Tetsuji Yabe

Pre- and postoperative x-ray and computed tomography evaluation in acute nasal fracture.

Between January 1997 and July 2003, 156 acute nasal fractures were treated by closed reduction in Ishikiri-Seiki Hospital. For all patients, x-ray and computed tomography (CT) taken pre- and postoperatively were used to classify fractures and evaluate postoperative conditions. Acute nasal fractures requiring surgery were classified into the following 5 types. Unilateral type (U), bilateral type (B), frontal type (F), laterofrontal type (L), and comminuted type (C). Postoperative conditions were classified as good, fair, or poor. On statistical analysis, it was found that reduction is easier in the U, F, B, L, and C types in order. Furthermore, it was found that in the U, B, and F types, reduction can be performed after swelling has subsided, but in the L and L+C types, reduction should be performed earlier. On follow-up x-ray and CT, there was no significant difference between the postoperative evaluation and follow-up evaluation. A few overreduced cases improved, but correct reduction was preferable to overreduction. Accurate preoperative understanding of the fracture type and postoperative evaluation by x-ray and CT are necessary to obtain good results and to decrease secondary deformity caused by poor primary reduction.

Preauricular transparotid approach to mandibular condylar fractures without dissecting facial nerves.

AbstractPreauricular transparotid approach without dissecting the facial nerve was used for surgical treatment of 15 condylar fractures in 14 patients. The parotid fascia was opened just above the fracture site, and by dissecting the parotid gland and masseter muscle, the fracture was directly exposed. The facial nerve itself was not dissected expressly. All fractures could be reduced accurately and fixed firmly with miniplates. A direct approach just above the fracture site provided good vision of the fracture, avoiding facial nerve palsy caused by strong retraction. Moreover, by not dissecting the facial nerve, the operation time was shortened. This approach was useful for surgical treatment of both condylar neck and subcondylar fractures.

Comparison of pediatric and adult nasal fractures.

Abstract Nasal fractures are the most common facial fracture in children and adults. Generally, it is believed that reduction of pediatric nasal fracture is more difficult and should be performed earlier compared with that of adult nasal fracture. However, there has been no article to prove this theory. We investigated 423 patients with acute nasal fractures requiring surgery and divided them into the following 2 groups: patients 12 years and younger (pediatric group) and patients 13 years and older (adult group). We then compared these patients in various aspects. There were no significant differences in the cause of fracture or postoperative conditions. Only the type of fracture and the anesthesia were different between these 2 groups. In the pediatric group, the interval between injury and surgery was arbitrarily divided into 2 groups, but there was no significant difference between these groups in the postoperative conditions. Some reports recommended that pediatric nasal fractures should be reduced within 3 to 5 days, but it cannot be proven. In conclusion, it is not necessary to distinguish treatment of pediatric nasal fracture from that of adult nasal fracture.

Treatment of nasoethmoid-orbital fractures using Kirschner wire fixation of the nasal septum.

As a postoperative complication in nasoethmoid-orbital fractures, nasal depression often occurs. The cause of this is an overlooked left nasal septum fracture. By reducing and fixing the nasal septum, nasal depression could have been avoided. Kirschner wire is useful for the fixation of the nasal septum, and it is fixed with zygomatic bone or/and frontal process of the maxillary bone. Three cases of nasoethmoid-orbital fractures were treated with this method. Kirschner wire fixation of the nasal septum is a simple and an easy method and can avoid unnecessary bone graft.

Treatment of acute temporomandibular joint dislocation using manipulation technique for disk displacement.

AbstractTemporomandibular joint dislocation is not frequently encountered, but it is often difficult to reduce the dislocation with conventional methods described in textbooks. The key points to success of reduction depend on the patient’s position, route of approach, and timing of reducing each side. We apply a manipulation technique for disk displacement to the reduction that corresponds to these key points. Using our method, temporomandibular joint dislocation can be easily reduced, without using sedative or analgesics. This method is simple, convenient, and worth trying in place of the conventional method.

Treatment of fingertip amputation: comparison of results between microsurgical replantation and pocket principle.

In this article, a comparison of replantation using microsurgical replantation (replantation) and the Brent method and its modification (pocket principle) in the treatment of fingertip amputation is reported. As a classification of amputation level, we used Ishikawas subzone classification of fingertip amputation, and the cases of amputations only in subzone 2 were included in this study. Between these two groups, there was no statistical difference in survival rate, postoperative atrophy, or postoperative range of motion. In terms of sensory recovery, some records were lost and exact study was difficult. But there was no obvious difference between these cases. In our comparison of microsurgical replantation versus the pocket principle in treatment of subzone 2 fingertip amputation, there was no difference in postoperative results. Each method has pros and cons, and the surgeon should choose which technique to use based on his or her understanding of the characteristics of both methods.

Intraoperative adjustment of eyelid level in aponeurotic blepharoptosis surgery.

AbstractThere have been numerous reports on the use of aponeurotic surgery to correct involutional blepharoptosis. However, it is still difficult to determine optimal eyelid level during operation. Here we present our new method to adjust eyelid level intraoperatively. After the aponeurosis was temporally sutured to the tarsus, while still in the supine position, the patient was asked to look up, and the position of the eyelid margin was confirmed. The margin should be located above the pupil but within the cornea while the patient gazes up. And it is ideal if the eyelid position is located in the upper half of this range. Although 3 of 29 patients were reoperated on in the follow-up period, only 1 patient required readjustment in the perioperative period. Our method is simple, easy and reduces operative time, because it is not necessary to change patient position during the operation.

Reduction of nasal fracture using an airway tube as a pivot.

When repairing nasal fracture by closed reduction, an airway tube is useful for the pivot of the forceps. By placing the tube on the upper white lip and using it as a pivot, the fracture is reduced with Walsham forceps or Langenbeck elevator. This method is useful for all nasal fractures that are too firm to reduce by conventional closed reduction.