Taylor JQ, Hopkins E, Yang R
… +1 more, Abramowicz S
Oral Maxillofac Surg Clin North Am
· 2023 Nov · PMID 37302950
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Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in th...Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries. In the United States, head trauma secondary to abuse is the leading cause of mortality among non-accidental trauma in this population.
Oral Maxillofac Surg Clin North Am
· 2023 Nov · PMID 37302949
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Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implicat...Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implications of pediatric facial fractures.
Oral Maxillofac Surg Clin North Am
· 2023 Nov · PMID 37302948
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Publisher ↗
Fractures of the pediatric midface are infrequent, particularly in children in the primary dentition, due to the prominence of the upper face relative to the midface and mandible. With downward and forward growth of the...Fractures of the pediatric midface are infrequent, particularly in children in the primary dentition, due to the prominence of the upper face relative to the midface and mandible. With downward and forward growth of the face, there is an increasing frequency of midface injuries seen in children in the mixed and adult dentitions. Midface fracture patterns seen in young children are quite variable; those in children at or near skeletal maturity mimic patterns seen in adults. Non-displaced injuries can typically be managed with observation. Displaced fractures require treatment with appropriate reduction and fixation and longitudinal follow-up to evaluate growth.
Tolley PD, Massenburg BB, Manning S
… +2 more, Lu GN, Bly RA
Oral Maxillofac Surg Clin North Am
· 2023 Nov · PMID 37302947
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Pediatric nasal bone and septal fractures represent a large number of craniofacial injuries in children each year. Due to their differences in anatomy and potential for growth and development, the management of these inj...Pediatric nasal bone and septal fractures represent a large number of craniofacial injuries in children each year. Due to their differences in anatomy and potential for growth and development, the management of these injuries varies slightly from that of the adult population. As with most pediatric fractures, there is a bias toward less-invasive management to limit disruption to future growth. Often this includes closed reduction and splinting in the acute setting followed by open septorhinoplasty at skeletal maturity as needed. The overall goal of treatment is to restore the nose to its preinjury shape, structure, and function.
Oral Maxillofac Surg Clin North Am
· 2023 Nov · PMID 37302946
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Publisher ↗
The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging....The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.
Shakir S, Ettinger RE, Susarla SM
… +1 more, Birgfeld CB
Oral Maxillofac Surg Clin North Am
· 2023 Nov · PMID 37280142
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Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing...Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
Oral Maxillofac Surg Clin North Am
· 2023 Nov · PMID 37270398
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Anatomic differences of the primary dentition may hinder traditional methods of intermaxillary fixation. Furthermore, the presence of both the primary and permanent dentition can complicate establishing, and maintaining,...Anatomic differences of the primary dentition may hinder traditional methods of intermaxillary fixation. Furthermore, the presence of both the primary and permanent dentition can complicate establishing, and maintaining, the preinjury occlusion. The treating surgeon must be aware of these differences for optimal treatment outcomes. This article discusses and illustrates methods that facial trauma surgeons can use to establish intermaxillary fixation in children aged 12 years and younger.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37149426
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Sinonasal tumors are rare, diverse, complex lesions with overlapping demographic and clinical features. Malignant tumors are more common, with a grave prognosis, and require biopsy for accurate diagnosis. This article br...Sinonasal tumors are rare, diverse, complex lesions with overlapping demographic and clinical features. Malignant tumors are more common, with a grave prognosis, and require biopsy for accurate diagnosis. This article briefly reviews the classification of sinonasal tumors and provides imaging examples and imaging characteristics of each clinically important nasal and paranasal mass lesions. Although there are no true pathognomonic imaging features, it is important for the radiologist to have a broad knowledge of the various CT and MR imaging findings that can help narrow the differential diagnosis and aid in early diagnosis and mapping of tumor for treatment planning.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37142448
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The skull base (SB) is the osseous foundation of the cranial vault. It contains many openings that allow communication between the extracranial and intracranial structures. This communication is crucial in normal physiol...The skull base (SB) is the osseous foundation of the cranial vault. It contains many openings that allow communication between the extracranial and intracranial structures. This communication is crucial in normal physiologic processes yet may also arrow spread of disease. This article provides a comprehensive review of SB anatomy including important landmarks and anatomic variants relevant to SB surgery. We also illustrate the diverse pathologies affecting the SB.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37117091
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Head and neck and base of skull malignancies are challenging for surgical and radiotherapy treatment due to the density of sensitive tissues. Carbon ion radiotherapy (CIRT) is a form of heavy particle therapy that uses a...Head and neck and base of skull malignancies are challenging for surgical and radiotherapy treatment due to the density of sensitive tissues. Carbon ion radiotherapy (CIRT) is a form of heavy particle therapy that uses accelerated carbon ions to treat malignancies that may be radioresistant or in challenging anatomic locations. CIRT has an increased biological effectiveness (ie, increased cell killing) at the end of the range of the carbon beam (ie, within the target tissue) but not in the entrance dose. This increased biological effectiveness can overcome the effects of radioresistant tumors, tissue hypoxia, and the need for radiotherapy fractionation.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032182
