反射性失神による転倒が原因と考えられた顔面多発骨折の1例

DOI
  • 村山 敦
    医療法人徳洲会岸和田徳洲会病院歯科口腔外科
  • 松本 憲
    医療法人徳洲会岸和田徳洲会病院歯科口腔外科 大阪大学大学院歯学研究科招聘教員
  • 西岡 稔浩
    医療法人徳洲会岸和田徳洲会病院歯科口腔外科
  • 吉川 恭平
    医療法人徳洲会岸和田徳洲会病院歯科口腔外科 兵庫医科大学医学部歯科口腔外科学講座

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  • A Case of Panfacial Fractures Caused by a Fall due to Reflex Syncope

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A fall due to syncope tends to show a slight trauma on the head or face, and serious cases are rare. We report a case of panfacial fractures that occurred after a fall due to reflex syncope. The patient was a 60-year-old man. He did not have a history of syncope, and after various examinations, we eliminated cardiogenic syncope and a transient ischemic attack as possible causes. Because syncope occurred after evacuation, we diagnosed the cause of the fall as reflex syncope. A midface examination revealed a Le Fort pattern of fractures: fractures of the maxillary frontal process, inferior orbital rim, zygomaticofrontal suture, maxillary sinus, and piriform aperture lateral margin were found. Moreover, a comminuted mandibular symphyseal fracture and bilateral condylar head fractures were also found. We performed open reduction and internal fixation surgery for all fractures except the bilateral condylar head fractures. For the fracture of the maxillary frontal process, we performed a butterfly incision from the proximal end of the left eyebrow to the midline of the glabella region. For the inferior orbital rim fracture, we performed a subciliary incision, and for the zygomaticofrontal suture fracture, we performed a supraorbital lateral eyebrow incision. For the inferior maxillary fracture, we performed an upper gingivobuccal sulcus incision, and for the comminuted mandibular symphyseal fracture, we performed a laceration approach. All fractures that underwent open reduction and internal fixation healed in proper union. The scar from the glabella incision healed neatly. The butterfly incision in the glabella region was a useful approach for the fracture of the maxillary frontal process. We considered that the situation syncope in the standing position caused a defenseless fall and severe blow to the patient’s face.

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