1-Craniofacial Trauma.

FOREWORD

Craniofacial Trauma

Rod J.Rohrich,M.D.

Dallas,

Texas

“L

ord,how my head aches!What a head have I!It beats as it would fall in twenty pieces.”1While the Nurse may just be

suffering a migraine from all the angst-ridden drama of Romeo and Juliet ,the words she speaks lend themselves quite literally to craniofacial trauma injuries.With fractures of the zygoma,or-bit,mandible,and sinus as just a few of the sundry trauma injuries that occur daily,it is not just a poignant metaphor that the head could fall into 20pieces;it’s a stark reality.

The Nurse’s fractured skull would not be a lost cause today,thanks to plastic and reconstructive surgeons in the field of craniofacial trauma.In the sixteenth century or earlier,however,it might have been a different story.For most of recorded human history,craniofacial injuries have war-ranted little to no medical attention.In ancient Egyptian manuscripts from the sixteenth century BC ,we find mixed messages about treating these types of injuries:juxtaposed with descriptions of a reduction of a dislocated jaw are cautions against attempting to treat other facial injuries,including zygoma and nose fractures.1

As we jump forward in time,the treatment of craniofacial injures leaps forward as well.Around 400BC ,we see Hippocratic physicians’descrip-tions of a closed reduction of a nasal fracture and suggestions for using gold wire in treating man-dibular fractures.As early as the thirteenth cen-tury AD ,we find the first credited description of intermaxillary fixation.1

In the late seventeenth century,the Nurse might have had a mediocre chance of survival with her 20-part head fracture,but it would not have been a “pretty”procedure.In 1686,Richard Wise-man,royal surgeon to England’s King Charles II,reported the reduction of a maxillary fracture caused by a horse kick to the face.“First,he pulled the maxilla forward with a finger behind the uvula and then developed a blunt hooklike instrument to apply forward traction more effectively.”1

In the following centuries,machinery and tools were developed to help treat craniofacial https://www.360docs.net/doc/9a6555933.html,te eighteenth century French physi-cians brought about a “cumbersome splinting de-vice that rested on the occlusal surface of a frac-tured mandible and was extended by screws to a wooden plate placed under the lower border of the mandible.”1The nineteenth century yielded a “systematic bandage,”a craniomaxillary suspen-sion device,circummandibular wire,and direct wire osteosynthesis of a mandibular fracture and other such advances.

The American Civil War proved to be a very developmental time in the area of treating cranio-facial wounds,as the UnionXX “sustained over 3300facial fractures from gunshot wounds,of which 1600were mandibular.”1Advances in splint-ing and dressing wounds,including vulcanized hard rubber splints,were made to treat fractured heads while the fractured country fought.

In 1901,Rene Le Fort,now one of the most famous figures in the field,published three con-secutive studies that located the most common lines of weakness in the face through which most fractures occur;these lines now bear his name:the Le Fort I,II,and III fractures.2Though his experi-mental work,conducted by dropping 35cadaver heads from high floors to paved areas below and beating them with wooden piano legs,seems macabre,1it undoubtedly laid the groundwork for the development of modern maxillofacial surgery.

Many advances were made during World Wars I and II and the years that followed by some leg-ends in our field,including Sir Harold Gillies,who performed the first Le Fort III osteotomy.These advances helped usher in the discipline of recon-structive plastic surgery as the highly respected surgical subspecialty that it is today.It is argued,however,that Paul Tessier was the “pioneer and originator”2of the field of craniofacial surgery as we know it.With methods and procedures in prac-tice today,including computed tomography scans,bone grafting,and soft-tissue repair,treatment of

Disclosure:The Editor-in-Chief has no financial interest in any of the products,devices,or drugs mentioned in this foreword or in the supplement as a whole .

https://www.360docs.net/doc/9a6555933.html, 1S

craniofacial trauma is highly technical and effi-cient and is a far cry from its ancestral origins.In Shakespeare’s time,had the Nurse’s injury been a true one,it would have most likely gone untreated, or at least bandaged but never corrected;now, however,most patients who suffer craniofacial trauma–-whether their heads have fallen“into twenty pieces”or not–-will be treated and“have the hope of being returned to normal in favorable situations or,in the worst cases,of at least having an acceptable human face.”1

The field has continued to see breakthroughs in our generation as well,especially in the use of rigid internal fixation and early management,as advocated by Manson,Gruss,Ellis,and others. These and many more modern contributions have taken the standard of care for the craniofacial trauma patient to a higher level of improved pa-tient safety outcomes and recovery.

As the history of treating craniofacial trauma injuries continues to be written every day,and ad-vancements and refinements in the field abound,it is my pleasure to introduce Plastic and Reconstructive Surgery’s Craniofacial Trauma Supplement.This spe-cial issue of the White Journal contains a broad range of articles,each discussing a unique aspect of treating craniofacial trauma.None of the materials con-tained in this supplement are considered to be practice guidelines or best medicine protocols,but are merely the authors’collective experience and expertise in the proscribed area.These articles represent state-of-the-art studies by the authors and were rigorously peer-reviewed and revised before acceptance.

I am greatly indebted to the strong contribu-tions,leadership,and acumen of the supple-ment’s guest editors,Larry Hollier,Jr.,M.D.,and James Thornton,M.D.Because of their dedication to completing this collection and their astuteness in choosing the article topics and selecting some of the best reconstructive surgeons in our field to author them,this issue is a very important contri-bution to the craniofacial trauma literature.

I also thank the contributors,who took much-valued time out of their schedules to write all-new articles on some of the most important topics in the field of craniofacial trauma treatment and management today.Their patience,persistence, and cooperation with the editorial office have al-lowed the articles before you to be representative of the best possible figures and manuscripts avail-able.The guest editors and I owe them many thanks for their efforts.

This supplement was made possible by unre-stricted educational grants from Biomet Microfix-ation and KLS-Martin.I am grateful for the gen-erosity of these sponsors and thankful for their help in bringing this timely information to our readers.The content of this supplement was by no means or methods dictated by the sponsors,and all financial declarations and affiliations of the authors have been disclosed and printed with all-new original articles in this supplement.

Finally,I am indebted to the tremendous ef-forts of our publishers,Lippincott Williams& Wilkins,and my editorial staff,especially Aaron Weinstein,coordinator of production and supple-ments,and Dan Sullivan,managing editor.Their hard work,resourcefulness,perseverance,and dedication to quality make Plastic and Reconstruc-tive Surgery and its supplements among the best journals in the world.

I hope you find this supplement interesting and perhaps consider information contained within in the treatment and care of patients with craniofacial trauma injuries,as long as the injuries sustained are not mere metaphors.

Rod J.Rohrich,M.D.

Editor-in-Chief University of Texas Southwestern Medical Center

5323Harry Hines Boulevard,HD01.544

Dallas,Texas75390-8820

rjreditor_prs@https://www.360docs.net/doc/9a6555933.html,

REFERENCES

1.Wolfe,S.A.,and Baker,S.Facial fractures.In Operative Tech-

niques in Plastic Surgery.New York:Thieme Medical Publishers.

1993.P.1–5.

2.Tennessee Craniofacial Trauma Center.Introduction:The History of

Craniofacial Surgery.2000.Erlanger Health Systems.Available at https://www.360docs.net/doc/9a6555933.html,/book/intro/history.htm.

Plastic and Reconstructive Surgery?December Supplement2,2007 2S