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KMID : 0361019770200020031
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Korean Journal of Otolaryngology - Head and Neck Surgery
1977 Volume.20 No. 2 p.31 ~ p.67
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Open Reduction with Internal Wiring Fixation to Facial Bone Fractures
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김기헌/Kim, Key Hun
김광수
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Abstract
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For many years the author has experienced improper healing and subsequent deformity after employing the usual closed methods of reduction in the treatment of facial bone fractures.
Since 1972, the procedures of open reduction with internal wiring fixation to the facial bone fractures have resulted in patients being returned to normal or nearly normal from the standpoint of function and appearance of the face contour.
Recently injured patient and incidence rates have increased in parallel with socioeconomic development in Korea. Fractures of facial bones have increased too in severity and frequency with advances in high speed transportation and destructive -weapon systems development.
Paralleling these. advances, improvements in management of patients in anesthesia, transfusion techniques with electrolyte balance, drug therapy and ´surgical techniques have made care possible even in severe facial bone fractures without complication.
The following results were obtained:
1) Open reduction method of setting an injury, using internal wiring fixation, is the best way to care for facial bone fractures. This method of treatment is more effective than intraoral and extraoral appliances, which have proved to be needlessly complicated, cumbersome and uncomfortable for the patient.
2) From a socioeconomic standpoint, more pedestrians in Korea are exposed to such injuries than a vehicle passenger in a more highly developed nation such as the United States. Studies have revealed. that malar or malar-maxillarycompound fractures are the most frequently occurring injuries in our series. Further, in almost all cases right handed persons have sustained injuries on the right side of their faces. The author proposed that right handed person attempts to shield themselves with their right hands. This gesture is a natural tendency, but ineffective in trying to ward off a mass of rolling metal striking mere flesh and blood. This protective device is unable to prevent injury, and in fact may abet further injury by drawing the right hand and arm away from what could be a means of breaking the person´s fall. This means that a person so struck falls with full force on his right side, inflicting injury to the right malar prominence and right cheek. During this fall, the right arm is extended in an attempt to ward off the blow. Once the person is forced to the ground, his head absorbs the full impact of the blow. (Fig. 2, 4)
3) From a socioeconomic comparison between Korea and. U.S.A., there´s a another interesting point that Dr. Smith reported his series of guest passenger injuries(middle facial fractures) which were sustained in the front seat beside the driver. My report revealed almost all cases were pedestrians in traffic accidents, i.e., my series revealed that all cases- were middle aged and young aged men who worked actively out side. On the contrary of his reports revealed many victims (70%) who were young girls and women who had been riding beside the driver in the front seat.
4) Another interesting point is that the suture surface between temporal process of zygomatic bone and zygomatic process of temporal bone was formed as an oblique surface. For example the surface of zygomatic process of temporal bone. was located undersurface, meanwhile the surface of temporal process of malar bone was sutured to overlap on the outer side by contaries, the surfaces of sutures of the parietal bone and sphenoid bone was sutured to overlap on the outer side. This concomitant anatomical significance of the joint surface is how to protect the arch from the out forces.. It´s almost impossible to occur that the bridge type fractures or depressed fractures without two lines fractures of the malar arch. Therefore, if dislocation of malar bone due to simple fracture of joint separation was occurred, it means that, simple joint separation or a joint separation which´s involved as a phenomena of tips fractures of the processes which may rarely occurred according to the basic concepts of the mentioned anatomic frameworks of the sutured surfaces. The author proposed that if a fractures of the malar arch occurred as a "bridge-type", there will be two line fractures, but no means of joint separation as a fundamental concepts of the tripod fractures.
5). In caring for frontal sinus fractures, the normal mucosa and bony, wall of the anterior and posterior should be preserved normal conditions maintained as much as possible. If this cannot be done in effectively treating the injury and allowing for rapid healing, an intranasal ethmoidectomy with a draining tube through the wound should be made.
6) If a tracheotomy is warranted during care of facial bone fractures, the incision should be made horizontal to alleviate as much as possible postoperative skin scar. In this instance a tracheotomy is not. an emergency situation ordinarily.
The author preferred that tracheotomy hole was made triangular incision as a pyramid shape on the anterior tracheal wall and the apex was everted to suture lower subcutaneous tissue. This is most effective in leaving the inner tracheal wall intact and also easy manipulation of the cannular, plus is the best post-operative course.
Presented partly before the 45th congress of the Korea Otolaryngological Society on April 21, 1973.
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