose defects, three ear defects, and one hard palate defect in seven patients ranging in age from 21 to 72 years were reconstructed using the same method. High-density porous polyethylene has been prefabricated and directly grafted for the very first time on a clinical basis. No serious complications have been observed, except for minimal graft loss in two patients. It is obvious that full-thickness skin grafts that are thinner than flaps will adapt better to the fine details of high-density porous polyethylene and will highly increase the detail obtained in the reconstruction of three-dimensional defects.

Topics: Abdomen; Adult; Aged; Animals; Carcinoma, Basosquamous; Ear, External; Epigastric Arteries; Facial Injuries; Humans; Implants, Experimental; Lip; Middle Aged; Neovascularization, Physiologic; Nose; Nose Neoplasms; Palate, Hard; Polyethylene; Prostheses and Implants; Rabbits; Random Allocation; Skin Neoplasms; Soft Tissue Injuries; Wound Healing

Patients who have survived thermal injuries to the face suffer severe disfigurement from the devastating deformities of full-thickness facial burns. The nose is the prominent central organ of the face, which has crucial effect on Aesthetic appearance. The plastic surgeon's role to deal with such cases is to undertake procedures to produce a more pleasant look although the target organ could be the non-burned areas of the face. It is a common belief that surgical intervention under the scarred or grafted nose is risky and may result in skin or covering graft necrosis. For this reason, plastic surgeons are cautious and hesitate to perform Aesthetic surgery on burn scarred tissue. We present 13 cases, 10 women and three men with complete or subtotal nasal burn. Classic Aesthetic Rhinoplasty operations were performed to create a better appearance and correct any internal or external deviations. These procedures are carried out under severely burned skins, or previously grafted and reconstructed noses. Cases were followed for about a one-year period. There was no necrosis in any part of skin after surgery. We believe that Aesthetic rhinoplasty can be done safely in these victims with pleasing outcome. The problems that we encountered in these cases were irregularities of burned alar margins, multiple operations and intractable nasal deviation in severe cases.

Topics: Adolescent; Adult; Burns; Cicatrix; Facial Injuries; Female; Humans; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Treatment Outcome

How to use the orbitonasolabial flap in vascular island thanks to his pedicle based an angular vessel. An anatomic study based on 11 cadavers allows to check the existence of a constant pedicle. This flap was used on 6 patients aged 62 to 90 years old on an average period of 16 months to fill up jugular, orbital, nasolabial and inner canthal defects. Two complications have occurred, a superficial necrosis of the lower part of the flap having spontaneously healed and an ectropion on a senile part. It has been necessary to degrease a second time in 50% of the cases. Nevertheless, the flap can be considered reliable and able to cover tissue defect in the central facial region with minor aesthetic and functional sequel on the donor site.

Topics: Aged; Aged, 80 and over; Cadaver; Craniofacial Abnormalities; Facial Injuries; Female; Humans; Lip; Male; Nose; Orbit; Plastic Surgery Procedures; Surgical Flaps

Although a popular endeavor, boxing has fallen under increased scrutiny because of its association with traumatic brain injury. However, few studies have investigated the overall epidemiology of boxing injuries from representative samples, and no study has ever documented the incidence of injuries in female boxers. This study is a review of professional boxing data from the state of Nevada from September 2001 through March 2003.. Medical and outcome data for all professional boxing matches occurring in Nevada between September 2001 and March 2003 (n = 524 matches) were analyzed on the basis of a pair-matched, case-control design. Cases were boxers who received an injury during the boxing matches. Boxers who were not injured served as control subjects. Both conditional and unconditional logistic regression models were used to assess risk factors for injury.. The overall incidence rate of injury was 17.1 per 100 boxer-matches, or 3.4 per 100 boxer-rounds. Facial laceration accounted for 51% of all injuries, followed by hand injury (17%), eye injury (14%), and nose injury (5%). Male boxers were significantly more likely than female boxers to receive injuries (3.6 versus 1.2 per 100 boxer-rounds, P = 0.01). Male boxing matches also ended in knockouts and technical knockouts more often than did female matches (P < 0.001). The risk of injury for those who lost the matches was nearly twice the risk for the winners. Those who lost by knockout had double the risk of injury compared with those who lost by other means. Neither age nor weight was significantly associated with the risk of injury.. The injury rate in professional boxing matches is high, particularly among male boxers. Superficial facial lacerations are the most common injury reported. Male boxers have a higher rate of knockout and technical knockouts than female boxers. Further research is necessary to determine the outcomes of injury, particularly the long-term neurologic outcome differences between sexes.

Topics: Adult; Age Factors; Athletic Injuries; Boxing; Case-Control Studies; Eye Injuries; Facial Injuries; Female; Hand Injuries; Humans; Incidence; Logistic Models; Male; Nevada; Nose; Risk Factors; Sex Factors

Topics: Facial Injuries; Humans; Intubation, Intratracheal; Maxillary Fractures; Nose; Pharynx

Topics: Adult; Chin; Facial Injuries; Female; France; Humans; Lip; Nose; Risk Factors; Transplants

The analysis of different posttraumatic deformities of the nasal tip gave evidence for a close correlation of internal nose deformities with nasal breathing ranging from common changes in the internal nose (hypertrophy of the inferior turbinated bone) to atresia when nasal breathing is completely blocked. Because of tissue edema, respiration improved and normalized only 1 and 3 months after surgery. It is concluded that functional examinations before and after surgery are beneficial for patients and warrant optimal terms of surgery.

Topics: Adult; Facial Injuries; Female; Follow-Up Studies; Humans; Male; Mouth Breathing; Nose; Nose Deformities, Acquired; Respiration; Rhinoplasty; Trauma Severity Indices

Deformities of a totally burned face present a profound challenge to the reconstructive plastic surgeon. Skin grafting has been used traditionally for resurfacing with limited success, especially when the burns were so severe the deeper structures were destroyed. Total face reconstruction, using bilateral extended scapular free flap, has been reported previously for severe deformities following an extensive facial burn. Although this method obtained better aesthetic and functional results than skin grafting, the donor-site morbidity was relatively high, with a large scar that extended across the entire back. In addition, the nose needed to be reconstructed separately with a forehead flap or free radial forearm flap. The authors experienced a case in which a totally burned face was reconstructed successfully with a single free-expanded flap. A 54-year-old man sustained a severe facial burn with gasoline that involved the face, anterior neck, anterior chest, and bilateral upper extremities. Sequential debridement and skin grafting were required to close the burn wound. A tissue expander was inserted in his left back before the facial reconstruction. Six months after insertion of the tissue expander, the left dorsal skin was transferred to the face as one large flap, size 28x27 cm, with three sets of vascular anastomoses. The flap totally survived with abundant tissue at the central area to reconstruct the nose. With five complementary procedures, including a costal cartridge graft, the shape of the nose was restored, and acceptable functional and aesthetic results were obtained. This method did not require a separate tissue transfer for nasal reconstruction. To our knowledge, this is the first case of successful reconstruction with one flap for total face reconstruction that included the nose.

Topics: Burns; Cicatrix; Facial Injuries; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Surgical Flaps; Tissue Expansion

Topics: Child, Preschool; Facial Bones; Facial Injuries; Facial Muscles; Female; Fractures, Comminuted; Humans; Lacerations; Nose; Plastic Surgery Procedures; Skull Fractures; Surgical Flaps; Suture Techniques

A case of nearly complete amputation of the alar wing is presented whereby a successful arterial revascularization was accomplished using an arterial rerouting technique. Venous stasis was overcome by means of stab-wound wiping. An excellent result was obtained following complete survival of the revascularized segment. The authors conclude that microvascular revascularization should always be attempted whenever possible, even if a skin bridge is preserved in nearly complete amputations of the nose.

Topics: Adult; Amputation, Traumatic; Anastomosis, Surgical; Arteries; Facial Injuries; Humans; Male; Microsurgery; Nose

To study the applications of bone grafts from the cranium or mandible in the repair of posttraumatic deformities of the nose.. From 1997 to 2002, a total of 44 patients, who presented with secondary nose deformity as well as facial fractures, were reconstructed by autogeneous outer table grafts of the calvarial or mandibular bone after facial skeleton reposition. In this series, 32 cases used the calvarial bone, 12 cases used the mandible bone, which was harvested through a coronal incision and an oral approach respectively.. The surgical incisions healed primarily in all patients with minimal scar. The facial appearance was greatly improved. No implant infection, extrusion and shift were observed in the postoperative follow-up of 6 months to 2 years. There was not obvious bone resorption, nor donor site morbidity.. Autogeneous calvarial and mandibular bone was an ideal material of bone graft in reconstruction of severe posttraumatic deformities of the nose. Compared with other autogeneous and alloplastic materials, the outer table of the calvarial and mandibular bone produced less morbidity of the donor site, invisible scar, no rejection and less resorption.

