Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries

Comparative Three-Dimensional Finite Element Analysis on Miniplate and Lag Screw Fixation to Symphysis Fractures

The purpose of this study was to compare the amount of stress on the fracture site via three-dimensional finite element analysis between lag screw and miniplate systems. Solid mathematical models were created from the CT of a patient and a fracture observed in the symphysis area. On the fracture site mini plates and lag screws applied to the bone to fixate segments. The physiologic mastication chewing forces were applied for simulation. These 2 fixation methods: were evaluated by their amount of stress values. The maximum Von Misses stress lag screw model was 2727 MPa on the apex of the lag screw and 934 MPa on the fracture site of the screw. At the miniplate model, the maximum Von Misses stress was 571 MPa on the head of the miniplate screw, and it was 202 MPa on the fracture site. Thus, lag screw model causes at least 4 times higher stress values than mini plate model. The stress level of lag screw model is higher than miniplate model. However, when the chewing forces are taken into account, the amount of stress in the lag screw system is also acceptable in clinical applications.

Pediatric-Specific Midfacial Fracture Patterns and Management: Pediatric Versus Adult Patients

PURPOSE

The purpose of this study was to compare the midfacial fracture patterns and management approaches between pediatric and adult patients.

METHODS

We retrospectively analyzed 164 pediatric patients (<16 years old) and 564 nongeriatric adult patients (16 to 65 years old) with midfacial fractures at a single institution between 2011 and 2016. The location of the fractures, along with the etiology and management of the midfacial fractures, were compared.

RESULTS

Significantly greater proportions of pediatric versus adult patients had sports-related injuries (P < 0.001) and sustained nasal fractures (P < 0.001). On the other hand, significantly greater proportions of adult versus pediatric patients were injured in falls, traffic accidents, or assaults (P = 0.004, P < 0.001, and P = 0.002) and sustained maxillary or zygomatic fractures (P = 0.039 and P < 0.001). Bivariate logistic regression analyses revealed that the risks of nasal, maxillary, and zygomatic fractures were significantly related to age status after adjusting for etiology (P < 0.001, P = 0.045, and P < 0.001). In contrast, the risks of hospitalization and surgical treatment were significantly associated with etiology, but not with age status (P = 0.290 and P = 0.847).

CONCLUSION

These data suggest that the age-related structure and composition of the facial skeleton affect the pediatric-specific fracture patterns independent of the etiology. The comparisons in this study may serve as a guide for the management of pediatric midfacial fractures.

Changes in admission laboratory tests in patients with maxillofacial fractures and the influence of dento-alveolar trauma

BACKGROUND/AIM

There are few studies in the literature evaluating possible alterations in laboratory tests in patients with maxillofacial fractures. The aim of this study was to analyze the changes in admission laboratory tests of patients with maxillofacial fractures with indications for surgical treatment, including the influence of dento-alveolar trauma.

MATERIAL AND METHODS

Data from complete blood counts, blood coagulation tests, blood chemistries, and urinalysis results were obtained. The occurrence of concomitant dento-alveolar trauma was noted. The medical records were also re-evaluated later to verify the treatment outcome and the occurrence of complications. Statistical analyses were performed using the likelihood-ratio test to verify significant changes in the evaluated parameters (P ≤ .050).

RESULTS

There was a prevalence of males (78%) with a mean age of 35.9 years. Lower erythrocyte counts, hemoglobin levels, and/or hematocrit were observed in males with associated fractures and with simultaneous dento-alveolar fractures. Higher mean neutrophil, segmented neutrophil, and lymphocyte counts were observed in patients with simultaneous dento-alveolar trauma. A higher mean activated partial thromboplastin time (aPTT) ratio was also observed. Lower potassium levels were observed for patients in the fourth decade of life. Higher leukocyte counts not associated with trauma were observed in the urinalysis results of females and in the group of patients aged 20 or younger. Verification of treatment outcome showed two cases of infections and two cases that needed re-operation after mandible fractures. These four cases showed no significant changes in laboratory tests regarding the predisposition for complications.

CONCLUSION

Patients with maxillofacial fractures had neutrophilia, increased aPTT, and non-traumatic leukocyturia. There was an influence of associated fractures and dento-alveolar trauma on the decrease in red blood cell parameters, neutrophilia, and lymphocytosis and of age on hypokalemia.

Sequential sequestrations increase the incorporation and retention of multiple growth factors in mineralized collagen scaffolds

Trauma induced injuries of the mouth, jaw, face, and related structures present unique clinical challenges due to their large size and complex geometry. Growth factor signaling coordinates the behavior of multiple cell types following an injury, and effective coordination of growth factor availability within a biomaterial can be critical for accelerating bone healing. Mineralized collagen scaffolds are a class of degradable biomaterial whose biophysical and compositional parameters can be adjusted to facilitate cell invasion and tissue remodeling. Here we describe the use of modified simulated body fluid treatments to enable sequential sequestration of bone morphogenic protein 2 and vascular endothelial growth factor into mineralized collagen scaffolds for bone repair. We report the capability of these scaffolds to sequester 60–90% of growth factor from solution without additional crosslinking treatments and show high levels of retention for individual (>94%) and multiple growth factors (>88%) that can be layered into the material via sequential sequestration steps. Sequentially sequestering growth factors allows prolonged release of growth factors in vitro (>94%) and suggests the potential to improve healing of large-scale bone injury models in vivo. Future work will utilize this sequestration method to induce cellular activities critical to bone healing such as vessel formation and cell migration.

Trauma induced injuries of the mouth, jaw, face, and related structures present unique clinical challenges due to their large size and complex geometry.

British Association of Oral and Maxillofacial Surgeons' National Facial Injury Surveys: hard tissue facial injuries presenting to UK emergency departments

The British Association of Oral and Maxillofacial Surgeons (BAOMS) and Saving Faces undertook two national prospective surveys 11 years apart. They recorded the facial injuries treated in UK emergency departments and collected data on 14872 patients. In this paper, which aims to act as a feasibility study for a third national survey of facial injuries, we have reviewed hard-tissue injuries and specifically focused on temporal changes in their morphology. The two sets of directly comparable, categorical, unpaired, cross-sectional data were evaluated independently for statistical significance. In 1997, there were 1977 hard-tissue facial injuries (33%) but in 2008 this had decreased to 1899 (22%) (p<0.05). In 1997, there were 1315 fractures (22%) and 662 dental injuries (11%) compared with 1462 (17%) fractures and 438 (5%) dental injuries in 2008 (p<0.05). There were proportional increases in orbital (21%), nasal (139%), and cranial fractures (340%) (p<0.05). The data showed a small reduction in the total number of hard-tissue injuries, but this was a considerable reduction as a proportion of the total injuries. Analysis of the type and subtype of injury generally pointed towards a reduction in their energy and severity, and to likely changes in mechanism. The project has proved the feasibility of a third national survey of facial injury.