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There is a broad spectrum of pathology that occurs in the oral cavity. Knowledge of the different anatomic subsites and contents of each is important for accurate diagnosis and treatment. Oral cavity tumors are predomina...There is a broad spectrum of pathology that occurs in the oral cavity. Knowledge of the different anatomic subsites and contents of each is important for accurate diagnosis and treatment. Oral cavity tumors are predominantly malignant in nature, but there are many nonmalignant lesions of which the practicing clinician should be aware. This article will discuss the anatomy, imaging approaches, and imaging characteristics of nonmalignant and malignant pathology in the oral cavity.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032181
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Infectious and inflammatory disorders are the commonest pathologies to affect the major salivary glands however frequently overlap in clinical presentation. Imaging plays an important role in diagnosis, usually initially...Infectious and inflammatory disorders are the commonest pathologies to affect the major salivary glands however frequently overlap in clinical presentation. Imaging plays an important role in diagnosis, usually initially performed by CT or ultrasound. MRI, with its superior soft-tissue characterization compared with CT, provides a better evaluation of tumors and tumor-like conditions. Imaging features may suggest that a mass is more likely to be benign versus malignant, however, biopsy is often needed to establish a definitive histopathologic diagnosis. Imaging plays a key role in the staging of neoplastic disease.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032180
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Acute infections of the oral cavity and suprahyoid neck range from simple superficial conditions that can be treated as an outpatient to complex multispatial processes that require surgical intervention and inpatient adm...Acute infections of the oral cavity and suprahyoid neck range from simple superficial conditions that can be treated as an outpatient to complex multispatial processes that require surgical intervention and inpatient admission. This article provides an imaging overview of the range of infections in this region that may be encountered by oral and maxillofacial surgeons, emergency physicians, and primary care providers.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032179
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Maxillofacial trauma is common. Computed tomography is the primary imaging tool for diagnosis. Study interpretation is aided by understanding regional anatomy and clinically relevant features of each subunit. Common inju...Maxillofacial trauma is common. Computed tomography is the primary imaging tool for diagnosis. Study interpretation is aided by understanding regional anatomy and clinically relevant features of each subunit. Common injury patterns and the most important factors related to surgical management are discussed.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032178
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Publisher ↗
Rhinosinusitis is a commonly encountered disease. Imaging is not typically required in acute uncomplicated rhinosinusitis; however, it is integral in the evaluation of patients who present with prolonged or atypical symp...Rhinosinusitis is a commonly encountered disease. Imaging is not typically required in acute uncomplicated rhinosinusitis; however, it is integral in the evaluation of patients who present with prolonged or atypical symptoms or when acute intracranial complications or alternate diagnoses are suspected. Knowledge of the paranasal sinus anatomy is important to understand patterns of sinonasal opacification. Bacterial, viral, and fungal pathogens are responsible culprits and, with duration of symptoms, serve to categorize infectious sinonasal disease. Several systemic inflammatory and vasculitic processes have a predilection for the sinonasal region. Imaging, along with laboratory and histopathologic analysis, assist in arriving at these diagnoses.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032177
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The anatomy of the paranasal sinuses is complex with multiple anatomic variants that can predispose patients to disease. Knowledge of this complex anatomy is important not only for successful treatment but to also avoid...The anatomy of the paranasal sinuses is complex with multiple anatomic variants that can predispose patients to disease. Knowledge of this complex anatomy is important not only for successful treatment but to also avoid complications at the time of surgery. This article will review the anatomy with emphasis on a variety of clinically important anatomic variants.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032176
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Publisher ↗
Imaging plays a critical role in the diagnosis, staging, and management of segmental mandibular defects. Imaging allows mandibular defects to be classified which aids in microvascular free flap reconstruction. This revie...Imaging plays a critical role in the diagnosis, staging, and management of segmental mandibular defects. Imaging allows mandibular defects to be classified which aids in microvascular free flap reconstruction. This review serves to complement the surgeon's clinical experience with image-based examples of mandibular pathology, defect classification systems, reconstruction options, treatment complications, and Virtual Surgical Planning.
Oral Maxillofac Surg Clin North Am
· 2023 Aug · PMID 37032175
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Publisher ↗
Percutaneous image-guided biopsy has largely replaced open surgical biopsies for many head and neck (H&N) lesions, being very safe and minimally invasive. Although the radiologist plays the primary role in these cases, i...Percutaneous image-guided biopsy has largely replaced open surgical biopsies for many head and neck (H&N) lesions, being very safe and minimally invasive. Although the radiologist plays the primary role in these cases, it requires a multidisciplinary approach. Depending upon numerous factors, these biopsies can be either fine-needle aspiration or core needle biopsy, using ultrasound for superficial lesions and computed tomography for deep neck lesions. The most crucial part of H&N biopsies is planning a trajectory to avoid injury to critical anatomic structures. This article outlines the standard biopsy approaches and key anatomical considerations for H&N procedures.