The Journal of craniofacial surgery
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Comparative Study
Fluid replacement in craniofacial pediatric surgery: normal saline or ringer's lactate?
Pediatric craniofacial surgery requires large amounts of intravenous fluid replacement that may alter the ionic composition of body compartments. Normal (0.9%) saline (NS) and Ringer's lactate (RL) solutions are commonly used, with different advantages and disadvantages. Our hypothesis was that there would be more acidosis with NS but with no advantage of NS over RL regarding the incidence of hyponatremia. Our objective was to determine whether acid-base and electrolyte outcomes could guide fluid management in this group of patients. ⋯ In young children undergoing craniofacial surgery, RL may be a preferred crystalloid over NS because metabolic acidosis is less frequent, with no increased incidence of hyponatremia.
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Comparative Study
Assessment of the adequacy of closed reduction in fractures of the zygomatic arch using "C"-arm image intensifier.
Major problems in closed reduction of isolated, minimally displaced, and depressed zygomatic arch fractures are blind nature of the technique, reliability on digital palpation, reduction click, and step deformity between fragments. The purpose of this study was to objectively confirm the adequacy of closed reduction intraoperatively and the usefulness of the "C"-arm image intensifier. A total of 12 patients with 1- to 8-day-old unilateral isolated and depressed zygomatic arch fracture underwent closed reduction under "C"-arm image intensifier. ⋯ In this patient, additional stabilization was provided. The "C"-arm image intensifier shows some poorly reduced or unstable isolated depressed zygomatic arch fractures that remain unidentified even after careful palpation. Thus, it plays a recognizable role to avoid the trouble of second intervention.
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Traumatic auricular amputation due to human bite is not a common event, but it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but replantation of a severed ear without microsurgery can be a safe alternative. ⋯ It is a simple technique and very reliable because it allows a great surface of contact between the graft and the vascular bed, substantially increasing its odds of survival in cases presenting with high risk of infection such as human bite injury. It also produces excellent aesthetic results.
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Pneumomediastinum (PM) secondary to an isolated orbital blow-out fracture is a rare but potentially severe and life-threatening complication. Fortunately, airway obstruction, pneumothorax, pneumopericardium, and mediastinitis are rare complications of PM. ⋯ We report here the rare case of a patient with PM after isolated orbital fracture. Only 3 similar cases have been previously reported in the literature.