Impacted Mandibular Third Molars and Their Influence on Mandibular Angle and Condyle Fractures

The aim of this study is to retrospectively analyze the effect unerupted or partially erupted third molars have on the angle and condyle fracture patterns of the mandible. It also focuses on evaluating the type of impaction that causes angle fracture and the level at which the condyle most commonly fractures. The study involves all the patients who had undergone treatment for condylar and angle of the mandible fractures from 2010 to 2017 in our craniofacial center. The case records and orthopantomograms of each patient were taken into consideration and a correlation was established based on gender, age, etiology, presence of third molars, position of third molars, angulation, and root development of third molars. Of the 150 angle fracture patients, 146 had third molars and 4 did not, whereas of the 130 condyle fractures, third molar was present in 54 patients and absent in 76. The prevalence of angle fractures was statistically significant when a third molar was present, whereas the prevalence of condyle fractures was higher when third molar was absent. The results of age, etiology, angulation, position, and root development of third molars were also statistically significant. However, sex of the patient did not influence the fracture pattern. The presence of an impacted third molar or a completely erupted one has a definite influence on the fracture pattern of the mandible. The occurrence of angle and condyle fractures was mostly affected by the continuity of the cortical bone at the angle of the mandible. Hence, prophylactic removal of mandibular third molars does increase the risk of condyle fractures.

A Cross-sectional Study of the Association between Homelessness and Facial Fractures

Background:

Little is known about the risk factors for facial fractures among homeless patients. We investigated the association between homelessness, mechanism of injury, and type of facial fracture in patients treated at an urban trauma center.

Methods:

Data for 2,221 adults with facial fractures were obtained retrospectively from a standardized registry of trauma patients at Zuckerberg San Francisco General Hospital from 2011 to 2016. Associations between homelessness and mechanism of injury, facial fracture type, and surgical repair type were evaluated with multivariate multinomial logistic regression analysis.

Results:

Among 2,221 patients with facial fractures, 12% were homeless and, compared with housed patients, more likely to be male, black, and test positive for drug and alcohol use (all P < 0.0001). They had lower injury severity scores but longer hospital stays and were more likely to be discharged to the community than to a rehabilitation facility (all P < 0.0001). After adjusting for confounding variables, homeless patients with facial fractures were nearly 3-fold more likely to have been assaulted than housed patients (OR = 2.8, 95% CI = 1.9–4.1, P < 0.0001) and twice as likely to have mandible fractures (OR = 2.0, 95% CI = 1.3–3.0, P = 0.0030) and to have surgery for these fractures (OR = 2.1, 95% CI = 1.2–3.7, P = 0.0110).

Conclusions:

Our novel results demonstrate that homeless patients with facial fractures are at much higher risk than the general population for being assaulted, suffering mandible fractures, and requiring surgery for these fractures. Further investigations could guide identification, treatment, and prevention efforts.

Clinical Analysis and CT 3D-Mediated Precise Internal Fixation in Maxillofacial Fracture

BACKGROUND/PURPOSE

To retrospectively analyze the epidemiological features, clinical diagnosis, and treatment of 610 patients with maxillofacial fractures, while providing a reference for the prevention and optimized treatment of maxillofacial fractures.

METHODS

Data of patients with maxillofacial fractures who were treated and followed up at the Second People's Hospital of Kashi Prefecture from June 2012 to April 2018 were summarized. The epidemiological features, clinical manifestations, fracture sites, treatment methods, and results were analyzed.

RESULTS

The highest incidence was in the age range of 20 to 49 years. The main cause of fracture was traffic injury. Mandibular fractures accounted for 37.77%, zygoma and zygomatic arch fractures for 37.00%, and maxillary fractures for 21.19%. Atypical zygomatic arch fractures were more common in the maxilla, followed by Le Fort I and II fractures. Closed fractures accounted for 85.97%. Many (73.39%) patients were treated with computed tomography 3-dimensional (3D)-mediated precision modified incision internal fixation with satisfactory results.

CONCLUSIONS

There is a high incidence of maxillofacial fractures among young men, especially in summer, with the most common injuries being traffic-related injuries. The most common site is the mandible, followed by the zygomatic arch, zygomatic complex, and maxilla. Computed tomography 3D-mediated precision modified incision internal fixation can achieve satisfactory results.

A Comparison of Ovine Facial and Limb Muscle as a Primary Cell Source for Engineered Skeletal Muscle

Volumetric muscle loss (VML) contributes to the number of soft tissue injuries that necessitate reconstructive surgery, but treatment options are often limited by tissue availability and donor site morbidity. To combat these issues, our laboratory has developed scaffold-free tissue-engineered skeletal muscle units (SMUs) as a novel treatment for VML injuries. Recently, we have begun experiments addressing VML in facial muscle, and the optimal starting cell population for engineered skeletal muscle tissue for this application may not be cells derived from hindlimb muscles due to reported heterogeneity of cell populations. Thus, the purpose of this study was to compare SMUs fabricated from both craniofacial and hindlimb sources to determine which cell source is best suited for the engineering of skeletal muscle. Herein, we assessed the development, structure, and function of SMUs derived from four muscle sources, including two hindlimb muscles (i.e., soleus and semimembranosus [SM]) and two craniofacial muscles (i.e., zygomaticus major and masseter). Overall, the zygomaticus major exhibited the least efficient digestion, and SMUs fabricated from this muscle exhibited the least aligned myosin heavy chain staining and consequently, the lowest average force production. Conversely, the SM muscle exhibited the most efficient digestion and the highest number of myotubes/mm²; however, the SM, masseter, and soleus groups were roughly equivalent in terms of force production and histological structure. Impact Statement An empirical comparison of the development, structure, and function of engineered skeletal muscle tissue fabricated from different muscles, including both craniofacial and hindlimb sources, will not only provide insight into innate regenerative mechanisms of skeletal muscle but also will give our team and other researchers the information necessary to determine which cell sources are best suited for the skeletal muscle tissue engineering.

In vivo tissue response and antibacterial efficacy of minocycline delivery system based on polymethylmethacrylate bone cement

This study aims the in vivo biological characterization of an innovative minocycline delivery system, based on polymethylmethacrylate bone cement. Bone cements containing 1% or 2.5% (w/w) minocycline were formulated and evaluated through solid-state characterization. Biological evaluation was conducted in vivo, within a rat model, following the subcutaneous and bone tissue implantation, and tissue implantation associated with Staphylococcus aureus is challenging. The assessment of the tissue/biomaterial interaction was conducted by histologic, histomorphometric and microtomographic techniques. Minocycline addition to the composition of the polymethylmethacrylate bone cement did not modify significantly the cement properties. Drug release profile was marked by an initial burst release followed by a low-dosage sustained release. Following the subcutaneous tissue implantation, a reduced immune-inflammatory reaction was verified, with diminished cell recruitment and a thinner fibro-connective capsule formation. Minocycline-releasing cements were found to enhance the bone-to-implant contact and bone tissue formation, following the tibial implantation. Lastly, an effective antibacterial activity was mediated by the implanted cement following the tissue challenging with S. aureus. Kinetic minocycline release profile, attained with the developed polymethylmethacrylate system, modulated adequately the in vivo biological response, lessening the immune-inflammatory activation and enhancing bone tissue formation. Also, an effective in vivo antibacterial activity was established. These findings highlight the adequacy and putative application of the developed system for orthopedic applications.

