• Archives of Plastic Surgery
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• v.41 no.6
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• pp.679-685
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• 2014

Background Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures. Methods Between March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws. Results Contour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed. Conclusions The subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.

• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.136-143
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• 2020

Background: The purpose of this study was to investigate the clinical differences between open reduction and plate fixation via a deltopectoral approach with allogenous fibular bone graft and a minimally invasive plate osteosynthesis (MIPO), in Neer's classification two-, threepart proximal humeral fractures. Methods: In this retrospective study, 77 patients with two-, three-part proximal humeral fractures were treated at two different institutions. Clinical and radiological evaluations were performed in 39 patients, who underwent MIPO at one institution (group A), and 38 patients, who underwent a deltopectoral approach with allo-fibular bone graft (group B) at another institution. The results between the groups were compared. Results: The MIPO technique was significantly less time consuming and caused less bleeding than the deltopectoral approach with allo-fibular bone graft (P<0.05). The duration of the fracture union was significantly reduced in group A (14.5±3.4; range, 10-22 weeks) compared to group B (16.4±4.3; range, 12-28) weeks (P<0.05). There were no statistically significant differences between the two groups when evaluating the visual analog scale and Constant scores between the two groups, 1 year postoperatively. In radiological evaluation, there was no difference in radiological outcomes between the two groups. There were no statistically significant differences in malunion between the two groups. Conclusions: The MIPO technique and deltopectoral approach with allo-fibular bone graft for two-, three-part proximal humeral fractures, show similar clinical and radiological results. However, allogenous fibular grafts require longer surgery, cause more bleeding, and result in longer fracture healing time than MIPO technique.

• Archives of Craniofacial Surgery
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• v.21 no.3
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• pp.166-170
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• 2020

Background: The standard treatment of nasal bone fractures in pediatric patients is closed reduction. Conservative treatment is sometimes performed, but poses a risk of nasal deformity. The aim of this study was to evaluate the outcomes of bone remodeling in pediatric nasal fractures. Methods: Information was extracted from the medical records of patients under 12 years of age who received conservative treatment for a nasal bone fracture and underwent follow-up computed tomography (CT) examinations. The initial fracture and its outcomes over time were graded as excellent, good, or fair according to the malalignment, displacement, or irregularity of the fractured segments. The outcomes of remodeling were evaluated through changes in the grade of the fracture between initial and subsequent CT scans. Results: The review identified 16 patients between March 2015 and December 2019. Their mean age was 6.2 years, and the average follow-up period was 4.9 months. Three of the five patients with a plane I frontal impact showed improved outcomes of remodeling from good to excellent, and the remaining two patients, improved from fair to good. Eight of the 11 patients with plane I lateral impacts showed improved outcomes, from good to excellent, while one patient, improved from fair to good, one patient, improved from fair to excellent, and one patient showed no interval changes. Conclusion: In 15 of these 16 patients with non-severe fractures, the bony contour improved through remodeling, without surgical intervention. Therefore, we suggest that conservative treatment is a feasible option for mild pediatric nasal fractures.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.91-96
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• 2009

Purpose: Frontal sinus fractures are relatively less common than other facial bone fractures. They are commonly concomitant with other facial bone fractures. They can cause severe complications but the optimal treatment of frontal sinus fractures remains controversial. Currently, many principles of treatment were introduced variously. The authors present valid and simplified protocols of treatment for frontal sinus fractures based on fracture pattern, nasofrontal duct injury, and complications. Methods: A retrospective chart review was performed on 36 cases of frontal sinus fractures between January, 2004 and January, 2009. The average age of patients was 33.7 years. Fracture patterns were classified by displacement of anterior and posterior wall, comminution, nasofrontal duct injury. These fractures were classified in 4 groups: I. anterior wall linear fractures; II. anterior wall displaced fractures; III. anterior wall displaced and posterior wall linear fractures; IV. anterior wall and posterior wall displaced fractures. Also, assessment of nasofrontal duct injury was conducted with preoperative coronal section computed tomographic scan and intraoperative findings. Patients were treated with various procedures including open reduction and internal fixation, obliteration, galeal frontalis flap and cranialization. Results: 12 patients are group I (33.3 percent), 14 patient were group II (38.8 percent), group III, IV were 5 each (13.9 percent). Frontal sinus fractures were commonly associated with zygomatic fractures (21.8 percent). 9 patients had nasofrontal duct injury. The complication rate was 25 percent (9 patients), including hypoesthesia, slight forehead irregularity, transient cerebrospinal fluid leakage. Conclusion: The critical element of successful frontal sinus fracture repair is precise diagnosis of the fracture pattern and nasofrontal duct injury. The main goal of management is the restoration of the sinus function and aesthetic preservation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.5
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• pp.207-213
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• 2014

Fractures of the mandible occur with a greater frequency in the elderly. This study reports three cases of edentulous atrophic mandible fracture in elderly patients treated with open reduction technique. Three patients who presented with edentulous atrophic mandible fractures underwent surgical management using open reduction and internal fixation. After treatment, clinical evaluations and postoperative complications were examined with postoperative x-ray. Patients were followed with clinical and radiographic examinations. In the postoperative clinical evaluation, two male patients healed well, but one female patient complained of pain and swelling. In radiographic examinations, no union delay or lack of fusion was observed in the edentulous area. Open reduction technique is a viable treatment option for the edentulous atrophic mandible fractures in geriatric patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.2
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• pp.90-93
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• 2013

Mandibular fractures in infants are rare. This case report describes management of a mandibular fracture in an 11-month-old infant using a microplate and screws with open reduction. The surgical treatment was successful. Because the bone fragments were displaced and only the primary incisors had erupted, conservative treatment, such as an acrylic splint and circummandibular wiring, was not recommended. Nine weeks after surgery, the microplate was removed. The results showed complete clinical and radiological bone healing with normal eruption of deciduous teeth.

