Facial Fractures in Kajang Hospital, Malaysia: A 5-Year Review

Diagnostic accuracy of the tongue blade test combined with clinical signs to detect maxillary and mandibular fractures in the emergency department

BACKGROUND

To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test (TBT) to detect maxillary and mandibular fractures.

METHODS

A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging (facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular fractures.

RESULTS

A total of 98 patients were identified, of whom 31.6% had maxillary fractures and 9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%.

CONCLUSION

The clinical decision tool is potentially useful to rule out mandibular fractures, thus preventing unnecessary radiation exposure.

Pediatric Facial Fractures in South Australia: Epidemiology, Clinical Characteristics, and Outcomes

INTRODUCTION

Facial fractures of children are relatively infrequent compared to adults. There are variations in facial fractures depending on the socioeconomic, cultural, and educational factors of the country and time. Our aim is to describe epidemiological trends of facial fractures in the pediatric population, understand differences amongst the age groups, and the impact this has on clinical outcomes and management in South Australia.

METHODS

A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hosptial, Adelaide. All facial fractures of children, aged 16 years and below, that attended or were referred to the unit were included in this study.

RESULTS

A total of 265 pediatric patients presented with a facial fracture with a male predominance. Some 49.1% occurred from a sports-related injury with bicycle motocross as the single most common type of sport. The mandible was the common fracture type with 21.9% of the total cohort having an associated injury. There were significant differences between boys and girls for age, age groups, mechanism of injury, and type of sport (P < 0.05). Boys were 2.3 times more likely to have a sport-related facial fracture than girls. Early adolescence were 5.2 times more likely to have an orbitozygomatic fracture than children of early childhood (P < 0.05). Age, associated injuries, and sport-related facial fractures were independently associated with increased length of stay (P < 0.001).

CONCLUSIONS

There are differences amongst boys and girls and an understanding of these differences can aid the diagnosis and management in a growing child's face.

The Most Common Relationship of a Midface Fracture in Maxillofacial Trauma Study

ABSTRACT

Oral and maxillofacial fractures are the most common injuries among multiple trauma. About 5% to 10% of trauma patients having facial fractures. The objectives of this case study are to focus the most common mid-face fractures types' and to determine the relationship of the midface fracture in maxillofacial trauma among the patient who attended the outpatient clinic in a Hospital Universiti Sains Malaysia. In this research paper, an advanced statistical tool was chosen through the multilayer perceptron neural network methodology (MLPNN). Multilayer perceptron neural network methodology was applied to determine the most associated predictor important toward maxillary bone injury. Through the predictor important classification analysis, the relationship of each bone will be determined, and sorting according to their contribution. After sorting the most associated predictor important toward maxillary bone injury, the validation process will be applied through the value of training, testing, and validation. The input variables of MLPNN were zygomatic complex fracture, orbital wall fracture, nasal bone fracture, frontal bone fracture, and zygomatic arch fracture. The performance of MLPNN having high accuracy with 82.2%. As a conclusion, the zygomatic complex fracture is the most common fracture trauma among the patient, having the most important association toward maxillary bone fracture. This finding has the highest potential for further statistical modeling for education purposes and the decision-maker among the surgeon.

Outcome of Different Treatment Modalities of Fracture Zygoma

OBJECTIVES

This study aimed to determine the pattern of fractured zygoma, different treatment modalities, and complications of the treatment in our center. It also aimed to determine the association between the treatment modalities and complication of treatment, and association between number of fixation and complication.

METHODOLOGY

A retrospective review was conducted from January 2008 until December 2011. All patients diagnosed with zygomatic complex fractured that met the inclusion and exclusion criteria were included in the study. Zingg's Classification was used in the study.