Craniofacial Morphometric Features Associated With Pericondylar Fractures of the Mandible

The research aimed at investigating potential correlations between craniofacial morphological measurements and mandibular pericondylar fractures, based on a retrospective study of 380 mandible fractures treated in our department, during 2010 to 2017. Predictors included morphological measurements and features. Primary outcome was presence of pericondylar fracture; 133 pericondylar fractures were found, including subcondylar, condylar neck, and condylar head fractures. Condylar neck fractures showed negative correlations with condylar neck width (5.7 mm versus 6.7 mm sagittaly, and 6.1 mm versus 6.8 mm coronally, respectively). Gonial angle (117.3 degrees versus 128.7), and mandibular length 106.2 mm versus 110.4 mm, respectively) showed negative correlation with all pericondylar fractures. Ramus height correlated positively with pericondylar fractures (53.6 mm versus 51.2 mm, respectively). Thus, our results showed condylar neck width was a predictor for condylar neck fractures. In addition, individuals suffering from pericondylar fractures had significantly smaller gonial angles, longer ramus height, and shorter mandibular length. These morphologic features are characteristic of individuals with decreased anterior facial height. Our results corroborated a previous study we had conducted, which suggested that increased anterior vertical growth correlates with angle fractures.

Radiographic evaluation of percutaneous transfacial wiring versus open internal fixation for surgical treatment of unstable zygomatic bone fractures

Introduction

The fixation of unstable zygomaticomaxillary complex (ZMC) fractures can be achieved by open reduction with rigid internal fixation (ORIF) and/or by closed reduction with percutaneous transfacial Kirschner wire fixation (CRWF). The aim of this study was to tomographically assess the symmetry and the protrusion of the cheekbone with unstable ZMC fractures that had been treated by ORIF vs. CRWF.

Materials and methods

Sixty patients exhibiting a surgically unstable tetrapodal ZMC fracture were included in this multicenter retrospective study. The coordinates of 5 landmarks representing the zygomatic protrusion were comparatively studied on the healthy and on the broken side using preoperative and postoperative tridimensional computed tomography (CT) scans or cone beam CT.

Results

No significant difference was found in the zygomatic protrusion irrespective of the surgical technique that was used. The zygomatico-maxillary ansa was found to be the most complicated area to reduce, particularly in the frontal plane with both the CRWF and the ORIF technique (p₁ = 0.001 and p₂ = 0.0009, respectively). There was no difference in terms of the level of complications, while the mean duration of the surgery was significantly less for the CRWF group.

Conclusion

With good postoperative radiographic outcomes, the CRWF can be proposed as an alternative or in association with the ORIF technique for fixation of tetrapodal fractures of the ZMC.

An in-depth technical and medical investigation of facial injuries caused by car accidents

BACKGROUND

Many studies have investigated the issue of facial injuries caused by car accidents, but only a few have addressed the technical and clinical aspects of such accidents and injuries in depth. The aim of this study was to identify risk factors and protective elements for facial injuries in car accidents.

METHODS

We analysed the technical and clinical data of patients with facial injuries caused by car accidents over a 16-year period (2000-2016) and investigated the following factors: sitting position, sex, age, accident time, use of a seatbelt, deployment of the front airbag, direction of impact, speed at the time of collision, and occurrence and location of facial injuries.

RESULTS

Of the 1291 patients involved in car accidents who were included in our study, 291 (22.5%) had suffered facial injuries. We found a significant association between occurrence of facial injuries and sex, speed at the time of collision, impact from the back, seatbelt usage, and deployment of the front airbag. In accidents occurring at speeds over 40 km/h, automobile security measures had no significant influence on the occurrence of facial injuries in drivers and front-seat passengers. In accidents occurring at speeds between 0 and 20 km/h, seatbelt usage (without airbag deployment) solely showed a significant protective influence against the occurrence of facial injuries (odd ratio [OR], 0.130; confidence interval [CI], 0.038-0.451). In contrast, patients who were in accidents at speeds between 21 and 40 km/h suffered significantly fewer facial injuries when wearing a seatbelt with the front airbag being deployed (OR, 0.245; CI, 0.091-0.665) or undeployed (OR, 0.216; CI, 0.084-0.561).

CONCLUSION

Male sex and a high speed at the time of collision are significant risk factors for the occurrence of facial injuries. The security measurements evaluated in this study only exerted a protective influence at low speeds (below 40 km/h). This indicates a possible weakness of these security systems with regard to preventing facial injuries. Engineers could benefit from these findings and improve the efficiency of existing security measures and eventually help decrease the incidence of facial injuries.

Maxillofacial Fracture Patterns in Military Casualties

PURPOSE

Morbidity and death after facial trauma are substantial issues of concern both in civilians and in military personnel. This cross-sectional retrospective study sought to assess the prevalence, pattern, treatment, and complications of soft and hard tissue injuries of the face in military personnel from 2012 to 2018.

PATIENTS AND METHODS

This cross-sectional, retrospective, chart study analyzed the descriptive statistics of 591 patients by use of Microsoft Excel software (version 2013; Microsoft, Redmond, WA); we assessed military casualties treated at our hospital from 2012 to 2018. All military personnel were documented in our trauma registry. The patient records were studied, and information relating to patients' injuries was documented and assessed after compilation of patient data. This study was approved by our local institutional review board; the causes and complications of maxillofacial (MF) trauma were assessed. Statistical analysis was done. This study used descriptive statistics based on a total of 591 patients and Microsoft Excel software (version 2013).

RESULTS

Among maxillofacial (MF) fractures, midface fractures (49%) were most prevalent, followed by lower face fractures (43%) and upper face fractures (24%). The most common cause of injury was explosives (58%). The most frequent site of fracture in the mandible was the angle region, followed by the mandibular body and condyle. Nasal fractures were seen in 44% of midface fractures. The most commonly used technique for treatment was open reduction-internal fixation, which was used in 89% of patients.

CONCLUSIONS

The pattern of MF injuries and the treatment modalities used to treat these patients showed that the most frequent type of injury was midface fracture and most patients were treated by open reduction-internal fixation.

Prevalence and patterns of maxillofacial trauma: a retrospective descriptive study

Introduction

We aimed to describe the prevalence and pattern of maxillofacial trauma in Qatar.

Methods

This is a retrospective study of trauma registry data at Hamad General Hospital during the period from January 2011 to December 2014. The study included all traumatic maxillofacial patients who underwent CT scan and were admitted during the study period.