• Journal of Trauma and Injury
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• v.34 no.4
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• pp.305-308
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• 2021

Comminuted fractures of the patella mostly occur at the inferior pole and require appropriate reduction and fixation to restore the extensor mechanism. Conventional methods such as tension-band wiring are not enough to gain proper fixation strength. Numerous methods have been reported, including circumferential cerclage wiring, osteosynthesis, and suture anchors depending on the fracture pattern. Herein, the author reports a relatively rare case of a comminuted fracture of the upper pole of the patella, for which we used augmented Krackow sutures in the quadriceps and fixation with tying of the suture limbs through patellar bone tunnels. Satisfactory results were obtained in terms of reduction and extensor mechanism recovery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.32-40
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• 1989

This study is based on 247 patients(348 cases) with facial bone fracture who were admitted to the department of oral and maxillofacial surgery, Kangnam sacred heart Hospital during the period of Jan. 1983 through sep. 1988. The patients with mandible fracture were analysed with the following items such as complications with treatment method undertaken : Bicortical osteosynthesis vs Monocortical osteosynthesis, advantages and Disadvantages. The results obtained are as follows : 1) The most common age groups for the facial bone fracture were 20 years 2) The ratio of Men to women was 5 : 1 3) The most frequent location of facial bone fractures was the Mandible(76.7%), Maxillae(10.6%), Zygoma(9.5%), Nasal bone(3.2%) 4) The ratio of Mandible to Maxillae was 7.2 : 1 5) In mandible fractures, the most frequent fracture site was Symphysis(48.7%) 6) In maxilla fractures, the most frequent case was Le fort III fracture(51.4%), followed by Le fort I fracture(29.7%), Le fort II fracture(18.9%) 7) The main contributing causes of facial bone fractures were Traffic Accident(37.7%), Fight(31.6%), Accident(27.5%) 8) In open reduction methods of mandible fracture, the frequency of postop, malocclusion was 15% in interosseous wiring, 7% in Bicortical osteosynthesis, 3% in Monocortical osteosynthesis. The miniplates show advantages over other forms of fixation, in that they are malleable and easy to insert, they achieve rigid fixation and stability.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.155-160
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• 2011

Purpose: Fibrillar collagens like type I collagen, are the major constituent of the extracellular matrix and structural protein of bone. Also, it can be a scaffold for osteoblast migration. The purpose of this study is to estimate the effects of absorbable atelo-collagen sponge (Teruplug$^{(R)}$, Terumo biomaterials Co., Tokyo, Japan) insertion in tooth extraction sites on periodontal healing of the second molar, healing of the fractured mandibular bone and new bone formation of third molar socket after the extraction of the impacted third molar with mandibular angle fracture. Methods: In our study of six cases of mandibular angle fractures, all of them underwent the extraction of the third molar tooth & absorbable atelo-collagen sponge insertion in tooth extraction site. Three of them had a intraoral infection & oral opening to fracture site, two of the six had dental caries, and only one had reduction problem due to third molar position. Six consecutive patients with noncomminuted fractures of the mandibular angle were treated by open reduction and internal fixation using one noncompression miniplates and screws placed through a transoral incision. Results: All of the patients have showed good postoperative functions and have not experienced complications requiring second surgical intervention. There was well healing of the mandibular bone and the most new bone formation of third molar socket after the extraction of the impacted third molar with mandibular angle fracture. Conclusion: The results of this study suggest that absorbable atelo-collagen sponge is relatively favorable bone void filler with prevention of tissue collapse, food packing, and enhance periodontal healing. Thus, the use of atelo-collagen sponge and one noncompression miniplate seems to be relatively easy, safe, and effective for the treatment of fractures of the mandibular angle and third molar extraction.

• Archives of Plastic Surgery
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• v.43 no.5
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• pp.411-417
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• 2016

Background Facial hypoesthesia is one of the most troublesome complaints in the management of facial bone fractures. However, there is a lack of literature on facial sensory recovery after facial trauma. The purpose of this study was to evaluate the facial sensory recovery period for facial bone fractures using Neurometer. Methods Sixty-three patients who underwent open reduction of zygomatic and blowout fractures between December 2013 and July 2015 were included in the study. The facial sensory status of the patients was repeatedly examined preoperatively and postoperatively by Neurometer current perception threshold (CPT) until the results were normalized. Results Among the 63 subjects, 30 patients had normal Neurometer results preoperatively and postoperatively. According to fracture types, 17 patients with blowout fracture had a median recovery period of 0.25 months. Twelve patients with zygomatic fracture had a median recovery period of 1.00 month. Four patients with both fracture types had a median recovery period of 0.625 months. The median recovery period of all 33 patients was 0.25 months. There was no statistically significant difference in the sensory recovery period between types and subgroups of zygomatic and blowout fractures. In addition, there was no statistically significant difference in the sensory recovery period according to Neurometer results and the patients' own subjective reports. Conclusions Neurometer CPT is effective for evaluating and comparing preoperative and postoperative facial sensory status and evaluating the sensory recovery period in facial bone fracture patients.