#facial fracture treatment

[hopkinrx]

Facial Degloving: Causes, Important Symptoms, Treatment, and Recovery

Facial Degloving: Causes, Important Symptoms, Treatment, and RecoveryIntroductionWhat is Facial Degloving?Causes and Risk FactorsSigns and SymptomsDiagnosis and AssessmentTreatment ApproachesMultidisciplinary ApproachRecovery and RehabilitationPotential ComplicationsLong-Term OutcomesPrevention StrategiesPatient StoriesAdvancements in TreatmentSupport SystemsExpert InsightsConclusionFacial…

[shotmrmiller]

Multiverse part 3

You sat in a small room on a padded chair, with equipment set up around your arm, chest, and fingertips. A polygraph test. That's what you were being forced to take. And to your chagrin, Ghost is in the room with you and Captain Price.

"Try to relax, yeah?" Price commented. He must've noticed your restless leg.

"I'll do that, shall I? I've done nothing wrong, other than exist and I'm being interrogated. Because that's what this is— an interrogation." You finally turn your attention from Ghost to look at Price, who's sitting at the desk by your side. "Tell me, Captain. Did you get this same treatment when you came back after spending all that time locked up in the gulag?"

His dark eyebrows furrow in confusion. A sigh escapes your bitten lips. That's only in your...world, for lack of a better term. Dimension? Universe?

"I haven't been to the gulag here." Yeah, obviously.

With an impatient wave of the hand that doesn't have cables strapped to it, you mutter, "Let's get on with this circus act, then. Ask your questions."

Ghost steps forward, his arms unfolding as if he's about to speak to you, but Price swiftly intervenes, halting him with a raised hand.

"Alright then. Baseline questions first. Name." Ghost gives away nothing when you say your last name is Riley.

It goes like this for a few, then he switches to the control questions, until finally moving on to the relevant ones.

"How did you get here?" I don't know.

"Do you know why you're here?" No.

He pulls up a photograph. "Recognize him?" Captain MacTavish.

Another photo. "Him?" I don't know.

"What do you mean by that?" If that's Roach, I've never seen his face unmasked.

"You're sure you don't know him?" Unless that man's name is Gary Sanderson, no. I do not know him.

Price acknowledges your response with a nod, then shifts his gaze towards Ghost, whose head slightly tilts forward. Returning his attention to you, he retrieves a final photograph. "What about him?"

As you look at the picture, your eyes begin to well with tears, lip trembling violently. A new fracture reverberated through your tender heart, intensifying the ache in your chest. Yes.

"Who is he?" Price softly asks.

"That's my Simon," your voice broke on the last syllable. It was hard to not use a possessive adjective when the face of your husband was in that picture.

Blinking the tears away, you clear your throat. "Anything else, Captain?"

Price purses his lips under his hefty facial hair and responds, "Just a few more questions."

Once finished, you sat unabashedly staring at Ghost in the tiny room. "I wear Roach's tags alongside yours, in honor. He was with you until the very end, and for that, I couldn't be more grateful."

Ghost is completely silent, but you continue talking anyway. "I've been married to you since a bit after you came home on leave that one time. You know the one."

His eyes are emotionless, blank, as he stares at you. But you know him like the back of your hand. You've got his full attention.

"I accompanied you to your brother's wedding. He married a woman, Beth. She was good for him. They had a baby, your nephew, named Joseph. The love you had for him was one of a kind. I had told you later that evening that I dreamed of the day you'd look at our children like that."

With a shuddery breath, you tell him how none of those matters. Because your husband is dead, and you're stuck here. With his counterpart that hates you.

With a hushed click, the door closes shut behind him as he leaves, yet its resounding noise fills the compact room you're in.

You begin to fidget with the sizeable ring that hangs on a thin necklace beneath your shirt— the metal is warm under your touch as if it had never gone cold in the first place.

As if Simon had never taken it off his finger to go find Makarov.

ah theyre short but hurt. much pain.

taglist: @1mawh0re @sae1kie @darkravenqueen98 @chinuneko @thestartitaness @bowtruckleninja @hawsx3 @uyudunmuyavru @prettyoatmeal @arael-asuka @spencerreidisbae123 @beau-min @lovefks @maliakealoha @kit-williams @clear-your-mind-and-dream @theloneshadow24 @wolfieisacat @littlebunie @bloobewy @kkaaaagt @sadsackssss @hypernovaxx @halobaby @lildemon475 @animarix @just-pure-trash @catatemyslideshow @hayleybarnesx @sasagehoes @thigh-o-saur @youdontknowe @destroyer-of-za-warudo @maxisqq @k4marina @onlineoutcast

[theres-whump-in-that-nebula]

Rare Whump Tropes

Blood-caked beards and mustaches, or generally just dirty facial hair.

Injuries to the pelvis and buttocks not caused by sexual trauma being treated seriously and not joked about (ie: getting shot in the butt or kicked in the groin). And this makes me mad because it’s such an underused and unappreciated way to hurt a character because it makes sitting impossible, and requires a lot of trust and/or humiliation to treat. But no, because they got shot in the ass instead of the gut, somehow it’s funny.

Someone getting knocked out from a blow to the head in the classic Hollywood style actually getting brain damage from it with a lengthy recovery process like they would in real life.

