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Pain management in facial fractures

Richard L Weiner, Carlos Montes Garcia, Niek Vanquathem
OBJECTIVE: To report a novel wireless neuromodulation system for treatment of refractory craniofacial pain. BACKGROUND: Previous studies utilizing peripheral nerve stimulation (PNS) of the occipital and trigeminal nerves reported positive outcomes for alleviating neuropathic pain localized to the craniofacial and occipital areas. However several technological limitations and cosmetic concerns inhibited a more widespread acceptance and use of neuromodulation. Also, a relatively high incidence of adverse events like electrode erosions, dislocation, wire fracture and/or infection at the surgical site mandates a change in our approach to neuromodulation technology and implant techniques in the craniofacial region...
October 10, 2017: Scandinavian Journal of Pain
Ki-Sung Park, Seung-Soo Kim, Wu-Seop Lee, Wan-Suk Yang
BACKGROUND: Nasal bone fracture is one of the most common facial bone fracture types, and the surgical results exert a strong influence on the facial contour and patient satisfaction. Preventing secondary deformity and restoring the original bone state are the major goals of surgeons managing nasal bone fracture patients. In this study, a treatment algorithm was established by applying the modified open reduction technique and postoperative care for several years. METHODS: This article is a retrospective chart review of 417 patients who had been received surgical treatment from 2014 to 2015...
June 2017: Archives of Craniofacial Surgery
Ioannis Papadiochos, Lampros Goutzanis, Vasileios Petsinis
Isolated mandibular fractures usually represent themselves as non-life-threatening injuries and are not treated in emergency setting. However, some rare patterns of them may result in airway obstruction as a result of displacement of bony fragments. The authors report a patient of an open comminuted fracture of mandibular symphysis which exhibited an uncommon split pattern with retrogression of lingual cortical plate, and thereby induced glossoptosis, painful deglutition, and obstruction of the upper airway within a few hours...
July 2017: Journal of Craniofacial Surgery
Mark Bastianelli, Stefan Hamilton, Matthew Hearn, Safeena Kherani, Kristian I Macdonald
Frontal sinus fractures (FSF) are relatively uncommon and can be challenging for trauma surgeons to manage. Patients with FSF typically present with facial swelling, pain, and nasofrontal ecchymosis. Here we present a rare case of a patient with FSF and anterior table fracture where the main presenting symptom was bilateral frontal paralysis. We outline our management strategy and review the current literature in regard to management of FSF.
2017: Case Reports in Otolaryngology
Ida Barca, Walter Colangeli, Maria Giulia Cristofaro, Amerigo Giudice, Elio Giofrè, Anna Varano, Mario Giudice
AIM: To evaluate the effectiveness of Hilotherm, a recently introduced cooling system, in controlling postoperative edema and pain and to compare the results with those obtained with conventional cryotherapy. MATERIAL OF STUDY: The investigators selected 40 patients with unilateral angle fracture of the jaw and divided them into two groups, cryotherapy with ice bag (A group), and Hilotherapy system (B Group); both groups with the same drug treatment. Facial swelling was preoperatively quantified measuring skin segments (called α, β, γ and δ), pain and patient satisfaction were measured for each with questionnaires...
2016: Annali Italiani di Chirurgia
Jonatan Hernandez Rosa, Nathaniel L Villanueva, Paymon Sanati-Mehrizy, Stephanie H Factor, Peter J Taub
From 2002 to 2006, more than 117,000 facial fractures were recorded in the U.S. National Trauma Database. These fractures are commonly treated with open reduction and internal fixation. While in place, the hardware facilitates successful bony union. However, when postoperative complications occur, the plates may require removal before bony union. Indications for salvage versus removal of the maxillofacial hardware are not well defined. A literature review was performed to identify instances when hardware may be salvaged...
June 2016: Craniomaxillofacial Trauma & Reconstruction
Muhammed Sedat Sakat, Korhan Kilic, Enver Altas, Mustafa Sitki Gozeler, Harun Ucuncu
Frontal sinus fractures (FSF) are relatively uncommon maxillofacial injuries. The most common cause of FSF is motor vehicle accidents with 62% percentage. Management of FSF depends on type of fracture, associated injuries, and involvement of naso-frontal duct. In this report, the authors presented a patient with comminuted fracture of anterior wall of frontal sinus reconstructed with titanium mesh. A 40-year-old man presented with depression of the frontal bone, facial pain, and epistaxis consisting of a motor vehicle accident...
