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Pajić, Srbislav S. 1962-
Značaj veličine i strukture zidova čeonog sinusa na nastanak kontuzije mozga kod traume čeone regije
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Academic metadata
Doktorska disertacija
Medicinske nauke
Univerzitet u Nišu
Medicinski fakultet
Katedra za maksilofacijalnu hirurgiju i oralnu hirurgiju
Other Theses Metadata
The importance of the size and structure of frontal sinus walls for the occurence of brain contusion in traumas to the frontal region
[S. S. Pajić]
245 listova
Beleška o autoru: list 245;
Prilog: listovi 233-243;
Bibliografija: listovi 215-231.
Datum odbrane:27.08.2018.
Science of Clinical Stomatology, Maxillofacial Surgery, Craniofacial Surgery
Pešić, Zoran (mentor)
Krasić, Dragan (predsednik komisije)
Petrović, Dragan (član komisije)
Filipović, Nenad (član komisije)
Rasulić, Lukas (član komisije)
The anatomy of frontal sinus may vary individually, concerning
volume and shape differences or, in rare cases, the absence of sinus.
However, there are scarce data about the influence of these variations
on the structure of fracture, which occurred with the force of a blunt
stroke. Therefore, the aim of this study was to analyze the influence
of frontal sinus volume on stress distribution and structure of fracture
in frontal area.
This dissertation studies objective parameters used for evaluation of
the size of frontal sinus in condition after the high intensity blunt stroke
effect on the appearance of brain contusion. The fracture pattern of
trauma is reflected in anterior and/ or posterior wall fractures with or
without fractures of nasofrontal canal. The injury of frontal sinus is
characterized by a high risk of possible complications, while their
management further remains a subject of different attitudes.
Dissertation contains epidemiological, experimental and clinical
study. Using descriptive method and retrospective study, the
epidemiological study inspected the incidence and etiology of fracture
of frontal sinus in the Center of Emergency and Neurotrauma –
Emergency Center at Clinical Center of Serbia. The cause of fractures
of frontal sinus and craniofacial massive injuries is presented, as well
as epidemiological and etiological characteristics, clinical parameters
and applied surgical procedures for frontal sinus fracture management.
All patients placed in trauma department from January 1st 2012 to
December 31st 2017 were managed by the same surgeons who were
guided by good clinical practice for this type of injury at Clinical
Center of Serbia.
In accordance with the set goals, the research related to the
experimental part of study is conducted in the Laboratory for Numerical
Simulations at Bioengineering desk of Faculty of Engineering Sciences,
University of Kragujevac.
Using computer simulation, the experimental part of the study has
analized the voltage distribution and deformation in a complex system
of frontal sinus and neurocranium. The study includes four Finite
Element skull model representatives.
The reference model is made by computerized tomographic scan of
human head with normally developed frontal sinuses. Modifying the
reference model, there were three additional models generated: a
model without sinus, the one with hypoplasia and a model with
hyperplastic sinuses. The force of 7,7 kN was applied straightforward
on forehead of each model, to simulate the frontal impact.
The results show that distribution of force impact in frontal area
depends on the volume of frontal sinus. External sinus wall showed
the greatest fragility in case of hyperplastic sinus, while posterior
wall/ internal plate showed greater fragility in hypoplastic or
undeveloped sinus. Well-developed frontal sinuses, through
absorption of the impact energy of anterior wall, can protect the
posterior wall and intracranial structures. Our results prove that the
distribution of stress caused by impacts in frontal region of the head
or fracture of bone structures largely depend on the size of the volume
of sinus cavity. Well-developed frontal sinuses may have a survival
role, acting like „shock absorbers― and protecting intracranial and
surrounding vital structures. This study explains for the first time
mechanisms of this, previously only assumed – protective role of
frontal sinuses. According to the results of clinical study, the main
etiological reason for occurrence of the frontal sinus fracture is traffic
accident – in particular, the category of co-driver. In our sample, the
injury of the frontal sinus is identified at 11,3%. Based on the results,
the fracture of sinus wall predict increasing the risk of contusion
occurrence by 2,071 times. In case of joint injuries, the risk of
contusion occurrence will increase by 1,7 times.