Tendon injuries. Not only is there deep, black bruising, there is also a hard, raised bump under the skin at the site of injury — on the tendon itself — which is extremely tender to the touch for at least a week. Injuries such as these may require the RICE treatment for a few weeks or longer, depending on how bad it is. The area aches for awhile and sometimes you’ll get weird radiating pain at the site of the injury way after it was healed. (Source: I walked on stilts so much during the summer that I strained my forearm due to the way I had to hold them under my arms and also because I started pole vaulting with them like a fucking maniac which is something I definitely wasn’t supposed to be doing, especially on the job, in front of impressionable children)

Ammonia poisoning. Depending on how bad it is, it can cause chemical burns to the lungs and for someone to lose all their teeth if they fiddle with them too much.

Flail chest from multiple broken — not fractured — ribs in a row.

Aftercare for a character who just went through a self-injurious meltdown

Wood splinters in wounds

[cripplecharacters]

Hi! Just made a new account here. I'm running a TTRPG where I have an NPC who recently got un-petrified with an experimental treatment. The dice and players decided that they would keep sequels from that, and I think that's a good idea anyway. The disabilities that makes the most sense to me is some flavor of chronic pain, and/or needing aids to walk, since all her joints were turned to stone. Maybe her bones are heavier or rougher or something. BUT. I myself have chronic pain and use aid to walk. While I have no problems with representing this in fiction, I have enough self insert NPCs in this campaign already. I'm looking for alternatives if you have ideas. Thanks!

Thank you for your ask! My first through was muscle atrophy, since she wasn’t moving for a while her muscles might have started weakening. Symptoms for whole body disuse atrophy can include difficulty moving (including facial muscles), numbness/tingling sensations, difficulty swallowing and breathing and even memory loss. Atrophy not caused by an underlying medical issue can be reversed with physical & occupational therapy, though it’s going to take some time and your character might need to use aids until then, and what aids used depends on how long she was frozen & the severity of her condition.

Muscle atrophy can happen alongside muscle and joint stiffness, which would limit her range of motion as well as causing pain. Other symptoms can include joint swelling, cracking or popping noises when moving, and cramping. Things such as massages, heat/cold therapy and plain relief medication can help, along with the treatments listed for atrophy.

Also taking a page from Dungeon Meshi’s book, someone turned to stone is at risk of cracking. This could range from hairline fractures (like getting a long paper cut) to chucks falling off (would need immediate medical attention once unfrozen). Body parts with less mass that protrude from the body are at higher risk of chipping, and while everyone’s body is different these can include fingers/toes, ears and nose. Things like hair and eyelashes are also a break risk, though that’s more of an aesthetic concern.

These are all I can think of, but definitely look into paralysis recovery and rehabilitation after being unable to move (there are probably more google-friendly ways to phrase that though lol)

Have a lovely day!

Mod Rot

[maria-crossover]

† The Believer †

General information | Prime Asset backstory | Trials | Dialogues

「 Prime Asset backstory」

Although she has a complete history of somewhat questionable crimes committed at an early age, it is not denied that a part of the subject's biography is missing. Especially the Walrider.

Originally born in Jujuy, Argentina, her family moved to California, USA, along with the girl's uncles with the decision of a better life and continuing with field work. Maria has been a fanatic of God since she can remember, a believer in religion. Her family and she have always been believers, praying for good progress and better crops in the field or better cattle.

It is said that she has ended up with a disability due to an accident while riding a horse, leaving fissures and poor physical development that affects the mobility of her left leg in the femur. Despite treatment with antibiotics, an alternative for the family in terms of economics, she has experienced moments of emotional decline due to her situation and living day to day in this condition. Despite being humble and with a clearly poor economy, she made the greatest effort to study. Because of her disability, she was not fit to work in the fields and was forced to study with her uncles at home, thanks to their professions as teachers and professors.

At eight years old, the girl's life took an unexpected turn after an incident that harmed her and her family. During a short walk with her uncles, running a couple of errands, they lost sight of Maria and could not find her anywhere in the village, the only thing they found was the cane that she used to help her move.

According to the latest reports of the Carmichael case, being a kidnapping, she has suffered years of psychological and emotional torture. The girl returned after six years, without the help of the cane and walking normally. Something that scared the family is that she still looked just as young, but the only difference was her height, her facial features didn't change completely and walking like a normal human was a miracle. According to the medical reports, she showed that the bones in her leg and femur were still the same, but somehow she walked well. However, her development has been affected by poor nutrition, clearly malnutrition and dehydration. Although it will take María some time to adjust to her old lifestyle after living day after day, it can be seen that she is not at all affected by the trauma she experienced during her childhood, which is quite scary and worrying.

She had confessed what her life was like being with her kidnappers, listening to screams of pain from other victims being tortured physically, psychologically and sexually. She has never been hurt or raped, luckily, according to what she remembers it is because she was too small to be used as a weapon. Weapon, that is what worried the officers who interviewed her after her reappearance.

The girl gave the address where she was kept in the shadows, out of her freedom and the other people who could not escape. The authorities immediately went to raid the place, what they found was an abandoned textile factory. In the basement of the place, they found bodies of men and women. In addition to artifacts, machines were used to experiment on people to try to make a weapon. The kidnappers identified themselves as foreigners, Russians and Germans. At least five doctors, fifteen armed men and seven men in charge of kidnapping many test subjects. After forensic studies, the victims are not correctly determined how they were massacred. They found fractures and parts of lower limbs separated from their bodies, which leaves many theories about the massacre. One person couldn't have killed thirty-five people, but what hasn't been determined is the gunpowder and ashes, which puts the theory on an attempt to erase evidence by burning the place.