March 2016: Journal of Craniofacial Surgery
Asish Kumar Das, Monimoy Bandopadhyay, Abira Chattopadhyay, Sailendranath Biswas, Anindita Saha, Uke Manjeet Balkrishna, Vineet Nair
INTRODUCTION: Zygomatico-orbital fractures are the second most common facial injuries. Trauma to mid-facial region can lead to an alteration or loss of sensation in the facial region which sometimes requires early surgical intervention to aid in an early recovery. AIM: To evaluate the different neurosensory changes in the infraorbital nerve function following common treatment modalities used in the management of zygomatico-maxillary complex fractures. MATERIALS AND METHODS: Thirteen patients selected for the study had unilateral zygomatic complex fracture with altered sensation in the region of distribution of the infraorbital nerve...
December 2015: Journal of Clinical and Diagnostic Research: JCDR
Camille Chatelle, Marie-Daniele De Val, Antonio Catano, Cristo Chaskis, Pierrette Seeldrayers, Steven Laureys, Patrick Biston, Caroline Schnakers
OBJECTIVES: Our objective was to assess the clinical usefulness of the Nociception Coma Scale-revised (NCS-R) in pain management of patients with disorders of consciousness. MATERIALS AND METHODS: Thirty-nine patients with potential painful conditions (eg, due to fractures, decubitus ulcers, or spasticity) were assessed during nursing cares before and after the administration of an analgesic treatment tailored to each patient's clinical status. In addition to the NCS-R, the Glasgow Coma Scale (GCS) was used before and during treatment to observe fluctuations in consciousness...
April 2016: Clinical Journal of Pain
Srinivas Chivukula, Zachary J Tempel, Gregory M Weiner, Abhiram V Gande, Ching-Jen Chen, Dale Ding, John J Moossy
BACKGROUND: The role for spinal cord stimulation (SCS) in the management of chronic spinal cord forms of pain involving cervical dermatomes or the cervicomedullary junction (CMJ) for facial pain remains largely uncharted. OBJECTIVE: To review outcomes with cervical and CMJ SCS performed by a single surgeon, with particular emphasis on complications and efficacy. METHODS: All patients that underwent cervical or CMJ SCS by the lead author were identified and follow-up obtained by telephone questionnaires...
December 2014: Clinical Neurology and Neurosurgery
Ravi M Agarwal, Ramakrishna Yeluri, Chanchal Singh, Kalpna Chaudhry, Autar K Munshi
A pediatric mandibular fracture can cause a child severe pain and the parent or caregiver extreme worry. While the pattern of fractures and associated injuries in children is similar to adults, the incidence is low. Due to a number of factors, including the anatomical complexity of the developing mandible in a child, management of such fractures differs from that of adults and can greatly challenge the pediatric dentist. Various treatment modalities of managing mandibular fracture are available, such as closed/open cap splint with circummandibular wiring, arch-bar fixation, and cementation of the cap splint...
September 2014: Compendium of Continuing Education in Dentistry
Foad Elahi, Chandan Reddy
Headache following head injuries has been reported for centuries. The majority of post-traumatic headache (PTH) patients will report resolution of their complaints within a few months from the time of the initial injury. PTHs can contribute to disability, lost productivity, and health care costs. In this article we discuss a 40-year-old male with a history of motor vehicle accident and basal skull fracture. The patient had no headache history prior to the accident. He presented with more than 3 years persistent daily headache...
July 2014: Pain Physician
Y Ko, J Park, C Kim, J Park, S H Baek, Y A Kook
Dentin hypersensitivity (DH) is defined as pain derived from exposed dentin in response to chemical, thermal, tactile, or osmotic stimuli that cannot be explained as having arisen from any other dental defect or disease. The aim of this trial was to test the efficacy and the safety of a low-level laser-emitting toothbrush on management of DH. A prospective, double blind, randomised clinical trial was designed; 96 individuals with hypersensitive teeth without caries or fracture were selected as subjects. The subjects were randomly allocated to either the test group with the 635 nm per 6 mW laser-emitting toothbrush, or the control group with the 635 nm per 12...