Topics: Adolescent; Adult; Facial Injuries; Female; Humans; Male; Mandible; Mandibular Injuries; Mandibular Prosthesis Implantation; Middle Aged; Nose; Patient Satisfaction; Plastic Surgery Procedures; Radiography; Skull; Treatment Outcome

Maxillofacial surgeons are more and more confronted with wide defects of the face, particularly after resection of facial cancer. Complex wounds of the face, whatever the etiology may be, poses the difficult problem of their rehabilitation. The surgical reconstruction offers usually the most interesting solutions on the conceptual and morphological stages. There remain some particular cases where the therapeutic choice tends towards the rehabilitation by epitheses. The improvement of texture and color of epitheses and the improvement of the possibilities of their osseous anchorage by implants (endo-osseous or juxta-osseous) permit to reconstruct that kind of complex facial wounds with restoration of oral function and with a good morphologic result.

Topics: Adult; Aged; Dental Implants; Esthetics; Eye, Artificial; Face; Facial Bones; Facial Injuries; Facial Neoplasms; Female; Humans; Male; Maxillofacial Prosthesis; Middle Aged; Nose; Orbital Implants; Plastic Surgery Procedures; Prostheses and Implants; Prosthesis Coloring; Prosthesis Design; Surface Properties

A 2-year-old boy sustained a massive facial soft-tissue wound secondary to a dog attack. Essentially all the soft tissues of the face were absent, including innervation and intraoral lining. We describe the reconstruction of this defect with five simultaneous free tissue transfers. To our knowledge, this is the first report of five simultaneous free flaps in any patient.

Topics: Animals; Bites and Stings; Cheek; Child, Preschool; Chin; Dogs; Facial Injuries; Humans; Male; Mouth; Nose; Plastic Surgery Procedures; Surgical Flaps

The retention of facial prostheses is a major factor influencing the successful outcome of rehabilitative treatment following ablative cancer surgery or trauma and for the prosthetic replacement of congenitally absent tissue. Since the sixteenth century to the present day, facial prosthetic devices have been retained by methods including adhesives and spectacle frames. The introduction of the Branemark extra oral implant system enhanced the stability of life-like prostheses thus giving patients more confidence in their use. This paper outlines the retention systems commonly used at the authors unit and the benefits gained by the use of implants to retain facial prostheses. The use of a single stage surgical technique instead of the usual two stage procedure is detailed.

Topics: Adolescent; Adult; Child; Ear, External; Facial Bones; Facial Injuries; Female; Gold Alloys; Head and Neck Neoplasms; Humans; Magnetics; Male; Middle Aged; Nose; Orbital Implants; Prostheses and Implants; Prosthesis Design; Prosthesis Implantation

Topics: Adolescent; Cefuroxime; Cephalosporins; Facial Injuries; Female; Floxacillin; Fractures, Bone; Humans; Infusions, Intravenous; Nose; Ocular Motility Disorders; Orbit; Penicillins; Streptococcal Infections; Visual Acuity

We report the successful use of the intubating laryngeal mask airway in a patient with maxillo-facial trauma for whom the facemask and laryngoscope were relatively contraindicated and the fibreoptic scope potentially difficult to use.

Topics: Adolescent; Contraindications; Facial Bones; Facial Injuries; Female; Fiber Optic Technology; Humans; Laryngeal Masks; Laryngoscopy; Masks; Mouth; Nose; Skull Fractures; Tooth Injuries

The present study comprises 300 cases of epistaxis. The analysis of these cases revealed a higher incidence in young males. Unilateral bleeding was seen in almost 60% each of indoor and outdoor cases. Litte's area was the most common site responsible for epistaxis in 28.8% of the indoor and 26.2% of the outdoor patients. Hypertension was the most common systemic cause among indoor patients (62.2%) and sickle cell disorder among the outdoor patients (37.5%). Atrophic rhinitis with myiasis was the local cause of epistaxis in maximum (27%) of the indoor patients and traumatic epistaxis was the commonest cause (33%) among outdoor patients-fingernail trauma in 75.9% of them. Idiopathic epistaxis contributed for 16.5% indoor and 26.1% of outdoor cases. Intractable epistaxis was seen in one case following accidental facial trauma.

Topics: Adolescent; Adult; Child; Diagnosis, Differential; Epistaxis; Facial Injuries; Female; Hematologic Diseases; Humans; Hypertension; Incidence; India; Male; Neoplasms; Nose; Prospective Studies; Retrospective Studies; Rhinitis, Atrophic

The plastic qualities and vascular reliability of the frontal flap have been widely used for reconstruction of facial tissue. We revised the files of 105 patients who had undergone surgical repair of facial tissue loss with frontal flaps. The epidemiology, etiology of the repaired tissue loss and indications for frontal flap as well as the various techniques were analyzed: 66.7% of the patients were over 60 years of age; 74% had ambulatory surgical repair; 54.4% of the repaired tissue losses were situated in the nasal region; 80% of the losses were due to tumoral formations. The median flap was the most widely used (23.2%).

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Carcinoma, Basal Cell; Child; Child, Preschool; Esthetics; Face; Facial Injuries; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Precancerous Conditions; Retrospective Studies; Sensation; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Injuries of the nasoethmoid-orbital (NEO) region are associated with midfacial fractures or fractures of the frontobase in over 90% of all cases. In up to 70% fractures of the skull base run through the roof of the ethmoidal bone or the lamina cribrosa. There are different surgical approaches for the treatment of these complex fractures. Between 1990 and 1997 50 patients with midfacial fractures in association with NEO fractures were treated in the Klinik für Mund-, Kiefer- und Gesichtschirurgie, Kantonsspital Luzern, Switzerland. Of these, 25 had suffered midfacial fractures combined with fractures of the nasoethmoid-orbital and frontobasal region and were treated via a transcranial approach. The other 25 patients with midfacial and NEO fractures without involvement of the frontobasis were managed by subcranial incisions. A total of 47 patients were followed up for up to 4 years. The results were reevaluated retrospectively. There was no case of secondary liquorrhea, intracranial or ethmoidal infection. Our therapeutic concept of transcranial and subcranial management of NEO fractures in combination with frontobasal and midfacial fractures is demonstrated.

Topics: Adolescent; Adult; Craniotomy; Ethmoid Bone; Facial Injuries; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Orbital Fractures; Postoperative Complications; Retrospective Studies; Skull Fractures

We report a case in which medicinal leeches (Hirudo medicinalis) were used to rescue a traumatic nasal flap from venous congestion and loss. A healthy 18-year-old had a bicycling accident and, in addition to other facial injuries, presented with a complex full thickness nasal laceration. After he had been resuscitated and the flap sutured, he was treated with two leeches four times a day for 48 h. His recovery was satisfactory and uncomplicated. Oral and maxillofacial surgeons should be familiar with the use of leeches, as they have a small but occasionally important role in the management of both traumatic and reconstructive flaps.

Topics: Adolescent; Animals; Bicycling; Facial Injuries; Humans; Leeches; Male; Nose; Plastic Surgery Procedures; Replantation; Tissue Survival

The objective in treating patients with injuries sustained in craniofacial trauma is to reinstate preinjury facial projection and function. The capability of providing spatially related facial reconstruction is predicated on basic craniofacial surgical principles, generally accepted as the standard of care. These principles include early surgical intervention, immediate bone grafting, and the use of internal rigid fixation. The introduction of osseointegrated dental implants has significantly improved the overall reconstruction of patients with cranio-maxillofacial injuries, including soft tissue repair and cosmetic surgery. The purpose of this article is to review the utilization of dental implants in the context of maxillofacial trauma, using three cases to document the clinical procedure.