The case had been put to one side, María being the only survivor of the kidnapping and the inhuman torture she had been through. However, Carmichael's case was taken up again after a year, after a serious accident at home left the village traumatised.

María's parents and uncles died in a fire, the house burned down and they lost most of their home and left the girl and her one-year-old sister, Annabelle, orphans. The origin of the fire has not been determined, but what is suspected was the girl's attitude. Since the accident she had been playing with the baby, ignoring the screams and cries of her family dying in the flames. But she wasn't identified as a suspect, as her way of acting was possibly fear and trying to block it so that it would not remember the trauma of her kidnapping, distracting Annabelle from the accident. It was a miracle that she and the baby survived that fire with ease, but after an interview with the girl, it left many questions for investigators. About the angel who called himself “Manny,” who saw him from the first months of his kidnapping. However, they brushed the questions aside, being nothing more than beliefs or possibly the girl’s imagination.

The girls were sent to an orphanage, unable to contact other relatives. But after a few months, Annabelle was adopted by a family, separating Maria from her. She was discouraged since then but never lost faith. But everything changes when the caregivers, nuns and priests end up slowly committing suicide, leaving the children. Some of those victims had confessed to having committed sins that do not deserve to be forgiven, such as physically and sexually abusing minors. But the most suspicious thing was the confession of one of the deceased nuns, who had seen the devil handling a puppet of flesh and bones, with that innocent smile and those eyes that look into the window of the darkest soul, feeding on our sins, fears and weaknesses.

María had been sent from orphanage to orphanage. With the same results, people who have taken their own lives or died under the flames of a fire. But the case comes to a conclusion, leaving the girl as the main suspect of all these events, since the incident with the Carmichael family. She was caught, trying to effortlessly hang a priest, with her feet on the roof of the church, however, she ends up killing the man by just breaking his neck. And as a response to trying to be stopped, she ended up killing the officers. However, it hasn't been determined how she killed them, but the forensic experts determined that they had found gunpowder and ashes, the same material that was found in the massacre of Maria's kidnappers.

Many neighbors said that they had seen the devil, disguised as the girl from the day she returned to the village. From time to time, detaching itself from Maria's body, being a kind of humanoid without facial features and composed only of dark shadows. Being one of the strangest and most sinister cases of the town, something supernatural. Although Maria had slipped away from the authorities, she didn't stop moving forward until she was nineteen years old, rebuilding her life in another country. In Cuba she had inherited fields from her grandparents, having the opportunity to do agriculture, but at the same time working in a fish market and keeping both businesses in balance for her own economy.

Clyde Perry went to investigate more about María Carmichael, being one of the people who has attracted a lot of attention. At first it was very difficult to communicate with her, since she was very distant and lonely. Finally, after buying fish and asking some casual questions, she invited him to talk in a more private place like her ranch, which Perry accepted with some trepidation but willing to take advantage of the opportunity.

From the moment they met, casually drinking tea and mate, María confesses that she knows that he has been following her and investigating her, being an interesting and peculiar person. But not only that, but she also flatters the investigator a lot about his appearance, especially his eyes, which makes him a little nervous. But after her questions and mockery, María shows the darkest side that a human being could have seen. Confessing how she hurt adults when she was a child, doctors, her kidnappers, nuns and priests, enjoying every scream of pain and asking for mercy as if God were judging each of them for their actions, the sins they committed. Feeling pleasure and satisfaction in doing justice with her own hands alongside her angel.

She had taken off her glasses and revealed one of her eyes completely dark as the devil, hungry for blood and afraid of its next victim. Then, the man could see how a kind of humanoid detached itself from its body and showed itself before him. Its dark form, without facial features and with swarms of ashes scattered on its body and the woman's, seeing the fear and before the eyes of the investigator. And the moment the humanoid tries to do something to Perry, Maria stops it with just one order and calling it "Manny."

The Walrider follows her order, returning to the woman's body and making her move normally again. She apologizes to the man, leaving him with a warning not to bother her again and to let him go unharmed, but wishing he would visit her again for being the only man to have caught her attention. Terrified, Clyde Perry leaves the shack with one hand in his pocket hiding his gun, unsure if that thing was going to come for him.

As Perry writes, he confesses that he has been having nightmares and bizarre dreams. After going to treatment for a while, they discovered that he had some kind of nanomachines and ashes in his ears, which explains his bad dreams and possibly a way for Manny to manipulate the minds of the victims to ground them, and corner each of them with the thoughts of taking their own lives. Which leaves the man traumatized, having seen the devil with his own eyes. After the researcher's treatment, Maria was later captured and sent to the Sinyala facility. However, she allowed herself to be captured while controlling Manny inside so as not to harm another person. Since then, she meets Dr. Easterman at some point, placing an ounce of her trust and loyalty in him.

