Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury - Is It Safe? Radiological Simulation in a Healthy Volunteer.

IF 0.8 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Craniomaxillofacial Trauma & Reconstruction Pub Date : 2022-12-01 Epub Date: 2022-01-03 DOI:10.1177/19433875211053091
Thomas Pepper, Harry Spiers, Alex Weller, Clare Schilling
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Abstract

Study design: Observational.

Objective: To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures.

Methods: Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations - neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer.

Results: In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4-C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1-2) joints.

Conclusions: Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.

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颌面外伤合并颈椎损伤患者术中定位安全吗?健康志愿者的放射模拟
研究设计:观察性研究。目的:通过模拟普通颌面手术术中体位,探讨颌面手术体位对患者颈椎的影响。方法:采用磁共振成像技术评估了一名健康志愿者在常见的术中体位——中立(前下颌骨体位)、伸展(气管造口体位)和侧向旋转(下颌髁体位)对c -脊柱的影响。结果:在气管造口位置,最大运动发生在颈枕交界处和C4-C5之间的矢状面以及颈胸交界处。最小的运动发生在C2(在C3上),C5(在C6上)和C6(在C7上)。在下颌髁位,颈椎在旋转面和矢状面均发生运动。最大活动发生在C4水平以上,集中在寰枕关节和寰枢关节(C1-2)。结论:对于屈伸稳定的损伤,如齿状突钉骨折和C5 - C7骨折,颈部伸展可能是相对安全的。对于C4以下的骨折,以及椎体骨折和无椎间盘破坏的椎板骨折,头部旋转可能相对安全。与神经外科团队的早期对话仍然是颌面部和颈椎合并损伤患者安全管理的核心原则。
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Craniomaxillofacial Trauma & Reconstruction
Craniomaxillofacial Trauma & Reconstruction DENTISTRY, ORAL SURGERY & MEDICINE-
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