Results

A total of 1187 patients with maxillofacial injuries were included in the study and 18.5% of all trauma admissions were related to maxillofacial injuries. Young age and males were predominantly affected. Mechanisms of injury were mainly traffic-related and fall. Orbital injuries were the commonest followed by maxillary injuries. The median and range face abbreviated injury score (AIS) was 2 [1–3] with 66% had a score of 2. Maxillofacial fractures were frequently associated with traumatic brain injuries. One out of five patients was managed with surgery and had median length of stays in ICU and hospital 5 and 7 days, respectively. Overall, in-hospital mortality was 8.3%. Mortality in isolated maxillofacial was low (0.3%) in comparison to 15% in polytrauma patients (p = 0.001). Multivariable regression analysis showed that Injury Severity Score, face AIS and Glasgow Coma Scale were predictors of mortality with age-adjusted odd ratio of 1.15, 2.48 and 0.82; respectively.

Conclusions

Maxillofacial trauma requiring admission is not uncommon in our trauma center and mostly it is mild to moderate in severity. Associated injuries are present in most of the maxillofacial injured patients and further diagnostic investigations should be part of the assessment in maxillofacial injuries.

A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation

Importance

Erich arch bars, 4-point fixation, and bone-supported arch bars are currently used in maxillomandibular fixation, although to what extent they differ in terms of overall charges and clinical outcomes has yet to be reported.

Objective

To determine the association of Erich arch bars, 4-point fixation, and bone-supported arch bars in maxillomandibular fixation with hospital charges and clinical outcomes.

Design, Setting, and Participants

This historical cohort included 93 patients with mandible fracture who underwent maxillomandibular fixation from January 1, 2005, to June 30, 2015, at a tertiary care center. Statistical analysis was conducted from October 4, 2015, to September 8, 2017.

Main Outcomes and Measures

Charge analysis from an institutional perspective, operative time, necessity for a secondary procedure, and postoperative complications.

Results

Of the 93 patients in the study (18 women and 75 men; median age, 28.0 years [interquartile range, 23.0-40.0 years]), 27 (29%) received Erich arch bars, 51 (55%) received 4-point fixation, and 15 (16%) received bone-supported arch bars. The mean operative time for Erich arch bars (98.7 minutes; 95% CI, 89.2-108.2 minutes) was significantly longer than for 4-point fixation (48.8 minutes; 95% CI, 41.8-55.7 minutes) and bone-supported arch bars (55.9 minutes; 95% CI, 43.1-68.6 minutes). A total of 17 patients who received Erich arch bars (63%), 37 patients who received 4-point fixation (72%), and 1 patient who received bone-supported arch bars (7%) needed to return to the operating room for hardware removal. Patients who received Erich arch bars and those who received 4-point fixation had significantly higher odds of requiring a secondary procedure than did patients who received bone-supported arch bars (Erich arch bars: odds ratio, 27.1; 95% CI, 2.7-274.6; and 4-point fixation: odds ratio, 42.8; 95% CI, 4.4-420.7). Mean total operative charges for application of the hardware alone were significantly less for 4-point fixation ($5290; 95% CI, $4846-$5733) and bone-supported arch bars ($6751; 95% CI, $5936-$7566) than for Erich arch bars ($7919; 95% CI, $7311-$8527). When secondary procedure charges were included, the mean total charge for Erich arch bars ($9585; 95% CI, $8927-$10 243) remained significantly more expensive than the mean total for 4-point fixation ($7204; 95% CI, $6724-$7684) and bone-supported arch bars ($6924; 95% CI, $6042-$7807). No clinically meaningful difference in complications between groups was found (Erich arch bars, 3 [11%]; 4-point fixation, 5 [10%]; and bone-supported arch bars, 2 [13%]).

Conclusions and Relevance

Bone-supported arch bars have comparable complication outcomes, operative time for placement, and overall charges when compared with Erich arch bars and 4-point fixation, and have a lower likelihood of requiring removal in an operative setting.

Biomechanical Evaluation of Mandibular Condyle Fracture Osteosynthesis Using the Rhombic Three-Dimensional Condylar Fracture Plate

PURPOSE

The aim of the present study was to evaluate the biomechanical stability of osteosynthesis in mandibular condyle fractures using a newly designed rhombic 3-dimensional (3D) condylar fracture plate and compare it with that using standard two 4-hole miniplates and with that in nonfractured condyles.

MATERIALS AND METHODS

Using 200 porcine mandibles, 3 different monocortical plating techniques were evaluated. The condyles were fractured along a defined line tangentially through the sigmoid notch and perpendicular to the posterior border. After anatomic reduction, osteosynthesis was performed using either standard rhombic 3D condylar fracture plates and standard screws (group A) or locking rhombic 3D condylar fracture plates, which were fixed either with standard screws (group B) or locking screws (group C). For comparison, nonfractured condyles (group D) and condyles fixed with standard two 4-hole miniplates and 8 screws (group E) were included. Using a universal mechanical testing machine (TIRA Test 2720; TIRA GmbH Schalkau, Germany), each group was subjected to linear loading from laterally to medially, medially to laterally, anteriorly to posteriorly, and posteriorly to anteriorly. The maximum axial force and displacement at the maximum force were measured. The mean values were compared for statistical significance using analysis of variance with Bonferroni's correction (statistical significance set at P < .05).

RESULTS

The main mode of failure in the plating techniques investigated was the pull out of screws from the proximal fragment. We found no statistically significant differences in the stability of osteosynthesis between the two 4-hole miniplates and the rhombic 3D condylar fracture plate when loading from posteriorly to anteriorly, laterally to medially, and medially to laterally. However, when loading from anteriorly to posteriorly, a statistically significant difference between the standard and locking system and the two 4-hole miniplate system was observed, with the latter proving more stable.

CONCLUSIONS

The results of the present biomechanical study suggest that the rhombic 3D condylar fracture plates are suitable for the treatment of condylar neck fractures. Both types of the plate are able to resist physiologic strains comparable to the two 4-hole miniplates.

Fall-related mandible fractures in a Japanese population: A retrospective study

BACKGROUND/AIM

Maxillofacial trauma is frequent and represents a heavy burden for patients and society. The aim of this study was to investigate the characteristics and management of mandibular fractures caused by falls.

MATERIAL AND METHODS

One hundred thirty-nine patients with 185 mandible fractures caused by falls were included in this retrospective study. The patients were grouped according to age, gender, fitness level (as classified by the American Society of Anesthesiology physical status classification), the month of the accident, sites of fractures and treatment methods.

RESULTS

Most adult and fit patients were treated with open reduction and internal fixation, except for intracapsular condyle fractures. Conservative management was chosen for paediatric patients and in all cases deemed at high risk for lengthy procedures under general anaesthesia (physical status III according to the American Society of Anesthesiology). Young patients were mainly males, whereas geriatric patients were mainly females. In cases of single-site fracture, condylar fractures were the most prevalent. In cases with multiple sites, the association of condyle and symphysis fractures was the most frequent.

CONCLUSIONS

The results show an increasing trend in geriatric condyle fractures, especially in females. The epidemiology of fall-related mandibular fractures is subject to the influence of seasonal, historical, cultural and demographic factors.