[dontforgetukraine]

Yuliia "Athena" Khomiak

Behind the scenes of the battle for Bakhmut

It was especially difficult, physically and psychologically, at the stabilisation point* in Konstiantynivka, during the battle for Bakhmut. I went to the stabilisation point for the 92nd Brigade and the International Legion, one might say, of my own free will. There were relatively few injuries among our unit's soldiers in those days, so I went to the stabilisation point to ask if anybody else needed any help. "I really need it," I was told. There was a stream of wounded 24/7. Sometimes 15 a day, sometimes 50 [wounded]. There were injuries that I had never seen before, for example, facial skull fractures and eye injuries... I lived in this flow for about three months. Hundreds of fighters have passed through my hands. My basic specialties are midwifery and gynaecology, which are surgical specialties. That's why I worked at the stabilisation point as a surgeon and anesthesiologist. Now, 90% of my work is as a therapist. Soldiers get sick just like civilians. Because of the big load, chronic diseases worsen. We need to develop treatment algorithms for different diagnoses. All this is my responsibility. I have enough work to do. *a place where combat medics evacuate the wounded from the line of contact and provide first aid - Ukrainska Pravda

—Yuliia "Athena" Khomiak, junior lieutenant and combat medic

Source: War tears off masks. Сombat medic Athena talks about the fear of death, the fragility of life, and her sense of time at the frontline

[humanrightsupdates]

Georgia: Brutal Police Violence Against Protesters

Effective Investigations, Accountability Urgently Needed

(Berlin, December 24, 2024) – Police and other security forces have used brutal violence against largely peaceful protesters in Georgia’s capital, Tbilisi, Human Rights Watch said today. In widespread and apparently punitive acts, security forces have chased down, violently detained, and beat protesters. Police also tortured and otherwise ill-treated them in police vans and police stations.

Human Rights Watch spoke with a dozen survivors of police violence who said they had sustained head traumas: concussions and multiple fractures to their noses, facial bones, ribs and limbs, and scratches and bruises all over their bodies. Police were wearing riot gear or full-face black masks, with no identifiable insignia. The authorities charged hundreds of protesters with the misdemeanor offense of police disobedience, and prosecuted them in perfunctory trials, while failing to take effective steps to address serious allegations of ill-treatment.

“The level of the authorities’ violence against largely peaceful protesters is shocking, blatantly retaliatory, and violates Georgia’s domestic laws and international norms,” said Hugh Williamson, Europe and Central Asia director at Human Rights Watch. “The scale of the police ill-treatment of protesters and the failure of Georgian authorities to hold them accountable for it indicates they either authorized or condoned the violence.”

Massive, nationwide protests erupted in Georgia following the ruling party’s November 28 decision to abandon Georgia’s EU accession process. The decision came one month after disputed October 26 parliamentary elections that kept the country’s ruling party in power, but local and international observers and Georgia’s president said it was marred by massive vote-rigging and other irregularities. The elections also follows the adoption of repressive legislation targeting civil society and independent media.

[justkidneying]

Skull Fractures: Le Fort I-III

Le Fort fractures are a specific type of midfacial fracture which can be split into three types: Type I, Type II, and Type III. These three types vary in severity and presentation. They are most commonly caused by high-speed or high-impact forces.

Facial and Cranial Anatomy 

Le Fort fractures of all types involve different bones which make up the facial structure. You can look up a picture of the skull if you don't know what I'm talking about, but you should have an idea of what's going on from. Anyways, the skull is 22 bones and that's too much to get into right now. Onto important stuff.

The mandible is not part of the skull and isn't part of what makes a Le Fort fracture, though facial trauma may also cause the fracture of this bone. It is also an important part of the facial anatomy and its misalignment with the other bones can help diagnose Le Fort fractures. 

Le Fort Type I

Le Fort type I injuries are the least damaging type of Le Fort fracture, though they still cause significant damage to the facial structures. This type of fracture involves the maxilla and pterygoid plates (four structures that are up inside the skull/back of the mouth) primarily. Due to the involvement of the maxilla, it can also be referred to as a trans-maxillary fracture. 

There are several mechanisms of injury for this type of fracture. Most commonly, it is caused by a downward blow to the face. This can be the result of a fall, assault (like stomping on someone's head), or motor vehicle accident, which causes the maxilla of the patient to impact a hard surface and detach from the rest of the facial structure. 

The downward force on the face causes the fracture of the internal structures of the maxillary sinus as well as the pterygoid plates. The fracture extends to the maxillary antrum, or the antrum of Highmore, which is a large sinus cavity that sits superior to the upper teeth and posteriorly to the nose. All three walls of the sinus are fractured, and the maxillary structures break away in a palate-facial separation.

Type I fractures oftentimes present with swelling in the upper lip and ecchymosis (bruising) to the maxilla and cheeks. The most telling sign of maxillary dissociation is malocclusion of the teeth. This means that the upper teeth are not in alignment with the lower teeth, which can be seen in dissociations and fracture of the maxilla and mandible. The triangular area of the face that comes away from the cranium is made of the maxilla, palate, and pterygoid plates.

The soft tissue damage of this fracture is mostly within the oral cavity, sinuses, and nasal cavities. This can cause the respiratory ability of the patient to become compromised. Because of the damage to the nasal passages and the possibility of fracture of the inner bones of the skull, a nasopharyngeal airway (NPA) device is not recommended. NPAs are devices made of a pliable foam or rubber, which are inserted through the nares, and allow for the linkage of the nasal openings to the pharynx (throat). When heavy facial trauma, especially to the nasal area, is present, NPAs are not indicated. Instead, airway management should be done with an endotracheal tube, which goes into the trachea (windpipe). This bypasses the damage done to the oral or nasal cavities and allows for the establishment of respiratory function. 

Other symptoms of the patient should be managed until they can reach a trauma center for further treatment, with the patient's airway, breathing, and cardiovascular function taking precedence. 

Le Fort Type II

Type II fractures are more severe than Type I. They involve more facial structures and cause a greater portion of the face to separate from the skull. This type of fracture involves the nasion, which is commonly referred to as the bridge of the nose. It also involves the medial wall of the orbit and the inferior orbital rims. Importantly, this type of fracture does not involve the zygomatic bones (cheek bones).