Topics: Adolescent; Adult; Bone Transplantation; Dental Implantation, Endosseous; Dental Implants; Facial Bones; Facial Injuries; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Male; Maxillofacial Injuries; Middle Aged; Nose; Osseointegration; Plastic Surgery Procedures; Prostheses and Implants; Prosthesis Design; Skull Fractures; Soft Tissue Injuries; Wounds, Gunshot

A 40-year-old man presented with near-complete mid and lower facial destruction from a shotgun blast to the face. His midface was reconstructed with a serratus anterior muscle composite flap employing rib for nasal reconstruction and scapular tip for palate. Surfacing was done with split-thickness skin grafts. A temporoparietal scalp flap completed the upper lip reconstruction, and tubed, thick, split-thickness grafts supplemented with full-thickness grafts allowed airway reconstruction. Successful restoration of form and modest function were achieved with several surgeries. Our paper discusses the controversies and difficulties encountered in achieving autogenous tissue reconstruction of this devastating injury.

Topics: Adult; Bone Transplantation; Facial Injuries; Humans; Male; Nose; Rhinoplasty; Suicide, Attempted; Surgery, Plastic; Surgical Flaps; Wound Healing; Wounds, Gunshot

This article reports the use of nasal septal cartilage for the repair of traumatic orbital wall defects.. Five patients with disruption of the orbital wall after facial trauma were included in this retrospective review. All of the patients underwent open reduction with internal fixation of the fractures as well as repair of the orbital wall defect with autogenous septal cartilage.. Nasal septal cartilage was used in four cases of orbital floor defect and one case of orbital roof defect. All of the cases were successfully treated by restoration of the orbital wall continuity.. Nasal septal cartilage is a readily accessible autogenous material that can be easily harvested with minimal donor site morbidity, and it should be considered when an autogenous orbital implant is needed for the repair of a traumatic orbital wall defect.

Topics: Adolescent; Adult; Cartilage; Facial Injuries; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Male; Nasal Septum; Nose; Orbital Fractures; Retrospective Studies; Transplantation, Autologous; Treatment Outcome; Zygomatic Fractures

Functional, aesthetically perfect restoration of the face of patients suffering from a severely smashed facial skeleton requires exact centrifugal repositioning and miniplate osteosynthesis of all bony fragments. Nevertheless, the original height and form of the nose will not be restored with these means in some cases. Therefore, in 23 cases with shattered noses out of 487 midface-trauma patients in the years 1990-1995 the noses were onlay-grafted as the primary procedure in 9 cases via the coronal approach and as the secondary one when the metal plates were removed in 10 cases. A combination of primary and secondary procedures was done in 4 cases. Five times autogenous bone from outer calvarium was used and 22 times allogenic, conserved bone from organ donors (AAA bone). According to extent of the damage, mini-screws and/or mini-plates served to fixate the graft. In addition to the group of 13 patients in the years 1990-1993 with nasal bone grafts via the coronary approach, another group the same size with the same amount of trauma but without rhinoplasty was defined and compared to the first group. An aesthetic analysis was done by grading the results according to simple criteria from 0 to 6 points by the patient and by the examiner. Noses grafted via the coronary approach were evaluated as being significantly (P = 0.004, t-test for independent samples, SPSS) better (2.1 points on average +/- 1.1 SD) than conventionally treated noses (3.5 points on average +/- 0.8 SD).

Topics: Bone Plates; Bone Transplantation; Facial Injuries; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Male; Nose; Nose Deformities, Acquired; Patient Satisfaction; Reoperation; Rhinoplasty

Traumatic loss of midface soft tissue and supporting structures may result in communication between the oral and nasal cavities. Reconstruction requires both oral and nasal lining, as well as supporting structures. The need for multilaminar tissue, as well as the paucity of local tissue, creates a reconstructive challenge. This case report describes the reconstruction of a traumatic defect of the alveolus, hard palate, inferior orbits, and local soft tissues. An intraoperative alginate mold facilitated a three-dimensional understanding of the wound, and allowed translation of an osseomyocutaneous groin flap to reconstruct the defect in one stage.

Topics: Adult; Alveolar Process; Bone Transplantation; Facial Bones; Facial Injuries; Fractures, Comminuted; Humans; Intraoperative Care; Male; Mandibular Fractures; Maxillary Fractures; Models, Anatomic; Muscle, Skeletal; Nose; Orbital Fractures; Palate, Hard; Plastic Surgery Procedures; Skin Transplantation; Skull Fractures; Soft Tissue Injuries; Surgical Flaps; Zygomatic Fractures

A 21-year-old man is reported in whom flap tissue was required to reconstruct the face and nose following burns. The whole of both forearms were used as radial forearm flaps for both cheeks, both lower eyelids, the right upper eyelid, upper and lower lips and chin. A Tagliacozzi arm flap and a dorsalis pedis flap were used for the nose. The ears were resurfaced using grafted skin along the line of the superficial temporal arteries. No thinning of the flaps was required and some facial muscle attachments to the forearm deep fascia led to more recovery of facial movement than might be expected with a flap reconstruction.

Topics: Accidents, Traffic; Adult; Burns; Facial Injuries; Forearm; Hand Injuries; Humans; Male; Multiple Trauma; Nose; Surgical Flaps; Treatment Outcome

The nose is in the medial portion of the face and is frequently injured in trauma of this area. Due to its situation its structure and shape, and its essential function, this organ is particularly exposed in the case of facial burns. These injuries, are usually associated with larger injuries, and frequently with systemic problems, such as respiratory problems. The authors describe nasal burns in the larger context of facial burns, and summarize recent data on this topic. They then recall the fascinating story of rhinopoiesis through the ages. The third part is devoted to their personal approach to reconstruction of the nose in severe panfacial burns, using a forehead flap with one or several tissue expanders.

Topics: Burns; Europe; Facial Injuries; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; History, Medieval; Humans; Nose; Rhinoplasty; Surgery, Plastic; Surgical Flaps; Tissue Expansion

In facially burned patients, a simple and effective technique is described for reconstruction of deformities of the lower third of the nose. The first stage consists of replacing the dorsal scarred skin with a skin graft from the buttocks or other area. The second stage is a vertical columella-based prefabricated flap that is outlined beginning near the tip of the nose and extending superiorly to the glabellar region. This flap is raised with the underlying muscle as a composite tissue, transposed to the defect, and sutured to the vestibular mucous membrane or the integument of the remaining portions of the nose at the alar rim. This very well vascularized vertical prefabricated myocutaneous flap can cover a cartilage graft taken from the ear to reconstruct an alar rim. The donor site is closed by undermining the nasal skin laterally on each side and suturing the edges at the dorsum to leave an acceptable midline scar. In patients for whom a nasolabial flap or other technique is not suitable or is impossible, this new and simple technique may be used successfully.

Topics: Adult; Burns; Cicatrix; Facial Injuries; Female; Humans; Male; Nose; Surgical Flaps

Dog bite injuries occur statistically in urban areas every three days. Thirty such injuries to the face were treated at the Ear-Nose-Throat University Hospital, Erlangen-Nuremberg, between 1973 and 1990. The average age of the patients was 15 years. The dogs most frequently involved were the Alsatian wolfhound (43%) and the badger dog (21%). The majority of the victims were family members (59%) or at least known to the owner of the dog (28%). Only in 14% of the cases was no correlation found. Dog bite injuries most frequently happened during playing with the dog (53%) or when the victim bowed to the dog (33%). Dog bites without cause were uncommonly found (7%). Of all facial injuries the nose was most frequently involved (50%) and severely afflicted. In our experience, replantation of the avulsed part always resulted in necrosis. In contrast, the most favorable results were achieved when defects were reconstructed immediately.

Topics: Adolescent; Adult; Aged; Animals; Bites and Stings; Child; Child, Preschool; Cross-Sectional Studies; Dogs; Facial Injuries; Female; Germany; Humans; Incidence; Infant; Male; Middle Aged; Nose; Rhinoplasty; Treatment Outcome

The nasolabial subcutaneous pedicle skin flap with infraorbital artery has been successfully used in 5 cases when the angular artery and facial artery could not be used because of damage. The flap is a good option for small defect in nose and facial region.

Topics: Adolescent; Adult; Cicatrix; Facial Injuries; Female; Humans; Male; Nose; Surgical Flaps

A challenge to the microsurgeon is perfecting the technique of replantation of small pieces of facial tissue, mainly because of the extremely small size of the arteries as well as a lack of suitable veins for drainage. In the past 4 years, we have had seven cases of facial amputations, which included one scalp, two nasal tips, two ears, one lower lip, and one eyebrow. All of these patients were replanted/revascularized by microvascular anastomosis. Only two of the cases had suitable veins for anastomosis. Alternative techniques used for improving venous outflow were arterio-venous fistula, chemical leeches, and pin pricks. Four of the cases were completely successful, two cases had partial loss of the replant, and one case failed due to absence of venous drainage. In facial amputation, an aggressive microsurgical attempt will result in more tissue surviving and a better cosmetic outcome than in any other reconstructive procedures.

