• Archives of Plastic Surgery
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• v.38 no.4
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• pp.555-558
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• 2011

Purpose: It is relatively unusual that infraorbital rim fracture is accompanied by nasal bone fracture. In order to correct effectively, subciliary approach and intranasal manipulation are applied simultaneously. But if reduction is not successful, intranasal manipulation may become aggressive and this often causes complications. We introduce a method using intermaxillary fixation screws for decreasing such complications and effective reduction of fracture. Methods: Total seven patients with fracture of frontal process of maxilla were treated with this method. The fracture site was exposed through the subciliary approach, and one or two screws were inserted into the displaced fracture fragment. During the traction of the screws using the wire, the fracture fragment was pushed upward from the intranasal side using an elevator supplementarily and fixed with a plate and the screws. Results: In all patients, the fracture fragment was reduced successfully and no complication occurred during one year's postoperative follow-up. Conclusion: When reduction cannot be attained through a bone hook or an elevator alone, reduction of fracture fragment can be done easily using intermaxillary fixation screws. This method is less likely to cause a mucosal injury because intranasal manipulation is not aggressive. Furthermore, as the screw can be inserted and removed easily, this method is considered effective not only for fracture of frontal process of maxilla but also for fractures in other regions.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.117-127
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• 1991

When open reduction of maxilla fractures is postponed due to concurrent life-threatening injuries, delayed union may result with malunion or nonunion. If delayed malunion is occurred, significant facial deformity may result, including a dished-out face, irregular retromaxillism with Angle's class III malocclusion, open anterior bite, nasal collapse, telecanthus and malar flattening. The treatment planning for this problem includes cephalometric evaluation anterior and lateral tomograms, dental casts, orthodontic planning, dental planning and use of impression tray to rupture the fibrous tissue casts, orthodontic planning, dental planning and use of impression tray to rupture the fibrous tissue attachment at the fracture site. In this paper, one case presented a 58-year-old female patient with maxilla retrusion after comminuted fracture, who was treated with orthodontic methods of maxillary protraction headgear and Plaster headcap, whereas the other two cases were about male patients who were treated principally with surgically open reduction or Le Fort I-controlled transverse osteotomy with iliac bone graft.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.4
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• pp.359-362
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• 2010

The zygoma is second most commonly vulnerable facial bone in fracture, in number only by nasal fractures. It is difficult to evaluate reduction state intraoperatively, because almost surgeons reduce the fractured zygoma by blind method. We suggest the use of orthopedic C-arm intraoperatively. We use plain radiography, CT to evaluate preoperative state. Gilles approach or intraoral approach were used to reduce the fractured zygomatic arch. The C-arm was positioned at chin area, used to evaluate reduction intraoperatively. We got postoperative image by CT or submento-vertex view. There are variable methods to evaluate reduction intraoperatively: palpation, ultrasonography, CT, plain films. C-arm is considered superior diagnostic tool to other methods. The use of intraoperative C-arm was very efficient, it could bring better results.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.238-242
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• 2017

Background: Conservative treatment is performed for isolated anterior wall of the maxillary sinus fractures, in many cases when the fracture is clinically not severe and asymptomatic. Despite the absence of symptoms, complications such as sinusitis, rhinitis, and chronic purulent secretion may develop; therefore, successful reduction is required. We attempted to reduce the risk of complications using an alternative technique: reduction of the fracture with two urinary balloon catheters inserted through the maxillary ostium and fixation using fibrin glue, which minimizes the damage to the bony fragments and sinus mucosa. Methods: In this study, 38 patients who were diagnosed with an isolated anterior wall of the maxillary sinus fracture at our hospital between January 2014 and January 2017 were enrolled. The fracture site was exposed via the Caldwell-Luc approach followed by reduction through the insertion of two urinary balloon catheters using a nasal endoscope and fixation with fibrin glue. The sex, cause of fracture, physical examination, and presence of complications were examined and patient's medical records and facial bone computed tomography scans were analyzed. Results: Radiological evaluation showed that there was no evidence of collapsed reduction fragments. Although some patients had remaining symptoms of hypoesthesia (15%; 3 patients), there were no complications such as infection, rhinitis, sinusitis, and chronic purulent secretion at the surgical site. Conclusion: In this study, we present an alternative surgical technique using two urinary balloon catheters and fibrin glue for the successful reconstruction of an isolated anterior wall of the maxillary sinus fracture. This technique enables precise restoration with a reduced risk of complications.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.504-508
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• 2010

Purpose: Traumatic telecanthus can result from nasoethmoid-orbital fractures. Repair of the medial canthal tendon (MCT) using transnasal wiring is regarded as a choice of method to treat telecanthus, however, is often complicated by incomplete anchoring and drift of canthus, extrusion of wire, in-fracture of orbital bone, and eye damage. The authors introduced oblique transnasal wiring method through the Hiraga's epicanthopalsty incision instead of well-known classical bicoronal approach. Methods: Five patients with traumatic telecanthus were treated with this method. Though the Hiraga's epicanthoplasty incision, we could approach the operative field; the medial orbital wall and detached MCT. Oblique transnasal wiring was performed as following steps. After slit skin incision on the contralateral nasal recession area, drill holes were made from this point to the superior and posterior point of lacrimal sac of deformed eye. A 2-0 wire was double-passed through the holes and MCT. Traction was applied to ensure pulling the MCT and the wires were twisted in the contralateral nose, securing the MCT in the correct position. Results: All patients except 1 person showed improvement and rapid recovery. On average each canthus was moved 5.6 mm medially. In all cases, there were no eyelashes disappear, lacrimal canaliculitis, lacrimal duct injury, or infections. Conclusion: The Hiraga's epicanthoplasty incision could give sufficient operative field to reattach the MCT in traumatic telecanthus patients. And the oblique transnasal wiring technique is effective for the Asians who have flat nose and exophthalmic eye. The authors conclude that this technique could be a simple, safe and scarless method to correct traumatic telecanthus.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.243-247
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• 2013

Introduction: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. Case 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent($8mm{\times}40mm$ in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. Case 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period. Conclusion: The challenge of repairing an SA injury can be overcome by using an endovascular approach.