This fracture is best traced beginning at the nasion. The fracture extends laterally to the medial wall of the orbit and downward into the inferior orbital rim. It then crosses downward into the maxilla. Inside of the structure, the fracture extends superiorly to the hard palate, and ends with the separation of the pterygoid buttress. The section of bone that breaks away from the cranium is pyramidal in structure. 

The involvement of the orbit in this fracture increases the severity of this fracture because of the complexity of orbital bones as well as the involvement of the soft tissue of the eyes. The forces which are of a great enough magnitude to fracture this portion of the face can create severe damage to the delicate tissues inside the orbit, including blood vessels and the eyes themselves. 

Type II fractures present distinctly from Type I fractures. In Le Fort Type II fractures, there will be mobility in the maxilla, but the nasal region will move with the maxilla away from the other facial structures. The increased severity also opens a possibility of cerebrospinal fluid (CSF) leakage from the nasal passages. CSF leakage can be confirmed using a piece of gauze to absorb some of the fluid. As the CSF dries, it will create a distinct two-ringed figure, which mucous does not. CSF is also very clear and watery compared to mucous, which is yellowish and sticky. 

Due to the damage to the nasion and surrounding area, the intercanthal space (the distance between the corners of the eyes) has a high possibility of widening. This will lead to severe deformity of the normal facial structure. Bruising will be significant, with presentation of bruising on both orbital areas, or bilateral periorbital ecchymosis, sometimes called “racoon eyes.” 

As with Type I fractures, an NPA is not indicated, particularly when CSF leakage is present. This indicates a fracture deep enough to compromise the integrity of the intracranial space. If an NPA is used in this case, even the soft tip of the  device could worsen the intrusion into the cavity or cause severe damage to the sensitive nervous system structures. The airway should be established using an endotracheal tube instead. The patient should be transported with haste to the nearest trauma center.

Le Fort Type III

Type III fractures are the most severe type of Le Fort fracture. This type is also called a full facial-cranial separation. It involves the nasion, two walls of the orbit, the orbital rim, the zygomas, and the pterygoid plates. 

The path of this fracture can be traced starting at the nasion.  From there it extends laterally through the medial orbital rim and orbit. The fracture extends horizontally across the entire orbit and to the lateral rim. Finally, it extends downwards across the zygomatic arch and through the superior pterygoid plates. This fracture extends bilaterally through both sides of the facial structure5.

Due to the fracture extending horizontally through the orbit, there is a great risk of damage to the soft tissues of the eye. The fracture also extends parallel to the base of the cranium, and will cause a complete separation of the midfacial skeleton from the cranium. Because of this extreme dissociation, there is an increased risk of cerebrospinal fluid leakage. This leakage can result in infection or serious brain injury. 

This type of fracture is most typically caused by large amounts of force to the nasion and superior maxilla. This force is of a great enough magnitude to cause a fracture to extend through the entirety of the facial structure in a posterior and downwards direction. 

Many signs from Type I and II carry over, including bilateral periorbital ecchymosis, orbital edema, and buccal ecchymosis. However, Type III presents uniquely with a sign commonly called “dish-face deformity.” This condition results from the breakdown of the structure of the face, and results in a lengthened and shallowed face. There may also be a condition known as “orbital hooding” present, which is the drooping of the upper eyelid commonly seen when zygomatic structure is compromised. Battle’s sign may also be seen, which is the bruising of the mastoid region, or the region behind the ear. Enophthalmos, the sinking of the eyes posteriorly into the sockets, may also be seen. This is due to the severe damage to the orbital area. CSF may also leak out of the ears and nasal passages, called CSF otorrhea and CSF rhinorrhea, respectively. Blood may also be within the inner ear in a condition called hemotympanum. 

The severe damage to the facial bones, along with intracranial hemorrhaging and CSF leakage will most likely cause a patient with a Type III fracture to be treated as critical. Airway integrity should be maintained with an endotracheal tube, but if the oral airway is compromised, stabilization can be difficult without a tracheostomy. A tracheostomy is a procedure where an opening is made in the neck into the trachea, where a breathing tube can be inserted. This bypasses any oral damage and allows for the respiratory function of the patient to be secured. The patient should be rushed to a trauma center, as the signs presenting give an impression of a condition that can be lethal. 

Treatment

As with any trauma patient, those with Le Fort fractures should be stabilized to ensure the continuation of life before any effort is made to repair the damage to the face. This gives the patient’s airway, breathing, and circulatory systems precedence in their care. Once the patient reaches the emergency room of what is hopefully a trauma center, more specialized care can begin. This includes testing, scans, and stabilization. 

Computerized tomography (CT) scans are very useful to determine the extent of the fracture and the type. These scans use several x-rays and an interpreting computer system to create several  two-dimensional slices of the structures captured. This is important in severe facial injuries, as simple film x-rays do not typically provide enough data to accurately diagnose and see all of the damage done to the face. In Le Fort fractures, the most appropriate type of CT scan ordered is a non-contrast, fine cut scan with axial cuts. Contrast is a substance injected intravenously that allows for a better view of body structures on the scan, but it is not used in this case. Typically, contrast used in trauma cases is for abdominal injuries. The CT scan should be fine cut, which means that the slices of data gathered from the patient are 2 mm in width. This means more can be seen from the scan. 

The two main areas of treatment in facial fractures are reduction and fixation. Reduction is the process of putting the structures back where they are meant to sit. Reduction can either be open or closed. Open reduction requires the “opening” of the face through surgical means. Typically, this means that the fracture was too complex to be reset through external manipulation. A closed reduction is done without exposing the bone. This is done externally through manipulation of the structures. Fixation is the process of keeping the bones in the correct place, typically through the use of metal plates, wires, and screws.