Topics: Adult; Amputation, Traumatic; Bites, Human; Ear; Eyebrows; Facial Injuries; Female; Humans; Lip; Male; Microsurgery; Middle Aged; Nose; Replantation; Scalp; Treatment Outcome

Reconstructive surgery does not always provide for sufficient functional, cosmetic und esthetic results of bone defects, loss of soft tissues and sense organs. 57 patients were treated by the "Bochum study group for oro-facial rehabilitation" from 1990 to 1992 using implant-retained prostheses. The advantages of the "Snap-Button-System" used for retention are presented.

Topics: Ear, External; Eye, Artificial; Facial Injuries; Facial Neoplasms; Humans; Nose; Prostheses and Implants; Prosthesis Design

Two cases of patient fires are presented. Components necessary for this complication to occur are outlined, in addition to recommendations for prevention.

Topics: Adult; Aged; Burns; Carcinoma, Basal Cell; Electrocoagulation; Eyelid Neoplasms; Facial Injuries; Fires; Humans; Lip; Male; Mouth; Nose; Nose Neoplasms; Operating Rooms; Safety; Skin

Topics: Contusions; Ear, External; Eyebrows; Eyelids; Facial Injuries; Facial Nerve Injuries; Humans; Lacerations; Lacrimal Apparatus; Nose; Parotid Gland; Peripheral Nerves; Salivary Ducts; Scalp

Free flaps are usually needed for the reconstruction of extensive facial burns, but the final result is often a poor texture and color match. The authors report a burn case managed with a radial forearm free flap. The aesthetic result was improved by surgical tattooing of the flap, including the appearance of a beard.

Topics: Adult; Burns; Cicatrix; Facial Injuries; Humans; Male; Mouth; Nose; Surgical Flaps; Tattooing

In acute facial burns, it is sometimes necessary to insert tubes down one or both nostrils. We describe a simple secure method of fixation.

Topics: Burns; Equipment Design; Facial Injuries; Humans; Intubation; Nose

The authors present some clinical applications of the concept of flap prefabrication. Three cases are described where reconstructions around the head and neck were accomplished. The radial vascular territory of the forearm was selected for prefabrication of structures which were then transferred by microsurgical techniques. In two cases, a sensate flap was used, with nerve repair in the neck.

Topics: Adolescent; Aged; Amputation, Surgical; Burns; Ear, External; Facial Injuries; Forearm; Humans; Lip; Male; Microsurgery; Middle Aged; Nose; Nose Neoplasms; Surgical Flaps

A total of 4724 newborns was screened for congenital nasal deformities. Altogether 91 (1.9%) pathological, screening-positive cases were found. Because of refusal to participate, 3 pathological cases were lost leaving 88 cases. The first 55 screening positive newborns were left without treatment while an attempt was made by an otolaryngologist to correct the remaining 33 cases within a week from delivery. Eighty-two newborns of those who passed the screening tests were analyzed as a control group. In 1987, at the age of 8 years the case and control children were interviewed by mailed questionnaire and invited to be re-examined by an ENT-surgeon. Forty-seven of the not corrected, 21 of the corrected cases and 61 controls came to the re-examination. The luxated septal cauda tended to be straight both spontaneously as well as after active treatment. The few mid-septal pathologies (vomerine junction) in the corrected group were resistant to the treatment attempted. The mid-septal deformities found in the follow-up were connected with frequent antibiotic prescriptions but not respiratory infections. No increase in frequency of otitis media or sinusitis was noticed. The immediate treatment of nasal deformities did not significantly affect the clinical status of the nose at the follow-up. Thus the benefit of immediate treatment on nasal deformities in newborns and screening to find them remains questionable.

Topics: Adenoidectomy; Child; Congenital Abnormalities; Facial Injuries; Follow-Up Studies; Humans; Infant, Newborn; Nasal Septum; Nose

Because of high infection rats and because of possible deformities after radical débridement there is still some restraint in primary wound closure in facial bite injuries. Today the sophistication of facial reconstructive surgery provides the possibility even with injuries with significant skin defects to gain primary healing with satisfactory results from a cosmetic point of view as well as from a functional one.

Topics: Adult; Bites and Stings; Child; Facial Injuries; Humans; Lip; Nose; Surgical Flaps; Suture Techniques; Wound Healing

Craniofacial surgery has evolved through an era of refinement and finesse, both in techniques and in results. Tissue expansion offers an opportunity to improve the quantity and quality of tissue available for these procedures. It may also be of benefit in long-term molding of the craniofacial skeleton during growth of the child, obviating the need for multiple revisions. This adjunct to craniofacial surgery is being performed with minimal complications and results in improved appearance for the patient.

Topics: Adolescent; Child; Face; Facial Injuries; Female; Forehead; Humans; Male; Nose; Prostheses and Implants; Scalp; Skull; Surgery, Plastic; Surgical Flaps; Time Factors

Burn reconstruction of the head and neck must first start with special care to this anatomic area in the early acute phase, with appropriate early débridement and coverage with sheet grafts of medium thickness into unit facial orientation. Postoperative garment and mask splinting, will help lessen the hypertrophic scar formation that frequently follows facial burns and skin coverage. Carefully planned reconstruction of these areas is indicated, with priority given first to the neck, then to the periorbital area, and then to perioral areas. Principles of scalp, ear, nasal, and cheek reconstruction following burns of the face are carefully outlined. The unit concept of burn scar resurfacing of the face has been the mainstay of our treatment. We have emphasized skin coverage of the face from similar donor site areas. The emotional and psychological effects of facial scarring secondary to severe burns are crippling to patients. Although numerous reconstructive surgical procedures may lessen the deformity, ultimately burn patients realize that their burn scars are permanent and no surgeon can give them back their original facial appearance. These patients need strong and continued support and reassurance from their physicians and nursing professional staff to maintain their self-identity and confidence.

Topics: Adolescent; Adult; Burns; Child; Child, Preschool; Chin; Ear, External; Eyebrows; Eyelids; Facial Injuries; Female; Humans; Infant; Male; Neck Injuries; Nose; Scalp; Skin Transplantation; Surgery, Plastic

Degloving injuries of the external nose are severe soft tissue avulsions requiring meticulous repair to prevent airway embarrassment and to provide the best aesthetic result. Usually the underlying nasal scaffolding remains intact, but associated facial fractures or other facial injuries are common and must not be overlooked. Two representative cases are reported to provide an overview of the salient features in the pathogenesis of injury and to reiterate the proper approach for treatment.

Topics: Accidents, Traffic; Facial Injuries; Humans; Male; Nose; Surgery, Plastic

Topics: Burns; Child; Ear, External; Ectropion; Eyelids; Facial Injuries; Humans; Nose; Scalp; Surgery, Plastic; Surgical Flaps

Topics: Cheek; Ear, External; Eyelids; Facial Injuries; Female; Forehead; Humans; Male; Nose; Rhinoplasty; Surgery, Plastic

Facial burns cause deformities through the permanent effects of wound contracture and scar hypertrophy; they are related to the depth of the burn. The depth of an acute burn can be accurately ascertained only by observation over a period of time. Facial skin burns that do not heal by three weeks are subject to increasingly permanent deformity with the passage of time. The best defense against wound contraction and hypertrophic scar is early and complete wound closure. Early and late grafting must be completely successful in "take" to avoid unsightly irregular scarring; therefore, the receptor bed must be meticulously prepared for optimal take. Both early and late grafts are patches that flatten normal contour. However, if the skin graft conforms to a position in the facial mosaic (aesthetic unit of the face), or some subunit that is harmonious with normal facial lines, the patch of proper color can give a more aesthetic result. Nonreproducible anatomical structures such as the margins of the lids, lips, and nostrils should be preserved whenever found to be normal or only partially destroyed. To minimize the distorting effects of wound contracture, pressure therapy of the face and neck, as well as the positional splinting of the neck, must be maintained for many months following grafting and epithelialization until the deleterious wound forces abate. Burns of mobile structures, such as lids and lips, do not lend themselves to control by pressure, and frequently must be managed secondarily by first totally removing scarred tissues and then applying thick skin grafts of the best color match.