The treatment process of this trauma largely depends on
complexity and associated injuries, as well as intracerebral conditions
which are very common in this type of traumatism.
voltage distribution, frontal sinus, fracture, sinus volume, brain
contusion, FEA
616.715-001.5-089:616.831-001.31
B 600
Serbian
1026127597
Tekst
The anatomy of frontal sinus may vary individually, concerning
volume and shape differences or, in rare cases, the absence of sinus.
However, there are scarce data about the influence of these variations
on the structure of fracture, which occurred with the force of a blunt
stroke. Therefore, the aim of this study was to analyze the influence
of frontal sinus volume on stress distribution and structure of fracture
in frontal area.
This dissertation studies objective parameters used for evaluation of
the size of frontal sinus in condition after the high intensity blunt stroke
effect on the appearance of brain contusion. The fracture pattern of
trauma is reflected in anterior and/ or posterior wall fractures with or
without fractures of nasofrontal canal. The injury of frontal sinus is
characterized by a high risk of possible complications, while their
management further remains a subject of different attitudes.
Dissertation contains epidemiological, experimental and clinical
study. Using descriptive method and retrospective study, the
epidemiological study inspected the incidence and etiology of fracture
of frontal sinus in the Center of Emergency and Neurotrauma –
Emergency Center at Clinical Center of Serbia. The cause of fractures
of frontal sinus and craniofacial massive injuries is presented, as well
as epidemiological and etiological characteristics, clinical parameters
and applied surgical procedures for frontal sinus fracture management.
All patients placed in trauma department from January 1st 2012 to
December 31st 2017 were managed by the same surgeons who were
guided by good clinical practice for this type of injury at Clinical
Center of Serbia.
In accordance with the set goals, the research related to the
experimental part of study is conducted in the Laboratory for Numerical
Simulations at Bioengineering desk of Faculty of Engineering Sciences,
University of Kragujevac.
Using computer simulation, the experimental part of the study has
analized the voltage distribution and deformation in a complex system
of frontal sinus and neurocranium. The study includes four Finite
Element skull model representatives.
The reference model is made by computerized tomographic scan of
human head with normally developed frontal sinuses. Modifying the
reference model, there were three additional models generated: a
model without sinus, the one with hypoplasia and a model with
hyperplastic sinuses. The force of 7,7 kN was applied straightforward
on forehead of each model, to simulate the frontal impact.
The results show that distribution of force impact in frontal area
depends on the volume of frontal sinus. External sinus wall showed
the greatest fragility in case of hyperplastic sinus, while posterior
wall/ internal plate showed greater fragility in hypoplastic or
undeveloped sinus. Well-developed frontal sinuses, through
absorption of the impact energy of anterior wall, can protect the
posterior wall and intracranial structures. Our results prove that the
distribution of stress caused by impacts in frontal region of the head
or fracture of bone structures largely depend on the size of the volume
of sinus cavity. Well-developed frontal sinuses may have a survival
role, acting like „shock absorbers― and protecting intracranial and
surrounding vital structures. This study explains for the first time
mechanisms of this, previously only assumed – protective role of
frontal sinuses. According to the results of clinical study, the main
etiological reason for occurrence of the frontal sinus fracture is traffic
accident – in particular, the category of co-driver. In our sample, the
injury of the frontal sinus is identified at 11,3%. Based on the results,
the fracture of sinus wall predict increasing the risk of contusion
occurrence by 2,071 times. In case of joint injuries, the risk of
contusion occurrence will increase by 1,7 times.
The treatment process of this trauma largely depends on
complexity and associated injuries, as well as intracerebral conditions
which are very common in this type of traumatism.