Intermaxillary fixation can be used to repair or stabilize the fracture. This should be done after all CT scans are completed. Intermaxillary fixation uses metal pieces screwed to the maxilla to demobilize it. Typically, metal plates are also screwed to the mandible and wire is connected between the mandible and the maxilla. This will reestablish proper occlusion of the teeth. Intermaxillary fixation can be used to stabilize the face while other surgeries are done, or as the treatment itself.

Facial reconstruction is most likely with Type III fractures. In a broad sense, facial reconstruction includes the reduction and fixation detailed previously. However, it also includes more fine and cosmetic reconstruction. After a more severe fracture and the resulting fixation, the skin and formation of the face can be altered from the patient’s original appearance. Due to this, there may be more extensive work required by a plastic surgeon after the initial treatment to repair the bone structure.

The goals of the fracture repair are to reestablish proper structure and restore the integrity of the face. The correct facial projection should be reclaimed, as to correct any deformity or dish-face condition. The sinus cavities should also be repaired so that they have proper function and location within the facial structure. The realignment of the orbital and nasal structures is also important to the overall soundness of the facial structure and function. Finally, malocclusion should be remedied, as proper occlusion of the teeth is necessary for not only facial structure, but the function of the teeth and mouth in chewing food.

Outcomes

The recovery of this type of fracture can be long and difficult, but the ultimate outcome is generally good. Mortality rates of patients with complex facial fractures, which includes Le Fort fractures, are estimated around 11.6%. Mortality of patients with simple facial fractures is estimated around 5.1%. For Le Fort fractures specifically, there are different mortality rates for each type. For Type I, there is a 0% mortality rate. For a Type II fracture, there is a 4.5% mortality rate. For Type III fractures, there is an 8.7% mortality rate. 

Besides death, disability can also be the result of Le Fort fractures. The following conditions have been reported as a result of Le Fort fractures: difficulty breathing (31% of patients), difficulty chewing (40% of patients), vision issues (47% of patients), double vision (21% of patients), and excessive tearing and poor eye drainage (37% of patients). These disabilities can greatly affect the ability of the patient to return to normal activities. For Type I and II fractures, 70% of patients were able to return to work. For Type III fractures, only 58% reported being able to return to work. The facial deformities resulting from these fractures and their repair have an impact on the patient’s mental wellbeing. Of patients who had facial surgery, 89.1% reported satisfaction with the outcome of their appearance.

End Notes

Wow this was fucking long, wasn't it? I guess I just got going and couldn't stop. Now you know everything you need to know about Le Fort fractures, which was probably nothing. But anyways, I wanted to include the outcome of severe injuries like these because I feel like in fiction I don't see it enough. Like if you get that fucked up you're gonna need some help for a while. I also think I see too many NPAs in patients that don't need them or shouldn't have them, so I think that might be some valuable information. I'm gonna write on the structure of the nose eventually, but for the love of god don't stick anything up there, especially if someone has head trauma.

Thanks for reading :))

[tofiqbohra11]

https://www.scribd.com/document/751731436/Common-Procedures-in-Oral-and-Maxillofacial-Surgery

[cartoonscientist]

is it just me or is trans discourse like

rich trans person who could afford extensive surgical treatments in addition to HRT: there’s no excuse to not pass 100% and if you don’t put in the effort you aren’t really trans because you would do anything to pass if you were actually trans mmkay

middle class trans person who can only afford HRT and doesn’t get it on a regular schedule: okay except transitioning does nothing?? you need to be genetically blessed or you will be doomed to a life of misery in the shadows, I’m personally researching the mole people community in my local disused subway system.

random hacker with access to the dark web and an engineering degree who attends a gym with members of three different mafias: um you need to be buying high dose black market E/T to see results, be gay do crime you fucking pussy, or ballsack, I didn’t check your profile for pronouns because I don’t have time to spend on LOSERS

weird transcel from the looksmaxxing community: also you need to make micro-fractures in your facial bones with a hammer

schizophrenic trans person who has been blanket-banned from all gender affirmation treatments due to their diagnosis: wait, you guys are taking hormones?

another non-transitioned schizophrenic trans person who lives on 25 acres of land in a series of storage containers and goes for weeks without using their vocal cords to produce human speech: honestly I have never had trouble passing even though I make no effort, the forest animals recognize my true gender from my smell and body language.

random person with a dog in a different fight: SEE? that’s proof that trans women don’t get harassed/trans men aren’t victims of misogyny!

[floral-and-fine]

hiiiii, gurl! it s me (again). I'm diving into a new obsession and I think you're the only person on the internet who knows about the existence of this man. may i request ANOTHER set of random headcanons about Carl Stargher from The Cell? and maybe the SO is also a psychologist like Catherine that gets close to him, in his mind, by approaching the mad side of Carl, rather than the innocent one, potentially avoiding his death? thank youuuuu!!!!😭😭😭

Hey Friend! I’m so grateful that I’m not the only one who loves this guy 😭❤️ so thank you for the ask!

