Traumatic asphyxia compounding craniofacial trauma

Features of cranio-maxillofacial trauma in the massive Sichuan earthquake: analysis of 221 cases with multi-detector row CT

OBJECTIVE

In a massive earthquake, cranio-maxillofacial trauma was common. The present study was to determine the features of cranio-maxillofacial trauma sustained in the massive Sichuan earthquake by multi-detector row computed tomography (MDCT).

METHODS

The study included 221 consecutive patients (123 males and 98 females; age range, 1-83 years; median age, 35 years) with cranio-maxillofacial trauma in the Sichuan earthquake, who underwent cranio-maxillofacial MDCT scans. The image data were retrospectively reviewed focusing on the injuries of the cranio-maxillofacial soft tissue, facial bones and cranium.

RESULTS

All patients had soft tissue injuries frequently with foreign bodies. Ninety-seven (43.9%) patients had fractures (1.5 involved sites per patient, range from 1 to 8) including single cranial fractures in 36 (37.1%) cases, single maxillofacial fractures were seen in 48 (49.5%) and cranio-maxillofacial fractures in 13 (13.4%). Single bone fracture was more common than multiple bone fractures (p<0.05). Nasal, ethmoid bones and the orbits were the most commonly involved sites of the craniofacial region. Thirty-eight (17.2%) patients had intracranial injuries, the commonest being subarachnoid haemorrhage and the commonest sites were the temporal and frontal regions. Coexisting intracranial injuries were more common in patients with cranial fractures than in patients with maxillofacial fractures (p<0.05).

CONCLUSION

Our results indicate that the cranio-maxillofacial trauma arising from the massive Sichuan earthquake had some characteristic features, and a significant number of individuals had the potential for combined cranial and maxillofacial injuries, successful management of which required a multidisciplinary approach.

Perthes Syndrome associated with intramedullary spinal cord hemorrhage in a 4-year-old child: a case report

Background

Perthes Syndrome (Traumatic asphyxia) is rare, which is caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face.

Case presentation

We present the case of a 4-year-old Caucasian girl who developed traumatic asphyxia associated with intramedullary spinal cord hemorrhage following thoracic compression.

Conclusion

We have not found the association of Perthes syndrome with intramedullary spinal cord hemorrhage described in the medical literature. To our knowledge, the current case is the first report of Perthes Syndrome associated with intramedullary spinal cord hemorrhage.

Autopsy findings from 111 deaths in the 1999 Athens earthquake as a basis for auditing the emergency response

Background

The aim of the study was to assess the emergency response to an earthquake.

Methods

This retrospective study, based on formal autopsy findings from 111 earthquake-related deaths, evaluated demographic data, circumstances of death, rescue time, mechanisms of injury, causes of death, Abbreviated Injury Scale (AIS 90) and Injury Severity Score (ISS) values, vital functions, co-morbidity and preventable deaths.

Results

The median extrication time for 99 of 102 victims buried or trapped in collapsed buildings was 2·1 (range 0·1–7·8) days. Deaths were cause by blunt injuries, asphyxia and myocardial infarction. Injuries impaired the airway, breathing, circulation, and brain or spinal functions in 10·5, 61·9, 46·6 and 57·1 per cent of the victims respectively. The 105 injured victims were classified into three main categories. The first comprised 36 victims (34·3 per cent) with injuries not compatible with life (ISS 75), the second included 38 victims (36·2 per cent) who suffered life-threatening injuries (ISS 9–74) but had no evidence of asphyxia, and the third category contained 31 victims (29·5 per cent) with findings of asphyxia and an ISS of 1–18. The reviewers concluded that 13 trauma-related deaths and 31 deaths from asphyxia were potentially preventable.

Conclusion

A method based on detailed evaluation of deaths provided information with which to audit the emergency response to an earthquake.

Syndrome d’asphyxie traumatique ou syndrome de Perthes. À propos de six cas

Perthe's syndrome or traumatic asphyxia is a clinical syndrome associating cervicofacial cyanosis, petechia and subconjonctival hemorrhage to neurological symptoms. This syndrome appears after severe and transient compressive blunt chest injury. A Valsalva maneuver is necessary before thoracic compression for the development of this syndrome. The treatment includes rapid chest decompression and cardiopulmonary resuscitation. The prognosis is good but a prolonged thoracic compression could lead to cerebral anoxia and neurological sequelae. We report six cases of Perthe's syndrome most of them resulting from thoracic compression after road traffic accidents. All of them made a good prognosis.