Topics: Burns; Cheek; Ear; Esthetics; Eyebrows; Eyelids; Facial Injuries; Forehead; Humans; Mouth; Neck; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

The onset of canthal drift after hypertelorism repair can nullify the effectiveness of the repair, despite roentgenographic evidence of normal interorbital distance. The problem of hypertelorism is simply replaced by the problem of telecanthus. An excess of bulky tissue between the orbits contributes to the problem. A procedure is described in which excess soft tissue (fat, nasal muscles, and parts of the orbicularis oculi) are excised. A pulley canthopexy with a figure-of-eight suture of polypropylene is performed to bring the canthal tendons together using a hollow awl with a removable handle. The pulley gives a 4 to 1 mechanical advantage to the suture, adding control and distributing the forces over a wider area. The pulley canthopexy is a valuable tool not only in congenital anomalies but also for correcting long-standing traumatic telecanthus and acute detachment of the canthal ligaments.

Topics: Craniofacial Dysostosis; Facial Injuries; Humans; Hypertelorism; Nose; Polypropylenes; Postoperative Complications; Surgery, Plastic; Suture Techniques

Management of patients with severe postburn facial deformities is elaborated. On the basis of over 400 patients, the planning and value of numerous surgical methods are discussed with--special regard to rarely adopted but effective solutions.

Topics: Burns; Cicatrix; Ear; Eyebrows; Eyelids; Face; Facial Injuries; Humans; Lip; Nose; Rhinoplasty; Skin Transplantation; Surgery, Plastic; Surgical Flaps; Transplantation, Autologous

Treatment of soft tissue facial trauma requires attention to detail. Careful cleansing, debridement, tailoring of skin edges and meticulous closure are factors which control the ultimate result. Specific attention is required for the special problems of eyelids, auricles, lips, nose and inside of the mouth. Scar formation occurs after all trauma and sometimes requies revision. In general, revision should be performed after maturation of the scar.

Topics: Anesthesia; Ear, External; Eyelids; Facial Injuries; Humans; Methods; Mouth; Nose

Topics: Bites and Stings; Cheek; Facial Injuries; Humans; Lip; Male; Nose; Surgery, Plastic

Topics: Adolescent; Adult; Burns; Child; Child, Preschool; Facial Injuries; Female; Humans; Infant; Lip; Male; Nose; Skin Transplantation; Transplantation, Autologous

An understanding of normal and abnormal postnatal skeletal changes can aid in the prevention, early recognition and proper surgical treatment of craniofacial deformities. Research findings may have important implications and applications in relation not only to the basic problem of change of bone form but also to the clinical problems of craniofacial operations. Precise analogies, however, should not be made between animals and human beings. Change of the craniofacial skeleton, a three-dimensional mosaic of bones and cavities, is a result of the synchronous co-ordination of the differential activities at various sites. The dynamics of normal and abnormal postnatal growth and change of the craniofacial skeletal system are a fascinating, complex, incomplete chapter in the field of biology.

Topics: Adult; Animals; Facial Bones; Facial Injuries; Humans; Infant; Mandible; Mandibular Condyle; Maxillofacial Development; Nose; Orbit; Skull; Tooth Eruption

Topics: Facial Injuries; Female; Humans; Jaw Fractures; Male; Mandibular Fractures; Nose; Tracheotomy; Zygomatic Fractures

Topics: Cheek; Ear, External; Facial Injuries; Facial Neoplasms; Female; Humans; Lip; Male; Nose; Orbit; Surgery, Plastic; Surgical Flaps

Topics: Adult; Bone Transplantation; Child; Ear, External; Emergencies; Eyelids; Facial Bones; Facial Injuries; Facial Nerve Injuries; Female; Humans; Male; Mandibular Fractures; Maxillary Fractures; Nasal Bone; Nose; Orbit; Parotid Gland; Prostheses and Implants; Skull Fractures; Transplantation, Autologous; Triage; Zygomatic Fractures

Topics: Adult; Craniocerebral Trauma; Emergencies; Epistaxis; Eye Injuries; Facial Injuries; Female; Foreign Bodies; Humans; Larynx; Male; Nasopharynx; Neck Injuries; Nose; Nose Deformities, Acquired; Paranasal Sinuses; Skull Fractures; Tongue; Trachea

In the second article on pediatric otolaryngology, speed of diagnosis is stressed as vital to prevent permanent aftereffects such as deafness or facial paralysis. Aggressive education of parents in preventing emergencies is recommended.

Topics: Acids; Child; Ear; Emergencies; Esophagus; Facial Bones; Facial Injuries; Foreign Bodies; Fractures, Bone; Humans; Larynx; Lye; Nasopharynx; Nose; Otitis Media; Otorhinolaryngologic Diseases; Respiratory System; Temporal Bone

Topics: Child; Facial Injuries; Fractures, Bone; Humans; Nasal Bone; Nose; Nose Deformities, Acquired

In 100 adults the effect of treatment of nasal fractures was followed up after 14 to 65 months. In 30% of 53 patients with closed reduction of the nose long-term results as to shape and function of the nose were not satisfying. Nasal obstruction deformity slowly developed several months after treatment mainly because of untreated septal fractures and green-stick fractures of the nasal bones. After open reduction and septal reconstruction only 1 of 17 patients had a poor result. By roentgenographic examinations three types of fracturelines could be distinguished: osseous (40), fibrous (37), and mixed transformations (23). In all types there was found a solid nasal pyramid. The osseous transformation of the fracture-line was promoted by reduction of the fracture within the first posttraumatic days, by a small distance of the fractured ends and if the injury was not too violent.

Topics: Adolescent; Adult; Aged; Facial Injuries; Female; Follow-Up Studies; Fractures, Bone; Fractures, Cartilage; Humans; Male; Middle Aged; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Radiography; Respiration Disorders

Topics: Accidents; Adult; Aged; Facial Injuries; Female; Hand Injuries; Humans; Male; Mouth; Nose; Thumb; Wounds, Penetrating

Topics: Adult; Facial Injuries; Female; Humans; Nose; Rhinoplasty; Skin Transplantation; Transplantation, Autologous

Topics: Adult; Facial Injuries; Female; Frontal Bone; Frontal Sinus; Humans; Nose; Orbit; Prostheses and Implants; Skin Transplantation; Skull; Surgery, Plastic; Transplantation, Autologous; Wounds, Gunshot

The prevention of unsightly scars and functional loss after facial lacerations is accomplished by early, meticulous repair in layers without tension on the suture line. The interrupted subcuticular suture applied with a small full-curved cutting needle and with the aid of a skin hook is recommended to reach the goal of aesthetic and functional restoration.

Topics: Cicatrix; Ear; Eyebrows; Eyelids; Facial Injuries; Facial Nerve; Humans; Nose; Surgery, Plastic; Suture Techniques; Sutures; Wound Healing

Nasal problems in children are very common. The factors that affect the embryologic development have been discussed. Injuries that occur in prenatal, natal, and postnatal periods affect normal development. Prompt treatment of minor injuries is necessary to prevent airway problems later. The "wait and see" attitude toward nasal deformity is ill advised. X-ray findings are not conclusive, as the nasal pyramid in a child is largely cartilaginous. Obstructive nasal breathing can result in facial asymmetry, malocclusion, and cardiopulmonary problems. Allergy and sinusitis are frequently causes of obstruction.

Topics: Acute Disease; Adolescent; Airway Obstruction; Birth Injuries; Cartilage; Child; Child, Preschool; Facial Injuries; Female; Humans; Infant; Infant, Newborn; Male; Malocclusion; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Pregnancy; Sinusitis; Skull Fractures; Wounds, Nonpenetrating; Wounds, Penetrating

Topics: Facial Injuries; Humans; Nose; Nose Diseases; Surgery, Plastic

Topics: Accidents, Traffic; Adult; Child; Craniocerebral Trauma; Facial Injuries; Fractures, Bone; Humans; Male; Nose

Topics: Adult; Aged; Carcinoma, Squamous Cell; Connective Tissue; Facial Injuries; Fibroma; Fibromyalgia; Humans; Laryngeal Neoplasms; Larynx; Male; Nose; Skin

Topics: Adult; Arteries; Epistaxis; Ethmoid Bone; Facial Injuries; Fractures, Bone; Humans; Ligation; Male; Nasal Bone; Nose; Zygomatic Fractures

The extent to which emotional factors play a direct or indirect role in the causation of traffic accidents has been presented along with the early and late emotional response of individuals to facial injuries as a result of traffic accidents. Illustrated case histories are presented.