Also sorry it took me awhile, I wrote these headcanons a little differently, kinda going through the plot of the movie (at least what I could remember of it) hopefully they’re worth the wait 😅

Carl definitely piqued your interest before entering his mind, both from a psychological aspect and a personal level

At one point, while still in college, you had considered joining the FBI and using your education to help better understand the behavior of serial killers

But you were concerned over how much you empathized with each killer you studied. So many of them had such terrible, abusive childhoods that you couldn’t help but feel for them

So instead you focused on helping children, in hopes to prevent future serial killers

After graduating and working as a child psychologist, you were presented with an opportunity that definitely was too interesting to pass up, a project involving an experimental virtual reality treatment

When the FBI contacted you and the other doctors working on this project with a proposal of using it to acquire information about a serial killer, you felt a mix of excitement and anxiousness

As you prepared to enter his mind, you stood beside Carl, your fingers gently touching the side of his face, committing his facial features to memory

You had no idea what to expect once you entered his mind but you wanted to be able recognize him

Waking in Carl’s mind was different, it was jarring, fractured, and cold… so many different areas and facets to explore

You feel like you could spend weeks analyzing it all, digging deep into what each scene and piece of imagery meant

It was clear that he was a complicated being, proud of his ‘accomplishments’, by how each of his victims were displayed, but there was also this darkness like he knew that it was wrong/twisted

When the strong woman dropped you unceremoniously on the ground, it took you a moment to regain your bearings… the man who had been seated upon a throne, stood up

“Where did you come from?” He demanded, his voice sounded distorted and monstrous.

You froze, thumb hovering over the button on your hand, part of you wanted to scream, but the other part wanted to see where this would go

His stare was unnerving, dark eyes watching your every move, you could hear shrieking in the background, you recognized the being as Carl, or at least a part of him, a terrifying part of him

You’re not sure what compelled you, but instead of escaping, you reached out towards him, fingers brushing against his hand

There was a moment where the two of you simply watched the other, your fingers still touching his skin when suddenly without warning he moved, faster than you expected

He tried to grab your wrist

Falling back, panic finally set in, and you scrambled backwards, your hands coming together and then you woke up

Afterward, you couldn’t stop thinking about the whole experience. Sitting on your bed, in the safety of your home, staring at your television while hands rubbed the very real fabric of your comforter, you were hoping to anchor yourself in reality but every time you closed your eyes, you felt like you were back there with him

The whole experience was… fascinating… terrifying… erotic, leaving you eager to return

It was strange how after that first encounter he could sense your presence/arrival, instead of waking alone on the ground, you’d wake on a bed of dead flowers or in shallow waters or in an empty tub and Carl/king Stargher was always close by, waiting for you

With each visit the length in which you stayed became longer, you’d greet him with the same feathery light touch that soon lingered longer and longer

It left you questioning your sanity, wondering why you weren’t more afraid, wondering why you attracted to this sort of darkness

When you encountered the part of Carl that most resembled the actual man, it was the first time the two of had an actual conversation

You told him your name, which he quietly repeated to himself several times

The conversation was brief, he was curious about you, you learned about his the abuse he endured but when you started to press him for information about his latest victim he became volatile

When he changed, becoming the evil/darker version of himself, you simply gave in

You didn’t fight him as he grabbed you from behind then pushed you to the ground

When he produced the collar, you simply allowed him to put the collar on your neck, even going as far as stretching your head up and moving your hair out of the way

The hungry look he gave you, filled with desire, spurred you on

You pressed your hands against his pale chest, leaning towards him for a kiss

He immediately reciprocated

His touch was rough, desperate

You hands grazed over the rings on his back and arms, causing him to buck his hips against you

You lost yourself to the dream, your mind drowsy, you had no clue how long you had been here this time around, but you didn’t care

All you wanted was to stay with him

During your stay, your surroundings would change, but you were constantly by Carl/King Stargher’s side

Sometimes you found yourself sitting on his lap in the gold colored throne room, his hand on your lower back, your head resting on his chest, while he sat perfectly straight and still

Other times you were on the floor with him crawling over you and his hands roaming all over your body

Or you’d find yourself sitting on a lavish bed, wearing an ornate dress and mask, while he admired you

His changing appearance would make you question if they were all different separate pieces of Carl or the same evil side

Either way you cared for him all the same

His own feelings for your were a combination of ownership and worship, similar to being a prized possession

At some point the other doctors and FBI would have to intervene, because you had gone too deep, giving into your feelings and allowing yourself to believe that Carl’s world was real

All parts of Carl were here in your mind, each aware that you accepted all of him, the innocent and the evil

This was enough to keep himself from fighting you and from hurting himself

It was unfamiliar, being welcomed in by someone, in way he wanted to stay here in this beautiful and peaceful world that was your mind

His whole world/mind was warped, his father had twisted his perception of strength, right and wrong, and of women

He idolized the the perverse part of himself and stifled the innocent part

Carl never quite understood how he had both this disdain for women but also this wish to understand them, to have one care for him

Perhaps you were the answer to that wish

Having shown him the sort of empathy and compassion and protection he had wished for as a child

Unfortunately whether Carl stays in the coma or wakes up, there isn’t a possibility for a traditional happy ending

If he remains in the coma, you visit him regularly, when you enter his mind for a visit he’s always pleased to see you, but when you can’t you sit by his bed, holding his hand and talk to him

If he wakes from his coma, you do your best to support him but he’ll have to face the consequences for his actions… depending on the sentencing you visit him whenever possible… but for both of you it’s never enough. He’ll write to you, long letters, and always looks forward to your replies

He’ll miss getting to hold and touch you, but absolutely appreciates how you’ve stuck by him

Similar to the actual ending, you adopt Carl’s dog, giving him updates on how the dog is doing, showing him pictures

[anuragbhargava]

Understanding the Role of a Maxillofacial Surgeon: Insights from Dr. Anurag Bhargava, a Leading Maxillofacial Surgeon in Indore

Maxillofacial surgery is a specialized field that addresses complex conditions of the face, mouth, and jaw. It requires a unique blend of dental, medical, and surgical expertise. Dr. Anurag Bhargava, a renowned maxillofacial surgeon in Indore, provides invaluable insights into this fascinating field, highlighting its importance and the transformative impact it can have on patients' lives.

