![]() Pre- and postoperative imaging is increasingly used in plastic and reconstructive surgery for evaluation of bony and soft tissue anatomy. Interdisciplinary preparation for the face transplant recipient and donor imaging is of paramount importance for operative planning.Īt our institution, preoperative imaging for both the donor and recipient consists of a high-resolution craniofacial CT, arterial, and venous phase CT angiogram of the head and neck, and 6-vessel digital subtraction angiography (DSA). Reference to the surgeon’s operative note, or direct communication with the surgical team is extremely helpful and highly recommended to avoid language in the imaging report which may be incorrect, misleading, or results in unnecessary patient concern or confusion.Ĭommonly addressed areas in facial feminization surgery (FFS) include the frontal and periorbital region, the nose, chin, and jawline, as these areas have been shown to play an important role in gender discrimination. These procedures are used to correct deformities of the midface, lower face, and chin, respectively. ![]() If extensive laceration, consider packing external auditory meatus with gelonet.Three commonly used orthognathic procedures include the Le Fort type I osteotomy, bilateral sagittal split osteotomy (BSSO), and osseous genioplasty. Ear lacerations - do not suture auricular cartilage but close the overlying skin. facial nerveĪpproximate tissues exactly, especially at the vermillion and nasal margins. Remember the risk to superficial structures – e.g. NB fractured nose is a rare injury in children Displaced fractures: arrange next available ENT clinic. Undisplaced fractures require no treatment Look for septal haematoma (an emergency – refer to ENT). This is a clinical diagnosis and there is no indication for X-ray. These are serious injuries with a risk of airway problems.Īll facial fractures should be discussed with the Maxillofacial team. Grasp the upper alveolus and attempt to pull / push -if it moves, then there is a middle third fracture but absence of movement does not exclude fracture. Le Fort Fractures of the Middle Third of the Face Following reduction refer to Maxillofacial team for follow up. It can usually be reduced by manipulation. ![]() This is a clinical diagnosis and does not need x-rays. Therefore, all patients with good clinical evidence of a fracture but with normal x-rays should be referred to the Maxillofacial team for review. These fractures may not be visible on a standard facial x-ray. Symptoms and signs may include: Black eye, visible depression of cheek, infra-orbital anaesthesia, surgical emphysema of face, tenderness of the frontal-zygomatic suture, lateral subconjuctival haemorrhage with no posterior limit and radiological signs of blood in the antrum. Suspected Fractures of Zygoma, Orbital Floor and Orbital Rim. Remember to look for intra-oral swelling or lacerations and lower lip or gum anaesthesia (inferior alveolar nerve). Test bite strength by asking to bite on a tongue depressor. Ask patient if bite feels abnormal (highly significant). they are intoxicated or have other injuries) and the patient is being admitted with other injuries (eg head injury) it may be better to wait and get proper x-rays the following morning.īeware airway problems in patient with bilateral mandible fractures. If the patient's clinical condition does not allow this (e.g. NB Facial x-rays must be of good quality and should be taken PA and not AP.
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