Topics: Accidents, Traffic; Adult; Age Factors; Automobile Driving; Craniocerebral Trauma; Depression; Emotions; Facial Injuries; Female; Fractures, Bone; Humans; Judgment; Male; Mental Disorders; Middle Aged; Neurotic Disorders; Nose; Personality Disorders; Phobic Disorders; Schizophrenia; Stress Disorders, Post-Traumatic; Suicide

Nasal injuries frequently occur and may result in immediate or delayed disturbances in both function and appearance. Early evaluation and management are beneficial in lessening the complications and disturbances in nasal function. A thorough intranasal examination is necessary to evaluate the injury, and examination may require local or general anesthesia to assess the injury properly. Specific management depends on the extent of injury. Minimal nasal injuries in children may result in a major disturbance of nasal function.

Topics: Anesthesia, General; Anesthesia, Local; Child; Cocaine; Facial Bones; Facial Injuries; Fractures, Bone; Hematoma; Humans; Nasal Bone; Nasal Septum; Nose; Nose Diseases; Radiography

The authors describe the diagnosis and operative methods for the treatment of 36 patients which were operated on in the last two years. These patients included 32 with various face fractures, of which 7 had blow-out fractures. In 4 patients the diplopia was caused by injuries to the soft tissues without bony fracture. The examinations comprised x-ray methods and also ophthalmological examinations, especially with the synoptometer. In 24 operated patients, reposition of the bony fragments or autologous bone grafts were done according to the kind of injury present. Although 17 patients were operated on very late (some weeks up to several months after the trauma), in 13 patients (54%) a complete cure could be achieved, and all the other patients showed an improvement. In 3 patients there was only a minor improvement, and it was decided to perform further operations on the extrinsic eye muscles. The authors emphasize the special sense of multi-disciplinary working together in the diagnosis and therapy of patients with face injuries, while this is very important for the success of the treatment.

Topics: Adult; Diplopia; Facial Injuries; Fractures, Bone; Humans; Male; Nose; Orbit

Topics: Facial Injuries; Fractures, Bone; Humans; Nose; Surgery, Plastic

Topics: Accidents, Traffic; Adult; Belgium; Cervical Vertebrae; Coma; Disability Evaluation; Facial Injuries; Female; Fractures, Bone; France; Humans; Male; Nose; Physician-Patient Relations; Rib Fractures; Spinal Injuries; Wounds and Injuries

Topics: Adolescent; Facial Injuries; Humans; Male; Methods; Nose; Replantation; Rhinoplasty

Topics: Facial Injuries; Female; Humans; Male; Maxillofacial Injuries; Nose; Ophthalmology; Orbit; Paranasal Sinuses; Referral and Consultation; Surgery, Oral; Surgery, Plastic; Time Factors; Tooth Injuries

Topics: Facial Injuries; Female; Humans; Male; Methods; Middle Aged; Nose; Nose Neoplasms; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Accidents, Traffic; Adolescent; Adult; Cerebrospinal Fluid Rhinorrhea; Child; Emergencies; Facial Injuries; Female; Follow-Up Studies; Fracture Fixation, Internal; Frontal Sinus; Humans; Lacrimal Apparatus; Male; Maxillary Fractures; Middle Aged; Nasal Septum; Nose; Orbit; Postoperative Complications; Radiography; Skull Fractures

Topics: Blepharoptosis; Dura Mater; Emphysema; Exophthalmos; Eye Injuries; Facial Injuries; Humans; Interprofessional Relations; Nose; Orbit; Paranasal Sinuses; Skull Fractures; Vision Disorders

Topics: Airway Obstruction; Cerebrospinal Fluid Rhinorrhea; Edema; Facial Injuries; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Humans; Maxillary Sinus; Methods; Nose; Orbit; Zygomatic Fractures

Topics: Cartilage; Ear, External; Facial Injuries; Humans; Methods; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Bites and Stings; Bites, Human; Face; Facial Injuries; Humans; Nose; Rabies Vaccines; Suture Techniques; Tetanus Antitoxin; Wound Healing

Topics: Adolescent; Adult; Animals; Bites and Stings; Carcinoma, Squamous Cell; Cheek; Child, Preschool; Dogs; Facial Injuries; Female; Fistula; Humans; Lip; Lip Diseases; Lip Neoplasms; Male; Methods; Middle Aged; Nose; Nose Diseases; Nose Neoplasms; Skin Transplantation; Transplantation, Autologous

Topics: Accidents, Traffic; Bone Regeneration; Facial Injuries; Humans; Hypertelorism; Male; Methods; Nose; Skin Transplantation; Surgery, Plastic

Topics: Adolescent; Adult; Child; Conjunctiva; Dacryocystitis; Dacryocystorhinostomy; Facial Injuries; Female; Follow-Up Studies; Fractures, Bone; Humans; Intubation; Lacrimal Apparatus; Male; Methods; Middle Aged; Nose; Polyethylenes; Radiography

Topics: Ear; Esthetics; Facial Injuries; Hemorrhage; Humans; Inflammation; Interprofessional Relations; Nose; Otolaryngology; Paranasal Sinuses; Patient Care Team; Radiography; Respiration; Skull Fractures

Topics: Adolescent; Adult; Aged; Airway Obstruction; Burns; Child; Child, Preschool; Ear; Eye Burns; Facial Injuries; Female; Humans; Infant; Lung Injury; Male; Middle Aged; Neck Injuries; Nose; Scalp; Skin Transplantation; Surgery, Plastic; Transplantation, Heterologous; Transplantation, Homologous; Wounds and Injuries

Topics: Bites and Stings; Burns; Face; Facial Injuries; Facial Neoplasms; Humans; Methods; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Adolescent; Adult; Aged; Child; Facial Injuries; Female; Follow-Up Studies; Fracture Fixation; Fractures, Bone; Humans; Male; Middle Aged; Nose; Scotland

Topics: Accidents, Home; Adolescent; Age Factors; Child; Child, Preschool; Facial Injuries; Female; Fractures, Bone; Germany, West; Humans; Joint Dislocations; Male; Nose; Prognosis; Rhinoplasty

Topics: Facial Bones; Facial Injuries; Female; Fractures, Bone; Fractures, Cartilage; Hematoma; Humans; Intubation, Intratracheal; Male; Maxillofacial Injuries; Nasal Septum; Nose

Topics: Facial Bones; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Nose; Postoperative Complications

Topics: Cerebrospinal Fluid Rhinorrhea; Ear; Ear, Middle; Facial Injuries; Humans; Larynx; Maxillary Fractures; Nose; Paranasal Sinuses; Skull Fractures

Topics: Facial Injuries; Humans; Microsurgery; Motion Pictures; Nose

Topics: Accidents, Traffic; Adolescent; Age Factors; Australia; Child; Child, Preschool; Facial Injuries; Female; Frontal Bone; Humans; Jaw Fractures; Male; Mandibular Condyle; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Parietal Bone; Sex Factors; Sports; Tooth Fractures; Zygomatic Fractures

Topics: Accidents, Traffic; Adult; Airway Obstruction; Child; Child, Preschool; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Intubation, Intratracheal; Male; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Orbit; Tracheotomy; Zygomatic Fractures

Topics: Bone Transplantation; Facial Injuries; Female; Humans; Ilium; Male; Mandibular Fractures; Maxillary Fractures; Nose; Radiography; Ribs; Skin Transplantation; Transplantation, Autologous; Wounds, Gunshot

Topics: Amputation, Traumatic; Carcinoma, Squamous Cell; Facial Injuries; Methods; Nose; Nose Neoplasms; Rhinoplasty; Skin Transplantation; Suture Techniques; Transplantation, Autologous

Topics: Accidents, Traffic; Craniocerebral Trauma; Facial Injuries; Glass; Humans; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Seat Belts; Suture Techniques; Zygomatic Fractures

Topics: Airway Obstruction; Blood Transfusion; Debridement; Ear; Facial Injuries; Fracture Fixation; Humans; Male; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Orbit; Radiography; Shock, Traumatic; Skin Transplantation; Tracheotomy; Transplantation, Autologous; Wound Healing

Topics: Craniocerebral Trauma; Ethmoid Bone; Facial Injuries; Fracture Fixation; Frontal Bone; Humans; Maxillofacial Injuries; Methods; Nose; Orbit; Paranasal Sinuses; Skull Fractures