Epidemiological Study of the Socioeconomic Impact of Mandible Fractures in a Spanish Tertiary Hospital: Review of the Literature

Introduction

Mandibles fractures are one of the most frequent pathologies treated in an Oral and Maxillofacial Department and represent a serious public health problem.

Materials and Methods

We present a retrospective study of patients treated for mandible fractures by the Oral and Maxillofacial Surgery Department in a Spanish tertiary hospital during 2010-2012.

Results

One hundred and thirty-nine patients with 201 mandible fracture sites were assisted in our department; 15% were female and 85% were male, with a male-to-female ratio of 5.5:1. The observed mean age was 35 years with a range between 15 and 89 years. The most frequent etiology of fractures was the assault (43%) followed by falls (32%). The most common fracture site was the mandibular angle (35%), followed by the parasymphysis (30%). Concerning combined fractures (60%), the most repeated association was the angle and the parasymphysis. The principal imaging test for diagnosis was the orthopantomography. The intermaxillary fixation was performed in the 25% of cases, and the rest of mandible fractures were fixed by osteosynthesis. The surgical treatment had an average of 4.2 days after the trauma, and the mean time of hospitalization was 6.5 days.

Conclusion

The principal aim of the treatment of mandible fractures is to restore the function of the patient occlusion. A malocclusion after surgery may decrease the patient quality of life, so a correct fracture reduction could shrink health spending. After the result shown in the present study, the social education should be improved in the developed countries with the objective of decline in the amount of aggressiveness.

[Frequency and management of complex facial fractures-an oral and maxillofacial surgical assessment]

INTRODUCTION

The treatment of facial fractures is an integral part of the oral and maxillofacial surgical treatment spectrum. In the case of complex fractures that involve multiple levels of the facial skeleton associated with severe concomitant injuries, an individual and interdisciplinary treatment approach is needed, which requires the infrastructure of a national trauma center.

OBJECTIVE

The aim of this study was to analyze the incidence and management of patients with complex facial fractures and considering the concomitant injury pattern.

MATERIAL AND METHODS

A retrospective analysis of patients with complex facial fractures during the years 2009-2015 admitted to the emergency surgical department of a national trauma center was carried out. The identification of appropriate patient cases was based on the International Statistical Classification of Diseases and Related Health Problems (ICD) coding of electronic patient data. Only patients with at least a combination of mandibular and midfacial fractures (2-level fractures) were considered. Patients with mainly dentoalveolar fractures and simple nasal bone fractures were not included. The evaluation of the electronic medical records included the etiology, fracture pattern, associated severe injuries on the basis of the injury severity score (ISS), treatment regimen as well as the length of the hospital stay.

RESULTS

In the 7‑year study period, 3382 patients were identified with facial fractures. Of these, 128 patients (3.78%) presented with a complex fracture pattern with a combination of mandibular fractures and fractures of the midface. The majority of these patients (n = 92) had less severe concomitant injuries (ISS ≤ 16), while 36 patients showed severe concomitant injuries (ISS > 16). The incidence of a 3-level fracture involving the mandible, midface and anterior skull base was only 0.47% and could be detected in 16 patients, of which 10 were classified as polytrauma (ISS > 16).

CONCLUSION

The incidence of complex fractures of the facial skeleton was comparatively low with almost 4%. More than one in four patients with complex injury patterns of the facial skeleton exhibited severe concomitant life-threatening injuries, necessitating an interdisciplinary management with the specialized infrastructure of a nationwide trauma center.

Aesthetic Outcome of a Case of Orbital Floor Fracture Treated Using a Retroseptal Transconjunctival Approach

The orbital floor is a bone structure frequently involved in orbital fractures. Various methods have been documented to approach the orbital floor and infraorbital rim. Traditionally, transcutaneous approaches like infraorbital, subciliary, and subtarsal have been employed to access the orbital floor and infraorbital rim. A significant amount of complications including a visible, prominent scar, eyelid abnormalities like ectropion, lower lid retraction, and increased scleral show result from these transcutaneous approaches. To overcome these complications, the transconjunctival approach has been preferred recently. However, the transconjunctival approach has been associated with rare complications like entropion, synechia, or trichiasis. In the present article, we report a case of orbital floor fracture treated using a retroseptal transconjunctival approach. We intend to evaluate the aesthetic outcome of a case of orbital floor fracture treated using a retroseptal transconjunctival approach.

Use of neuron-specific enolase to predict mild brain injury in motorcycle crash patients with maxillofacial fractures: A pilot study

PURPOSE

Mild traumatic brain injury (TBI) is common but accurate diagnosis and its clinical consequences have been a problem. Maxillofacial trauma does have an association with TBI. Neuron-specific enolase (NSE) has been developed to evaluate neuronal damage. The objective of this study was to investigate the accuracy of NSE serum levels to detect mild brain injury of patients with sustained maxillofacial fractures during motor vehicle accidents.

METHODS

Blood samples were drawn from 40 healthy people (control group) and 48 trauma patients who had sustained isolated maxillofacial fractures and mild brain injury in motor vehicle accidents. Brain injuries were graded by Glasgow Coma Scale. In the trauma group, correlations between the NSE serum value and different facial fracture sites were also assessed.

RESULTS

The NSE serum level (mean ± SD, ng/ml) in the 48 patients with maxillofacial fractures and mild TBI was 13.12 ± 9.68, significantly higher than that measured in the healthy control group (7.72 ± 1.82, p < 0.001). The mean NSE serum level (ng/ml) in the lower part of the facial skeleton (15.44 with SD 15.34) was higher than that in the upper facial part (12.42 with SD 7.68); and the mean NSE level (ng/ml) in the middle-and lower part (11.97 with SD 5.63) was higher than in the middle part (7.88 with SD 2.64).

CONCLUSION

An increase in NSE serum levels can be observed in patients sustained maxillofacial fractures and mild brain injury.

Which fixation methods are better between three-dimensional anatomical plate and two miniplates for the mandibular subcondylar fracture open treatment?

PURPOSE

To compare the clinical outcomes of a single three-dimensional (3-D) anatomical plate versus two conventional straight miniplates for the open treatment of mandibular subcondylar fractures.

METHODS

This retrospective clinical study included patients with mandibular subcondylar fractures treated by the retromandibular transparotid approach using a 3-D plate or two straight miniplates. Outcome variables included preoperative conditions of patients and fractures, extent of postoperative bone healing, and incidence of complications. Other variables included age, sex, fracture site, and follow-up duration. Variables were evaluated using descriptive statistics and compared between groups.

RESULTS

Twenty-eight fractures were analyzed: 13 fractures using 3-D plate and 15 fractures using two straight miniplates. None of the assessed variables showed significant differences between the two groups (p < 0.05). Unfortunately, in the 3-D plate group, reoperation was necessary for nonunion owing to plate breakage in one case with a bone defect around the fracture.

CONCLUSION

The 3-D plate and two straight miniplates were equally effective for the surgical management of mandibular subcondylar fractures. Although a 3-D plate is sufficient for a typical simple fracture, in cases with a bone defect around the fracture, selection of the plate fixation method should be carefully considered.

