Demetrius Papavassiliou

Fractures of the facial skeleton in children

Among 3,908 patients with fractures of the facial skeleton hospitalized in a 25-year period, 202 were children. 69% were boys and 31% girls. A child is most active at the age of fourteen. Fractures of the upper alveolar bone and the condyle were the most common. We compared the pattern of fractures in children and those in adults recorded at the same period of time.

Blindness after facial trauma

Blindness after facial fractures has been reported to occur with an incidence that ranges between 0.67% and 3% depending on the reporting institution. To verify this finding we undertook a retrospective chart review of 5936 patients with facial fractures that occurred over a 12 1/2-year period. We found that vision in 19 eyes were lost in 18 patients. Vision loss was more frequently encountered in Le Fort III level fractures (2.2%) followed distantly by Le Fort II level fractures (0.64%), and zygomatic fractures (0.45%). The cause of blindness was most frequently associated with motor vehicle accidents and gunshot injuries. Injuries of this type require immediate and prompt consultation by the ophthalmologic surgery service.

The pattern and aetiology of maxillofacial injuries in Greece: A retrospective study of 25 years and a comparison with other countries

In comparison with other countries, Greece demonstrates a high incidence of road traffic accidents (RTAs). Most are the result of violation of the highway code. Violence as a causative agent of fractures of the facial skeleton is still a minor factor in comparison with other countries. Most of the people involved are young. In a 25-year period we have treated 6,847 fractures of the facial skeleton. Fractures of the mandibular condyle, the genial symphysis and the zygomatico-maxillary complex were the most numerous. 25% of the patients were women and 75% men. 56% were treated conservatively; an open reduction was the treatment of choice in 37%, while no treatment was considered necessary in 7%. In the period under study, K.A.T. Hospital admitted 60% of the maxillofacial trauma in the whole country.

The superior orbital fissure syndrome

The superior orbital fissure syndrome is a very rare condition, characterized by a fixed dilated pupil, ptosis and proptosis of the eye and ophthalmoplegia. We have had the opportunity to observe a number of such cases, and now report four of them.

Fractures of the facial skeleton in Greece: A retrospective study covering 1791 cases in 10 years

1791 fractures of the facial skeleton covering 10 years are reviewed. There was a 3:1 male/female relationship and the majority of the cases involved the 11 to 30 years old group. Road traffic accidents by far (58%) outnumber any other cause for the injury. 56.03% of the cases arrived from the greater Athens area, which is inhabited by 40% of the population of the country. There were 1.5 fractures per patient and in the majority of the cases (78%) the mandible was involved.

Ossifying fibroma of the jaws. Review of the literature and report of 16 cases

Ossifying fibroma is a fibro-osseous lesion rarely occurring in the jaws, although more often than in other bones of the skeleton. It is not clear whether it represents a distinct entity or a certain stage of the fibro-osseous condition. We are presenting our experience with 16 cases of ossifying fibroma treated with local excision or resection and bone graft. Their radiographic picture varied significantly from one case to another. One case was peripheral and one recurred.

The alterations in sensitivity of the infraorbital nerve following fractures of the zygomaticomaxillary complex.

52 patients with fractures of the zygomaticomaxillary complex associated with hypoaesthesia of the infraorbital nerve were evaluated as to the degree of residual impairment in sensitivity. Those with minor displacements or no displacements at all showed complete recovery. Early treatment was associated with better results, while no correlation was found between the degree of anatomical reduction and the improvement in nerve sensitivity. The results appeared to be better when the lateral orbital approach was part of the treatment.

Traumatic carotid-cavernous sinus fistula

Traumatic carotid-cavernous sinus fistula is an uncommon situation resulting from severe trauma, with less than 40 cases having been reported. It is usually associated with a skull base, frontal or mid-facial fracture, but it may also be a spontaneous phenomenon of congenital, infective or degenerative origin. The blood shunts from the internal carotid to the cavernous sinus resulting in pulsating exophthalmos, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia, ophthalmoplegia and the differential diagnosis should include superior orbital fissure syndrome, orbital apex syndrome and cavernous sinus thrombosis. Several modes of treatment have been proposed. We were recently faced with such a case, who had sustained fractures of the facial skeleton and developed the fistula despite an initial non-contributory angiogram. The patient remained in a permanent coma.

Benign neurogenic tumors of the oral cavity

Neurogenic tumors are rare in the oral cavity, particularly so when malignant. Traumatic neuroma, although usually included with neurogenic tumors, is a reactive process rather than a true neoplasm. Neurofibroma and schwannoma derive from nerve fibers, the perineurium, the endoneurium and the neurolemmomal cells. They present histological differences. The neurofibroma may present in solitary and generalized types; the latter also known as neurofibromatosis or von Recklinghausens disease of the skin. We here report typical cases of benign neurogenic tumors of the oral cavity.

Fractures of the facial skeleton in the edentulous patient

An evaluation was made of 112 fractures that occurred in 66 edentulous patients in a 10 year period. There was an average of 1.7 fractures per person. 104 fractures occurred in the mandible and 75% of these were treated without intermaxillary fixation or were not treated at all. In 28.5% of the cases no treatment was provided other than soft or liquid diet and appropriate instructions. As a group, the condylar fractures were those that were left with no treatment to a greater extent than any other group, apart from the Le Fort type of fracture; the latter being very few in absolute numbers. The age group associated with the edentulous state quite often suffers from conditions that may prohibit aggressive treatment. These conditions may be aggravated by the accident and, by the time the patient is ready for maxillofacial surgery, one has to contemplate (and discuss with the patient) the advantages and disadvantages of a procedure. It appears that aesthetics are of minor importance (to a certain degree) for elderly patients and small deviations from the normal (both in appearance and function) are acceptable to them, considering the prospect of an operation or of the prolonged discomfort, such as that associated with intermaxillary fixation. The advisability of the latter should be assessed carefully in view of the respiratory impairment that it may cause in patients whose airway may already be compromised.(ABSTRACT TRUNCATED AT 250 WORDS)