Topics: Adolescent; Adult; Brain Concussion; Expert Testimony; Facial Injuries; Female; Frontal Bone; Humans; Male; Middle Aged; Nose; Olfaction Disorders; Skull Fractures; Wounds and Injuries

Topics: Accidents, Traffic; Adult; Facial Injuries; Fractures, Bone; Frontal Sinus; Humans; Male; Nose

Topics: Amputation, Traumatic; Craniocerebral Trauma; Ear, External; Facial Injuries; Female; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Lip; Male; Maxillofacial Injuries; Necrosis; Nose; Replantation; Time Factors

Topics: Adolescent; Adult; Facial Bones; Facial Injuries; Fractures, Bone; Humans; Male; Mandibular Fractures; Maxillofacial Injuries; Nose; Orbit; Protective Devices; Recreation; Sports Medicine; Zygomatic Fractures

Topics: Accidents; Ear; Facial Injuries; Female; Humans; Larynx; Male; Nose; Poland; Wounds and Injuries

Topics: Angiography; Carotid Arteries; Cervical Vertebrae; Craniocerebral Trauma; Debridement; Facial Injuries; Humans; Mandibular Fractures; Maxillary Fractures; Nose; Orbit; Palate; Spinal Injuries; Wounds, Gunshot; Zygomatic Fractures

Topics: Adolescent; Adult; Ear, External; Eyelids; Facial Injuries; Humans; Lacrimal Apparatus; Lip; Male; Nose; Surgery, Plastic; Wounds and Injuries

Topics: Facial Injuries; Fractures, Bone; Humans; Mandibular Fractures; Maxillary Fractures; Nose; Orbit; Zygomatic Fractures

Topics: Bone Plates; Cerebrospinal Fluid Rhinorrhea; Craniofacial Dysostosis; Epistaxis; Ethmoid Bone; Face; Facial Bones; Facial Injuries; Fracture Fixation; Frontal Bone; Frontal Sinus; Humans; Lead; Nose; Radiography; Skull Fractures

Topics: Adolescent; Alloys; Facial Injuries; Foreign Bodies; Humans; Male; Nasal Mucosa; Nasal Septum; Nose

Topics: Adult; Facial Bones; Facial Injuries; Fracture Fixation; Humans; Male; Maxillary Fractures; Nose; Orbit; Paranasal Sinuses; Skull Fractures; Zygomatic Fractures

Topics: Accidents, Traffic; Adolescent; Cartilage; Facial Injuries; Female; Humans; Ilium; Maxillofacial Injuries; Methods; Nasal Septum; Nose; Nose Deformities, Acquired; Osteotomy; Rhinoplasty; Ribs; Skin Transplantation

Topics: Aged; Facial Injuries; Female; Humans; Nose; Surgery, Plastic

Topics: Accidents, Traffic; Child; Child, Preschool; Facial Injuries; Female; Fractures, Bone; Humans; Infant; Infant, Newborn; Male; Mandibular Fractures; Maxillary Fractures; Nose; Protective Devices; Zygoma

Topics: Facial Injuries; Humans; Nose; Paranasal Sinuses; Rhinoplasty

Topics: Eyelids; Facial Injuries; Humans; Lip; Nose

Topics: Facial Injuries; Fractures, Bone; Humans; Maxillofacial Injuries; Methods; Nose; Orbit; Skull Fractures

Topics: Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Orbit; Physical Examination; Radiography; Skull Fractures; Zygomatic Fractures

Topics: Adult; Facial Injuries; Fracture Fixation, Internal; Fractures, Ununited; Humans; Male; Malocclusion; Mandibular Fractures; Maxillofacial Injuries; Nose; Osteotomy; Postoperative Complications; Trismus

Topics: Accidents, Traffic; Bone Transplantation; Facial Bones; Facial Injuries; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Frontal Bone; Humans; Ilium; Mandibular Fractures; Maxillary Fractures; Methods; Nose; Orbit; Prostheses and Implants; Radiography; Ribs; Transplantation, Autologous; Zygoma

Topics: Accidents, Traffic; Face; Facial Injuries; Head; Humans; Lip Neoplasms; Male; Methods; Neck; Nose; Postoperative Complications; Scalp; Skin; Skin Transplantation; Surgery, Plastic; Temporal Arteries; Transplantation, Autologous; Vascular Surgical Procedures

Topics: Bone Transplantation; Cicatrix; Ear Deformities, Acquired; Facial Injuries; Humans; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Color; Ear, External; Facial Injuries; Facial Neoplasms; Humans; Maxillofacial Prosthesis; Nose; Nose Neoplasms; Prostheses and Implants; Rubber; Silicones; Tattooing

Topics: Child, Preschool; Facial Injuries; Female; Humans; Incisor; Nose; Tooth, Deciduous; Tooth, Impacted

Topics: Child; Facial Bones; Facial Injuries; Fractures, Bone; Humans; Male; Maxillofacial Injuries; Nose; Radiography

Topics: Adolescent; Adult; Age Factors; Facial Injuries; Female; Follow-Up Studies; Growth; Humans; Male; Maxillofacial Development; Nose; Nose Deformities, Acquired; Rhinoplasty; Sex Factors; Time Factors

Topics: Facial Injuries; Female; Fracture Fixation; Humans; Male; Nose; Orbit; Skull Fractures; Surgery, Plastic

Topics: Facial Injuries; Fractures, Bone; Frontal Bone; Humans; Male; Middle Aged; Nose; Orbit; Zygoma

Topics: Accidents, Traffic; Adult; Drainage; Facial Injuries; Female; Germany, West; Humans; Male; Methods; Nose; Parotid Gland; Time Factors

Topics: Facial Bones; Facial Injuries; Fracture Fixation; Frontal Bone; Humans; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Methods; Nose; Orbit; Time Factors; Wound Healing; Zygoma

Topics: Facial Injuries; Frontal Sinus; Humans; Nose; Sinusitis; Skull Fractures

Topics: Adolescent; Adult; Congenital Abnormalities; Facial Injuries; Female; Fluorocarbon Polymers; Humans; Injections; Male; Nose; Nose Deformities, Acquired; Postoperative Complications; Prostheses and Implants; Rhinoplasty

Topics: Child; Child, Preschool; Facial Bones; Facial Injuries; Female; Fractures, Bone; Humans; Infant; Male; Nose

Topics: Child; Facial Injuries; Female; Follow-Up Studies; Humans; Nose; Nose Diseases; Replantation; Surgery, Plastic; Sutures

Topics: Anesthesia, Local; Bandages; Debridement; Eyelids; Facial Injuries; Facial Nerve Injuries; Humans; Lip; Nose; Parotid Gland; Physical Examination; Suture Techniques

Topics: Dentures; Facial Bones; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Jaw; Mandibular Fractures; Mandibular Prosthesis; Methods; Nose; Orbit; Splints; Zygoma

Topics: Adult; Aged; Child; Ethmoid Bone; Facial Bones; Facial Injuries; Female; Humans; Male; Maxillary Fractures; Methods; Nose; Orbit; Radiography; Silicones; Skull Fractures; Surgery, Plastic; Zygoma

Topics: Accidents, Traffic; Athletic Injuries; Black or African American; Black People; Crime; Facial Injuries; Female; Fracture Fixation; Fractures, Bone; Humans; Male; Maxillofacial Injuries; Nose; South Africa; White People

Topics: Accidents; Carotid Artery Injuries; Cervical Vertebrae; Esophagus; Facial Injuries; Facial Nerve Injuries; Female; Humans; Larynx; Male; Methods; Mouth; Neck Injuries; Nose; Otolaryngology; Pharynx; Skin Transplantation; Spinal Injuries; Thyroid Gland; Trachea; Tracheotomy; Transplantation, Autologous; Vertebral Artery

Topics: Cerebrospinal Fluid; Facial Bones; Facial Injuries; Female; Fistula; Fracture Fixation; Humans; Male; Methods; Middle Aged; Nose; Pharynx; Radiography; Subarachnoid Space; Surgery, Plastic; Suture Techniques; Time Factors

Topics: Accidents, Traffic; Adolescent; Adult; Aged; Automobile Driving; Child; Child, Preschool; Ear; Facial Injuries; Facial Nerve Injuries; Humans; Lip; Middle Aged; Necrosis; Nose; Orbit; Parotid Gland; Postoperative Care; Scalp; Skin; Surgery, Plastic; Wounds and Injuries