Traffic accidents, maxillofacial injuries and risk factors: A systematic review of observational studies

AIM

This study aimed to evaluate the scientific evidence regarding the risk factors for maxillofacial injuries among victims of traffic accidents.

METHOD

A systematic review of articles published until February 2017 was carried out in the following databases: PubMed, Web of Science, Scopus, and Cochrane Library. Studies were selected by two independent reviewers (ϰ = 0.841). The risk of bias in the selected studies was assessed using an adapted version of the Newcastle-Ottawa Scale for observational studies.

RESULTS

A total of 2703 records were found, of which only three articles fulfilled the inclusion criteria and were analyzed, including 422 244 patients. The male/female ratio ranged from 3.4: 1 to 6: 1. All eligible studies performed the multivariate statistical analysis. Eleven risk factors for maxillofacial traumas were identified: victim's gender (P < 0.05), age group (P < 0.05), residence region (P < 0.05), impact characteristics (P < 0.05), increased net change in velocity due to collision (P < 0.05), increase in occupant's height (P < 0.05), nonuse of protective equipment (P < 0.05), type of accident (P < 0.05), time of occurrence (P < 0.05), lesion severity (P < 0.05), and occurrence of concomitant lesions (P < 0.05).

CONCLUSION

The results suggest that sociodemographic characteristics, as well as those related to the collision patterns and circumstances of traffic accidents, may influence the occurrence of maxillofacial injuries. However, the results should be interpreted with caution due to the high heterogeneity among studies.

A retrospective cross-sectional study of maxillofacial trauma in Delhi-NCR Region

Aim and Objectives

To evaluate the pattern, prevalence, etiology, site of fractures, and their management in patients with maxillofacial injury in Delhi-NCR region.

Materials and Methods

A total of 1278 maxillofacial trauma patients visiting different registered hospitals from Delhi-NCR region from January 2012 to December 2017, treated by open reduction and internal fixation under general anesthesia (GA)/local anesthesia (LA) or closed reduction/conservatively, were taken into the study. The parameters considered in the study were age and sex distribution, etiological factors and incidence of maxillofacial trauma, pattern and site distribution of maxillofacial fractures, and management.

Results

From a total of 2250 trauma patients, 1278 patients (1053 males and 225 females) had maxillofacial injury. The average prevalence rate was 56.8%. Yearly incidence rate was 20.4%. Road traffic accident (RTA) was the most common cause of trauma in 1029 (80.5%) patients, followed by physical assault [158 (12.3%)] with significant male predominance in different age groups. Isolated mandibular fractures were the most common [48.6% (parasymphysis 31.6%, condyle 28.2%)], followed by midface with maxilla fracture [27.6% (zygomatic bone and arch 50.2% and Lefort II fractures 18%)]. Treatment modalities were conservative management, closed reduction, and open reduction with internal fixation under GA/LA.

Conclusion

RTA followed by physical assault is still the leading cause of maxillofacial trauma in young males in Delhi-NCR region. Mini plate osteosynthesis is the main treatment procedure for maxillofacial trauma. We need to enforce strict traffic rules, road safety law, and preventive measures along with improvement in education and socioeconomic status in the population to avoid maxillofacial injuries.

A retrospective study of mandibular fractures in children

Objectives

The incidence and patterns of mandibular fractures vary by country and population age. This retrospective study evaluated the etiologies and patterns of mandibular fractures in children.

Materials and Methods

The clinical records of 89 children (45 males and 44 females) aged 0 to 12 years who presented with mandibular fractures from July 2012 to June 2016 were retrospectively reviewed. The sex, patient age, site of fracture, etiology of trauma, and monthly variations of the fractures were recorded. Descriptive statistics, the z-test and chi-square test were used for statistical analysis and the P-value was set at <0.05.

Results

Eighty-nine children (male-to-female ratio 1.02:1) sustained 131 mandibular fractures. Within the study sample, the 6 to 9 year age group most frequently experienced fractures (47.3%). Falls and road traffic accidents (RTA) were the two most common etiological factors that accounted for 44.9% and 24.7% of cases. The condylar fracture was the most common anatomical location (38.9%) followed by the angle (20.6%), parasymphysis (18.3%), body (15.3%), and symphysis (5.3%). A single fracture (51.7%) was more common than multiple fractures (48.3%). The month-wise distribution of mandibular fractures was fairly constant.

Conclusion

The condylar region was the most common anatomic site for fractures; in addition, a fall and RTA were the major etiological factors for mandibular fractures. A single fracture was observed in 51.7% of patients while multiple fracture lines accounted for 48.3% of cases.

[Clinic analysis of 198 elder patients with maxillofacial fracture]

OBJECTIVE

The purpose of the study was to analyze the characteristics of elder patients with maxillofacial fracture.

METHODS

We retrospectively analyzed the characteristics of maxillofacial fractures in the elder patients, who were treated from July 2010 to October 2017. The clinical characteristics of the etiology, fracture site, combined injury, systemic disease, and treatment method were analyzed.

RESULTS

In the 198 elderly patients with maxillofacial fractures, the male-to-female ratio was 3.95︰1, and the mean age was 66.15 years old. Traffic accident injury (78 patients, 39.39%), fall injury (49 patients, 24.75%), high fall injury (33 patients, 16.67%) were the main factors of maxillofacial fracture in elderly patients. The most frequently observed fracture site was the mandible (120 patients). A total of 60 patients demonstrated associated injuries, in which limb injuries were the most prevalent (28 patients); whereas 66 patients had other systemic medical conditions, in which cardiovascular diseases was the most frequent (50 patients). The main treatment method of 198 patients was rigid internal fixation with small or micro-plates.

CONCLUSIONS

Falling and traffic accidents are the main factors of maxillofacial fracture in elderly patients. Thus, interference measures should be observed for the prevention of maxillofacial fractures in elderly patients.

Dental Injuries in a Sample of Portuguese Militaries - A Preliminary Research

Introduction

Traumatic dental and maxillofacial injuries are very common and appear to affect approximately 20-30% of permanent dentition, with often serious psychological, economic, functional, and esthetic consequences. Militaries are a highest risk group for orofacial trauma, not only because they are constantly engaged in physical activity (which increase the risk of traumatic injuries) but also because they are exposed to many risk factors. The aim of this study was to evaluate the prevalence of orofacial injuries, militaries knowledge about first-aid procedures following a dental avulsion and the use of mouthguards in a sample of Portuguese militaries.

Materials and Methods

An observational cross-sectional study was conducted for forces of the Infantry Regiment n°14 of Viseu, Portugal. The study involved 122 members of the armed forces who were asked to complete a questionnaire, which enquired about: the occurrence of dental trauma, the use of mouthguards and militaries knowledge with regard to first-aid management of dental avulsions.