RESULTS

The median age was 23.5. Type A was the most common fracture type made up 26.6%. About 90.8% of the injury was caused by road traffic accident. Forty-four patients were treated with open reduction and internal fixation and 4 patients were treated with close reduction only. Fifty patients were treated conservatively. Gillies approach in combination with fixation is the most common procedure accounted for 50%. Three-point fixation at infraorbital, maxillary buttress, frontozygomatic suture, and zygomatic arch was the most common site. However, there were no significant associations between the number of fixation and the occurrence of the complication (P = 0.307). About 29.2% in the treatment group and 66% in the conservative group had complications. About 35.7% of patients in treatment group had complications, while 66% had trismus in conservative group.

CONCLUSION

There was a significant association between types of treatment and the occurrence of complication (P = 0.001). However, there were no significant association between number of fixation and the occurrence of complications (P = 0.307).

Motorcycle accident is the main cause of maxillofacial injuries in the Penang Mainland, Malaysia

BACKGROUND/AIM

Maxillofacial injuries are among the commonest forms of body injuries. There are three divisions, namely, facial bone fractures, soft tissue injuries, and dentoalveolar injuries. Etiologies include motor vehicle accidents, assaults, falls, and sporting injuries. The aim of this study was to determine the profiles including the causes of maxillofacial injuries seen in an urban government hospital in the mainland of Penang State, Malaysia.

MATERIALS AND METHODS

This was a cross-sectional study that recruited cases reported within a period of 1 year. The source population was maxillofacial injury patients presenting to the Oral and Maxillofacial Surgery Department of an urban hospital in the Penang Mainland, North Malaysia between May 2007 and May 2008. Cases of patients involved in accidents that occurred outside the reference vicinity were excluded. A case report form was developed and completed by the attending clinicians. Data were analyzed using spss version 12.0.

RESULTS

A total of 194 cases were studied, with the mean patient age being 27.8 (SD 15.20) years. The majority of patients were Malay men between 20 and 29 years of age. The main cause of injury was motorcycle accident (53.6%). The commonest injury (in isolation/combination with other injuries) involved the soft tissues (87.2%), dentoalveolar region (33.4%), and facial bones (23.9%). Laceration was the commonest soft tissue injury, and crown fracture was the most frequent dentoalveolar injury. The facial bone that was most highly involved in the injury was the zygoma. Subjects involved in motorcycle accidents had a significantly higher incidence of sustaining facial bone fractures.

CONCLUSIONS

Motorcycle accidents were the commonest cause of maxillofacial injuries in the Penang Mainland, Malaysia. Most patients were young men. Hence, it is prudent to reinforce appropriate road safety and awareness interventions particularly focusing young male motorcyclists so as to reduce the risk of accidents.

Maxillofacial trauma of pediatric patients in Malaysia: a retrospective study from 1999 to 2001 in three hospitals

OBJECTIVE

Maxillofacial trauma in children is not common worldwide. Domestic injuries are frequently seen in younger children while older children are mostly involved in motor vehicle accidents (MVA). The objective of this study was to analyze the pattern of maxillofacial injuries in pediatric patients referred to three government main hospitals in different areas of West Malaysia.

METHODS

Patients' records of three selected hospitals in Malaysia (National University of Malaysia Hospital, Kajang Hospital and Seremban Hospital) from January 1999 to December 2001 were reviewed. Data associated with demographics, etiology of injury in relation to age group, type of injuries whether soft tissues of hard tissue in relation to age group and treatment modalities were collected.

RESULTS

A total of 521 pediatric patients' records were reviewed. Malays made up the majority of patients with maxillofacial injuries in the three hospitals. Males outnumbered females in all the three hospitals. Injuries commonly occur in the 11-16 years old. MVA was the most common etiology followed by fall and assault. Soft tissue injuries were the most common type of injuries in all the hospitals. In relation to fractures, mandible was the most common bone to fracture with condyle being the most common site. Orbital fracture was the most common fracture in the midfacial area. Most of the fractures were managed conservatively especially in the younger age groups. Open reduction with or without internal fixation was more frequently carried out in the 11-16 years old group.

CONCLUSION

Children exhibit different pattern of clinical features depending on the etiology and stage of their bone maturation. A dedicated team, who is competent in trauma and aware of the unique anatomy, physical and psychological characteristics of children, should manage pediatric patient with trauma.