Topics: Debridement; Facial Injuries; Fracture Fixation; Humans; Jaw Fractures; Maxillofacial Injuries; Methods; Nasal Septum; Nose; Traction; Zygoma

Topics: Adolescent; Adult; Facial Injuries; Fracture Fixation; Humans; Interprofessional Relations; Male; Mandibular Fractures; Maxillary Fractures; Nose; Splints; Zygoma

Topics: Bronchi; Craniocerebral Trauma; Ear; Esophagus; Facial Injuries; First Aid; Foreign Bodies; Humans; Nose; Tracheotomy

Topics: Adult; Facial Injuries; Female; Fluorocarbon Polymers; Fracture Fixation; Fractures, Bone; Humans; Male; Mandibular Injuries; Middle Aged; Nose; Orbit; Prostheses and Implants; Zygoma

Topics: Child Abuse; Child, Preschool; Eye Injuries; Facial Injuries; Female; Fractures, Bone; Humans; Infant; Male; Nose

Topics: Ear; Ear Deformities, Acquired; Eye Neoplasms; Eye, Artificial; Facial Injuries; Facial Neoplasms; Female; Humans; Male; Maxillofacial Prosthesis; Nose; Nose Neoplasms

Topics: Facial Injuries; Female; Humans; Male; Mouth Rehabilitation; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Facial Injuries; Female; Humans; Lip; Male; Nose; Surgery, Plastic

Topics: Adolescent; Adult; Child; Child, Preschool; Facial Injuries; Female; Fractures, Bone; Growth; Humans; Infant; Infant, Newborn; Male; Maxilla; Maxillary Fractures; Nose; Skull Fractures; Zygoma

Topics: Facial Injuries; Fractures, Bone; Humans; Nose; Nose Deformities, Acquired; Rhinitis, Atrophic; Rhinoplasty; Surgery, Plastic

Topics: Eye Injuries; Facial Injuries; Fractures, Bone; Humans; Maxillofacial Injuries; Nose

Topics: Facial Injuries; Fracture Fixation; Humans; Maxillofacial Injuries; Nose; Zygoma

Topics: Accidents; Facial Injuries; Female; First Aid; Fracture Fixation; Humans; Jaw Fractures; Male; Methods; Nose; Skull Fractures

Topics: Facial Bones; Facial Injuries; Fractures, Bone; Humans; Mandibular Fractures; Maxillary Fractures; Nose; Orbit; Skull Fractures; Zygoma

Topics: Accidents; Boxing; Facial Injuries; Fracture Fixation; Humans; Nose

Topics: Animals; Facial Injuries; Growth; Joint Dislocations; Nasal Septum; Nose; Nose Deformities, Acquired; Pathology; Rabbits; Research

Topics: Ear, External; Facial Injuries; Finger Injuries; Fingers; History; History, 18th Century; History, 19th Century; Humans; Nose; Replantation

Topics: Adenoidectomy; Facial Injuries; Fluorocarbon Polymers; Humans; Nasal Mucosa; Nasal Septum; Nose; Polytetrafluoroethylene; Postoperative Complications; Surgical Procedures, Operative; Tissue Adhesions

Topics: Adolescent; Adult; Aged; Anesthesia, Local; Child; Cocaine; Facial Injuries; Fracture Fixation; Humans; Middle Aged; Nose

Topics: Child; Facial Injuries; Nasal Septum; Nasal Surgical Procedures; Nose; Nose Deformities, Acquired; Prognosis; Rhinoplasty

Topics: Congenital Abnormalities; Ear Deformities, Acquired; Ear, External; Facial Injuries; Facial Neoplasms; Humans; Mandibular Injuries; Nose; Nose Deformities, Acquired; Plastics; Prostheses and Implants; Surgery, Plastic

Topics: Cleft Palate; Dental Prosthesis; Ear Deformities, Acquired; Ear, External; Eye Injuries; Eye, Artificial; Facial Injuries; History; History, Modern 1601-; Humans; Mandibular Injuries; Nose; Nose Deformities, Acquired; Prostheses and Implants

Topics: Child; Facial Injuries; Fracture Fixation; Fractures, Bone; Geriatrics; Humans; Mandibular Injuries; Maxilla; Nose; Palate; Surgical Procedures, Operative; Zygoma

Topics: Adolescent; Bone Transplantation; Child; Cleft Palate; Congenital Abnormalities; Face; Facial Bones; Facial Injuries; Humans; Nose; Nose Deformities, Acquired; Plastics; Surgery, Plastic

Topics: Arteriovenous Fistula; Blindness; Carotid Arteries; Cataract; Cavernous Sinus; Facial Injuries; Fistula; Glaucoma; Humans; Nose

Topics: Burns; Facial Bones; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Mandible; Nose

Topics: Accidents; Esthetics; Facial Bones; Facial Injuries; Fractures, Bone; Humans; Insurance, Accident; Maxilla; Nose

Topics: Diagnosis; Facial Injuries; Fractures, Bone; Humans; Nose; Prognosis; Rhinoplasty; Surgical Procedures, Operative

Topics: Boxing; Facial Injuries; Humans; Nose; Nose Deformities, Acquired; Sports Medicine

Topics: Facial Injuries; Genetics, Medical; Humans; Nose; Nose Deformities, Acquired; Rhinoplasty

Topics: Anatomy; Facial Bones; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Nose; Physiology

Topics: Accidents; Accidents, Traffic; Facial Injuries; Fractures, Bone; Humans; Nose

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Cavernous Sinus Thrombosis; Dermatologic Agents; Facial Injuries; Humans; Nose; Sinus Thrombosis, Intracranial

Topics: Facial Injuries; Fractures, Bone; Fractures, Malunited; Humans; Nose; Rhinoplasty

Topics: Facial Injuries; Humans; Nose; Rhinoplasty; Skin Transplantation; Surgical Flaps; Wound Healing

Topics: Facial Injuries; Humans; Lidocaine; Neuralgia; Nose; Ophthalmic Nerve; Trigeminal Neuralgia

Topics: Child; Classification; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Nose; Rhinoplasty

Topics: Diagnosis; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Maxilla; Nose; Plastics; Postoperative Complications; Surgery, Plastic; Zygoma

Topics: Facial Injuries; Fractures, Bone; Humans; Nose; Plastics; Surgery, Plastic

Topics: Adolescent; Child; Facial Injuries; Humans; Nose; Nose Deformities, Acquired; Plastics; Soft Tissue Injuries; Surgery, Plastic

Topics: Facial Bones; Facial Injuries; Fracture Fixation; Fractures, Bone; Frontal Bone; Humans; Maxilla; Nose; Orbit; Zygoma

Topics: Burns; Cheek; Cicatrix; Craniocerebral Trauma; Eyelids; Facial Injuries; Hand Injuries; Humans; Neck; Nose; Plastics; Surgery, Plastic; Tendon Injuries; Thoracic Injuries

Topics: Accidents; Accidents, Traffic; Anti-Bacterial Agents; Facial Bones; Facial Injuries; Fracture Fixation; Humans; Nasal Bone; Nose; Skull Fractures; Sports Medicine

Topics: Facial Injuries; Humans; Nose; Plastic Surgery Procedures

Topics: Facial Injuries; Humans; Nose

Topics: Cheek; Eyelids; Facial Injuries; Fractures, Bone; Humans; Lip; Nose

Topics: Child; Facial Bones; Facial Injuries; Humans; Infant; Jaw; Jaw Fractures; Maxillofacial Injuries; Nose; Skull Fractures

Topics: Facial Injuries; Humans; Nose

Topics: Facial Injuries; Humans; Infant, Newborn; Nose

Topics: Facial Bones; Facial Injuries; Fractures, Bone; Humans; Jaw Fractures; Nose; Skull Fractures; Zygoma; Zygomatic Fractures

Topics: Facial Injuries; Humans; Nose; Wounds and Injuries

Topics: Bone Transplantation; Facial Bones; Facial Injuries; Humans; Nose; Transplantation; Wounds and Injuries

Topics: Facial Bones; Facial Injuries; Fractures, Bone; Humans; Nose; Skull Fractures

Topics: Facial Injuries; Humans; Hyaluronoglucosaminidase; Nose; Wounds and Injuries

Topics: Brain; Brain Injuries; Facial Injuries; Humans; Nose; Orbit; Paranasal Sinuses; Skull

Topics: Facial Injuries; Humans; Nose