Results

In our sample, 5.7% reported having experienced a dental trauma. This was further broken down to reveal that 2.5% had experienced an avulsion and 3.3% had a dental fracture. All respondents who reported having suffered dental trauma, reported that this was the only time that they had experienced dental trauma. Within this group, 71.4% visited a dentist, however only one (20%) visited the dentist during the same day that the trauma occurred. In addition, 21.3% mentioned that they had seen a dental trauma in at least one colleague during military trainings/operations. In the case of dental avulsion, the majority (54.9%) did not know how to act. The rate of mouthguard's use among militaries was very low (6.4%). The main reason reported for not using a mouthguard was thinking that it is not necessary (53.3%). Besides that, 31.1% did not know what a mouthguard was for.

Conclusion

Prevention programs and promoting actions with this population are important reflections and should be adopted to reduce the incidence of orofacial trauma and to increase knowledge about this topic.

Fracture patterns and causes in the craniofacial region: an 8-year review of 2076 patients

Background

For proper recovery from craniofacial fracture, it is necessary to establish guidelines based on trends. This study aimed to analyze the patterns and causes of craniofacial fractures.

Methods

This retrospective study analyzed patients who underwent surgery for craniofacial fractures between 2010 and 2017 at a single center. Several parameters, including time of injury, region and cause of fracture, alcohol intoxication, time from injury to surgery, hospitalization period, and postoperative complications, were evaluated.

Results

This study analyzed 2708 fracture lesions of 2076 patients, among whom males aged 10 to 39 years were the most numerous. The number of patients was significantly higher in the middle of a month. The most common fractures were a nasal bone fracture. The most common causes of fracture were ground accidents and personal assault, which tended to frequently cause more nasal bone fracture than other fractures. Traffic accidents and high falls tended to cause zygomatic arch and maxillary wall fractures more frequently. Postoperative complications—observed in 126 patients—had a significant relationship with the end of a month, mandible or panfacial fracture, and traffic accidents.

Conclusions

The present findings on long-term craniofacial fracture trends should be considered by clinicians dealing with fractures and could be useful for policy decisions.

Electronic supplementary material

The online version of this article (10.1186/s40902-018-0168-y) contains supplementary material, which is available to authorized users.

Patterns of maxillofacial fractures in Hofuf, Saudi Arabia: A 10-year retrospective case series

Objectives

This retrospective study was performed to analyze the incidence, etiology, and types of maxillofacial fractures in a major city in Eastern Province, Saudi Arabia.

Materials and methods

The medical records of all patients treated in the operating rooms for maxillofacial fractures by the Oral and Maxillofacial Surgery Department at King Fahad Hospital, Hofuf, Al-Ahsa, Saudi Arabia, between January 1, 2007, and December 31, 2016, were reviewed. A total of 270 patients with complete records were included. The data extracted included the age, gender, nationality, causes of injury, and patterns of maxillofacial fractures involved.

Results

Among the 270 patients, 241 (89.3%) were males, and 29 (10.7%) were females. The young adult (19-44 years) age group was the most affected (65.6%). Road traffic accidents (63.3%) were found to be the most frequent causes of maxillofacial fractures; falls were the second most common (15.9%). The rate of mandibular (54.6%) fractures was higher than that of mid-facial (45.4%) fractures. Among the mandibular fractures, the most common type was the parasymphyseal fracture (24.6%). Zygomatic fractures were the most common (48.6%) of midface fractures.

Conclusions

Similar to reports of other studies in different regions of Saudi Arabia, Al-Ahsa showed that road traffic accidents were the most predominant etiology of maxillofacial fractures affecting most frequently males of young adult age group. These findings emphasize the need for better education of road safety and enforcement of traffic laws, especially for the most affected age group.

Relationship Between Nasal Fracture and Blowout Fracture: Can Nasal Fracture Be a Predictor of Blowout Fracture?

PURPOSE

Nasal and blowout fractures are the most common injuries from craniomaxillofacial trauma. Nasal fractures are easily diagnosed by clinical signs, such as pain and crepitus. However, blowout fractures are frequently asymptomatic and are easy to miss without computed tomographic (CT) scanning. This study analyzed the relation between the 2 fracture types to determine whether nasal fracture could be used as a predictor of blowout fracture.

MATERIALS AND METHODS

CT scans of 1,368 patients who underwent reduction surgery for nasal fracture were retrospectively reviewed. The pattern of nasal fractures (n = 1,368) was classified as frontal or lateral according to the direction of impact. Blowout fractures (n = 297) were classified into 3 types according to the position of the fracture: medial, inferior, or inferomedial wall. After calculating the number of patients in each group, the relation between nasal and blowout fracture types was statistically analyzed.

RESULTS

Of 305 patients with frontal-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 26, 7, and 9, respectively. Of 1,063 patients with lateral-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 118, 75, and 62, respectively. Medial wall fracture was most common in the 2 nasal fracture groups and showed a higher frequency in the lateral-type group.

CONCLUSIONS

This study showed a strong relation between nasal fractures and medial wall blowout fractures. If nasal fracture is suspected, especially the lateral type, then thorough examination for medial wall blowout fracture, with a high index of suspicion, should be performed.

Facial Fractures

AIMS AND OBJECTIVES

The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital.

MATERIALS AND METHODS

This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test.

RESULTS

A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%).

CONCLUSION

This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.

The effect of the dental root on single mandibular bone fractures

Background

This study was conducted to determine the effect of the distributional relationship between dental roots and the mandibular bone on single mandibular bone fractures, which are common craniofacial fractures.

Methods

This was a retrospective, single-center study in Seoul, Korea. Patients with single mandibular fractures in the symphysis, parasymphysis, body, and angle area, with tooth structure involvement were included. The control group included patients with simple, bone-level lacerations without fractures. In total, 94 patients (72 males and 22 females) were included in the treatment group, and 125 (71 males and 54 females) were included in the control group. The height of the mandibular bone and the dental root were measured with panoramic radiography. The central incisor represented the symphysis area, the canine represented the parasymphysis area, the first molar represented the body area, and the second molar represented the angle area.

Results

In the treatment group, symphysis fractures occurred in 16 patients (17%), parasymphysis fractures in 36 patients (38%), body fractures in 17 patients (18%), and angle fractures in 25 patients (27%). The ratios of the dental roots to the total height of the mandibular bone in the treatment group were 30.35%, 39.75%, 39.53%, and 36.27% for symphysis, parasymphysis, body, and angle areas, respectively, whereas in the control group, they were 27.73%, 39.70%, 36.76%, and 35.48%. The ratios of the treatment group were significantly higher than those of the control group.

Conclusion

The results show that the higher ratio of the dental root to the height of the mandibular bone increases the fracture risk.

Double unilateral, bilateral, and multiple mandibular fractures: an observational study

PURPOSE

Double and multiple mandibular fractures are associated to high morbidity and functional damage. This study aimed to evaluate the characteristics and outcomes of double unilateral, bilateral, and multiple mandibular fractures.

METHODS

A 7-year observational retrospective analysis was performed, and the injury-related data were collected from the medical records. Statistical analysis was performed using Fisher's exact test (p < 0.05).