July 2014: Journal of Oral Rehabilitation
Jacob N Grow, Roberto L Flores, Sunil S Tholpady
The proper management of complex pediatric mandibular fractures remains a topic of debate because of the relatively uncommon presentation of these fractures, combined with concerns related with deciduous teeth, tooth buds, and growth inhibition. In this current study, we present a novel approach to the repair of bilateral condylar fractures with concomitant symphyseal fracture in a 4-year-old girl. Manual closed reduction was first obtained, followed by placement of a transfacial Steinman pin through the angles of the mandible and placement of circummandibular wires...
2014: Journal of Craniofacial Surgery
A P Mohan, K A Jeevan Kumar, V Venkatesh, B Pavan Kumar, Kapil Patil
AIM: The aim of the study is to compare the two extra oral approaches to the TMJ viz preauricular and retromandibular approach in management of condylar fractures of mandible. METHODS AND MATERIALS: Patients with fractured dislocation and displacement of mandible condyle in medial direction were managed by preauricular approach. Patients with lateral displacement of mandibular condyle were managed by retromandibular approach. OPG, Reverse towne's, and C.T. scan were taken in all the cases prior to surgery to assess the pattern of displacement...
December 2012: Journal of Maxillofacial and Oral Surgery
Griffin Harold West, Jason Alan Griggs, Ravi Chandran, Harry Vincent Precheur, William Buchanan, Ron Caloss
PURPOSE: The purpose of this prospective randomized study was to assess whether uncomplicated mandible fractures could be treated successfully in an open or closed fashion using maxillomandibular fixation (MMF) screws. MATERIALS AND METHODS: This was a prospective institutional review board-approved study involving 20 adult patients who presented to the university emergency department or oral and maxillofacial surgical clinic with uncomplicated mandible fractures...
January 2014: Journal of Oral and Maxillofacial Surgery
Ali Modabber, Madiha Rana, Alireza Ghassemi, Marcus Gerressen, Nils-Claudius Gellrich, Frank Hölzle, Majeed Rana
BACKGROUND: Surgical treatment and complications in patients with zygomatic bone fractures can lead to a significant degree of tissue trauma resulting in common postoperative symptoms and types of pain, facial swelling and functional impairment. Beneficial effects of local cold treatment on postoperative swelling, edema, pain, inflammation, and hemorrhage, as well as the reduction of metabolism, bleeding and hematomas, have been described.The aim of this study was to compare postoperative cooling therapy applied through the use of cooling compresses with the water-circulating cooling face mask manufactured by Hilotherm in terms of beneficial impact on postoperative facial swelling, pain, eye motility, diplopia, neurological complaints and patient satisfaction...
July 29, 2013: Trials
Oliver Ristow, Bettina Hohlweg-Majert, Victoria Kehl, Steffen Koerdt, Lilian Hahnefeld, Christoph Pautke
PURPOSE: The aim of the present study was to investigate whether the application of elastic therapeutic tape (Kinesio Tape [KT]) prevents or decreases swelling, pain, and trismus after open reduction and internal fixation of mandibular fracture, thus improving patients' postoperative morbidity. MATERIALS AND METHODS: To address the research purpose, the investigators designed and implemented an open-label, monocentric, parallel-group, randomized clinical trial. Patients were prospectively assigned for treatment of unilateral mandibular fractures and randomly allocated to receive treatment with or without KT application...
August 2013: Journal of Oral and Maxillofacial Surgery
Lei Tian, Li-Sheng He, Bhavesh Soni, Hong-Tao Shang
Osteoradionecrosis (ORN) in the head and neck area is the most devastating long-term complication of radiotherapy, with slow progression and inability to heal spontaneously. ORN can lead to intolerable pain, fractures, and sequestration of devitalized bone and fistulae, making oral feeding impossible and causing facial deformation. In spite of its notorious reputation over at least 90 years, the precise pathogenesis of ORN has not been fully clarified, which has led to obstacles in the management of the disease...
2012: Clinical, Cosmetic and Investigational Dentistry
L Shen, J Li, P Li, J Long, W Tian, W Tang
Fractures of the coronoid process are uncommon and can easily be missed. The purpose of this study was to classify the fracture patterns and explore the treatment options. This retrospective study included 39 patients with fractures of the mandibular coronoid process. Treatment protocols were developed based on the time of fracture, degree of mouth opening, location of the coronoid fracture, types of fracture, and other concomitant fractures. All patients were followed up for 12-60 months. Sixteen patients underwent conservative management and four of these patients developed progressive trismus, which improved significantly after removal of the coronoid process...
June 2013: International Journal of Oral and Maxillofacial Surgery
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