What is Maxillofacial Surgery?

Maxillofacial surgery, also known as oral and maxillofacial surgery (OMS), involves surgical interventions to treat diseases, injuries, and defects of the face, mouth, teeth, and jaws. This specialty bridges the gap between medicine and dentistry, requiring a deep understanding of both fields. Procedures can range from corrective jaw surgery and facial trauma reconstruction to dental implants and cosmetic enhancements.

Common Conditions Treated by Maxillofacial Surgeons

1. Facial Trauma:

Fractures: Maxillofacial surgeons treat fractures of the jaw, cheekbones, and eye sockets, ensuring proper alignment and healing.

Soft Tissue Injuries: These include lacerations and injuries to the facial skin and muscles, often requiring precise suturing to minimize scarring.

2. Corrective Jaw Surgery (Orthognathic Surgery):

Malocclusion: This involves correcting misaligned jaws to improve chewing, speaking, and facial aesthetics.

Sleep Apnea: Surgical intervention can help reposition the jaw and airway structures to alleviate obstructive sleep apnea.

3. Congenital Disorders:

Cleft Lip and Palate: Maxillofacial surgeons perform surgeries to repair these congenital deformities, improving function and appearance.

Craniofacial Anomalies: These are complex conditions affecting the skull and face, often requiring multi-disciplinary surgical approaches.

4. Dental and Oral Health:

Impacted Teeth: Removal of impacted wisdom teeth and other problematic teeth.

Dental Implants: Placement of dental implants to replace missing teeth and restore oral function.

5. Temporomandibular Joint (TMJ) Disorders:

TMJ Dysfunction: Treatment includes surgical and non-surgical options to alleviate pain and improve jaw function.

The Importance of Maxillofacial Surgery

Maxillofacial surgery is vital for restoring both function and aesthetics. Conditions affecting the face and jaw can have profound impacts on a person's ability to eat, speak, and breathe, as well as their self-esteem and social interactions. A skilled maxillofacial surgeon can significantly enhance a patient's quality of life through meticulous surgical interventions.

Dr. Anurag Bhargava: Expertise and Approach

As a leading maxillofacial surgeon in Indore, Dr. Anurag Bhargava combines extensive training and experience with a patient-centered approach. His expertise spans a wide range of maxillofacial procedures, ensuring comprehensive care for his patients.

1. Personalized Treatment Plans:

Comprehensive Evaluation: Dr. Bhargava conducts thorough evaluations to understand each patient's unique needs and conditions.

Customized Care: He develops personalized treatment plans, considering both functional and aesthetic goals.

2. Advanced Surgical Techniques:

Minimally Invasive Procedures: Whenever possible, Dr. Bhargava employs minimally invasive techniques to reduce recovery time and enhance outcomes.

State-of-the-Art Technology: He utilizes the latest technology and surgical advancements to ensure precision and safety.

3. Holistic Patient Care:

Pre- and Post-Operative Support: Dr. Bhargava provides detailed guidance and support throughout the surgical process, from pre-operative preparation to post-operative recovery.

Interdisciplinary Collaboration: He works closely with other specialists, including orthodontists, plastic surgeons, and ENT specialists, to provide comprehensive care for complex cases.

Success Stories and Patient Testimonials

Dr. Anurag Bhargava’s expertise and compassionate approach have transformed the lives of many patients. Here are a few success stories:

1. Corrective Jaw Surgery: A young woman with severe malocclusion and facial asymmetry underwent orthognathic surgery. Post-surgery, she experienced improved chewing function, enhanced speech, and boosted self-confidence.

2. Facial Trauma Reconstruction: A patient with multiple facial fractures from a car accident received reconstructive surgery. Dr. Bhargava’s skillful intervention restored the patient’s facial structure and function, facilitating a remarkable recovery.

3. Cleft Lip and Palate Repair: A child born with a cleft lip and palate underwent surgical repair. The surgery not only improved the child’s appearance but also enhanced their ability to eat, speak, and breathe properly.

Why Choose Dr. Anurag Bhargava?

Choosing the right maxillofacial surgeon is crucial for achieving optimal outcomes. Here’s why Dr. Anurag Bhargava stands out:

Extensive Experience: With years of experience and numerous successful surgeries, Dr. Bhargava is a trusted expert in the field.

Comprehensive Care: From consultation to recovery, he provides thorough and compassionate care.

Patient-Centered Approach: Dr. Bhargava prioritizes patient comfort, safety, and satisfaction, ensuring a positive surgical experience.

Conclusion

Maxillofacial surgery is a transformative specialty that addresses complex facial and jaw conditions, enhancing both functionality and aesthetics. Dr. Anurag Bhargava, a leading maxillofacial surgeon in Indore, offers expert care and personalized treatment plans, ensuring the best possible outcomes for his patients. If you’re seeking skilled and compassionate care for maxillofacial issues, Dr. Bhargava is the go-to expert in Indore.

For more information or to schedule a consultation, visit Dr. Anurag Bhargava’s website.