RESULTS

In this period, 283 patients showed mandibular fractures. Of them, 83 (29.7%) had double or multiple mandibular fractures and were included in the study. Double bilateral fractures were more prevalent than multiple or double unilateral. Multiple fractures presented significant association with the combination of load-bearing and load-sharing fixation protocols. Most cases (94.0%) applied at least one type of internal fixation system. However, there was a positive association between condylar fractures and non-surgical treatment (p < 0.01). Moreover, mandibular body fractures were associated with load-bearing fixation (p < 0.01). In 56 cases, no complications were observed (67.5%). Complications were divided into treatment failure (10.8%) and transitory or minor complications (21.7%). There was no statistical association between complications and fracture pattern, fracture-tooth relation, and treatment modality.

CONCLUSION

Double and multiple mandibular fractures represented almost one third of all mandibular fractures, and regardless to treatment protocol, there was no difference about complications. Moreover, although a considerable complication rate was found, most of them were minor or transitory.

Age and Number of Surgeries Increase Risk for Complications in Polytrauma Patients with Operative Maxillofacial Fractures

BACKGROUND

Poly-trauma patients often sustain complex head/neck injuries requiring prolonged hospitalizations and multiple operations. Few studies have evaluated the associated injury patterns and risk factors for poor clinical outcomes.

METHODS

Consecutive poly-trauma patients with operative maxillofacial fractures treated at a level 1 trauma medical center between 1995 and 2013 were evaluated. Concomitant head/neck injuries to identify potential injury patterns were numerated. Lastly, a multivariate analysis was performed to determine independent risk factors for complications during the acute hospitalization period.

RESULTS

Totally, 232 poly-trauma patients presented with operative maxillofacial fractures, while 38.8% of patients had a secondary maxillofacial fracture, 16.4% had intracranial hemorrhage, 23.7% had skull fractures, and 12.1% had spinal fractures. The rate of complication during admission was 28.3%. Multivariate analysis revealed advanced patient age and increased number of operations to predict the rate of complication. Patients requiring more than one operation had a 1.8-fold increase in complication rate (p<0.01) and older patients had a 4.5% increase in complication rate (p<0.05) for every year of increased age.

CONCLUSION

Poly-trauma patients have a high incidence of secondary maxillofacial fractures, concomitant head/neck injury, and inpatient complication rate. Knowledge of associated injury patterns can help increased awareness and can guide physician decision-making to avoid missed/delayed injuries.

Trend and Demographic Characteristics of Maxillofacial Fractures in Level I Trauma Center

AIM

The aim of this study was to analyze the pattern and treatment of craniomaxillofacial injuries in the northern part of Israel, within a Jewish majority and large Arab minority population.

PATIENTS AND METHODS

A 5-year retrospective study evaluated patients treated for craniomaxillofacial fractures. Fracture cause, type, site, and patient demographics were evaluated.

RESULTS

Patient age ranged from 1 to 94 years with an average age of 36.7 years; 52% of the victims were Jews and 48% Arabs. There was male predilection in both sectors (78.3% vs 21.7%). The main site of injury was the zygomatic bone (33.5%) followed by nasal bone, orbital, mandible, frontal sinus, and maxillary fractures. The main etiology of injuries was falls (45.4%) with significantly more falls reported by females (52.1% vs 43.2% in males). Motor vehicle accidents caused injuries more frequent in males. Arabs experienced CMF fractures at a younger age compared to Jews (27.8 and 44.8 average age, respectively). In the elderly, the trend reversed where Jews were more prone to craniomaxillofacial fractures.

CONCLUSIONS

Compared to their weight in the population, the Arab sector experiences more craniomaxillofacial injuries. The Jewish elderly population tends to reside in nursing homes where they are more susceptible to accidental falls, whereas young Arab males are more exposed to motor vehicle accidents and interpersonal violence. Falls were the main cause of injuries particularly in women. This may reflect the women's fear of reporting domestic violence. We believe that increased government investments in infrastructures and education will lower the incidence of craniomaxillofacial trauma and balance the gap between both sectors and sexes.

Wet and wounded: Pediatric facial trauma from swimming and diving

OBJECTIVES

Swimming has been reported as the most common recreational activity among American youths, while diving remains a popular youth activity as well. We characterize the most common facial injuries occurring during these activities and evaluate facial fracture mechanisms and demographic trends, as this information may be helpful in preventative counseling as well as diagnosis.

METHODS

The National Electronic Injury Surveillance System was assessed for swimming- and diving-related facial injuries in children from 2007 to 2016. Estimates of national injury incidence were recorded, and patient diagnoses, demographics, and injury mechanisms were evaluated.

RESULTS

In the 10-year period assessed, 789 NEISS entries extrapolated to an estimated 27,709 patients nationwide were analyzed. The yearly incidence fluctuated but steadily rose from 2013 to 2016. Males comprised a majority of injuries (58%), and laceration was the most common diagnosis (65%), followed by abrasion/contusion (22%) and fracture (9%). Facial fractures were most likely to involve the nasal bones (87%). Swimming injuries were more numerous overall (74%), but a greater proportion of diving injuries resulted in fracture (12% vs. 7%). Teenagers were also more likely to suffer fractures than were younger children involved in the same activities.

CONCLUSION

Most analyses of swimming and diving injuries have focused on spinal and orthopedic trauma. Nevertheless, the nature of headfirst diving and swim strokes suggest facial trauma is an underappreciated concern for clinicians. These findings reinforce the need for safer swimming and diving practices and serve as a useful resource for physicians managing pediatric facial injuries.

Oral and maxillofacial trauma in motorcyclists in an Iranian subpopulation

BACKGROUND/AIMS

Road traffic accidents are considered a major cause of oral and maxillofacial trauma. Given that many traumatic injuries and deaths involve motorcyclists, the aim of this study was to investigate this vulnerable group in terms of oral and maxillofacial injuries following accidents.

MATERIALS AND METHODS

This cross-sectional study was conducted on 330 patients with oral and maxillofacial injuries at Shahid Rajaee Hospital in Shiraz, Iran, from April to September 2017. A questionnaire with questions regarding age, gender, helmet use, and driver's license was completed for all the patients and their injury type (including dental injuries). Data were analyzed using descriptive statistics and the chi-squared test with a significance level of 95%.

RESULTS

Of the 330 patients, 291 (88.2%) were male and 39 (11.8%) were female. There were 283 (85.75%) patients aged 21-30 years, and their mean age was 27.2 ± 6.5. Most of them (287, 87%) had not been wearing helmets at the time of the accident. Dental injuries were observed in 168 (50.9%) of the patients. Uncomplicated crown fractures were diagnosed in 25.4% of the patients, luxation injuries in 23.2%, and avulsion in 18.9%. Only 19.9% of the patients under the age of 25 had suffered facial injuries.

CONCLUSION

Most injuries in motorcycle accidents were dental trauma in men due to not wearing a helmet. Dental injuries had the highest frequency of damage.