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Monaro M, Bertomeu CB, Zecchinato F, Fietta V, Sartori G, De Rosario Martínez H. The detection of malingering in whiplash-related injuries: a targeted literature review of the available strategies. Int J Legal Med 2021; 135:2017-2032. [PMID: 33829284 PMCID: PMC8354940 DOI: 10.1007/s00414-021-02589-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present review is intended to provide an up-to-date overview of the strategies available to detect malingered symptoms following whiplash. Whiplash-associated disorders (WADs) represent the most common traffic injuries, having a major impact on economic and healthcare systems worldwide. Heterogeneous symptoms that may arise following whiplash injuries are difficult to objectify and are normally determined based on self-reported complaints. These elements, together with the litigation context, make fraudulent claims particularly likely. Crucially, at present, there is no clear evidence of the instruments available to detect malingered WADs. METHODS We conducted a targeted literature review of the methodologies adopted to detect malingered WADs. Relevant studies were identified via Medline (PubMed) and Scopus databases published up to September 2020. RESULTS Twenty-two methodologies are included in the review, grouped into biomechanical techniques, clinical tools applied to forensic settings, and cognitive-based lie detection techniques. Strengths and weaknesses of each methodology are presented, and future directions are discussed. CONCLUSIONS Despite the variety of techniques that have been developed to identify malingering in forensic contexts, the present work highlights the current lack of rigorous methodologies for the assessment of WADs that take into account both the heterogeneous nature of the syndrome and the possibility of malingering. We conclude that it is pivotal to promote awareness about the presence of malingering in whiplash cases and highlight the need for novel, high-quality research in this field, with the potential to contribute to the development of standardised procedures for the evaluation of WADs and the detection of malingering.
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Affiliation(s)
- Merylin Monaro
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy.
| | - Chema Baydal Bertomeu
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain
| | - Francesca Zecchinato
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy
| | - Valentina Fietta
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy
| | - Giuseppe Sartori
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy
| | - Helios De Rosario Martínez
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain
- CIBER de Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Zaragoza, Spain
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Figueiredo C, Afonso A, Caramelo F, Corte-Real A. Temporomandibular joint trauma and disability assessment - A longitudinal exploratory study. J Forensic Leg Med 2021; 82:102230. [PMID: 34385019 DOI: 10.1016/j.jflm.2021.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Orofacial trauma can encompass, isolated or not, several anatomical regions, namely facial, dental and temporomandibular joint (TMJ), one of the most complex joints in the human body. Evidence-based knowledge in the field of TMJ trauma and in temporomandibular joint disorders (TMD) diagnosis and treatment, provides the necessary data for medico-legal assessment. OBJECTIVE The aim of this study is to bring up epidemiological data referring to TMJ injuries and sequelae, in order to present a medico-legal approach of TMJ disability. METHODS An observational longitudinal exploratory study was performed in the database of the National Institute of Legal Medicine and Forensic Sciences, Portugal, between 2000 and 2017, regarding inclusion and exclusion criteria.Statistical significance was set as P‹0.05, Fisher's exact test, Binomial test and Goodman and Kruskal's test were used. RESULTS Post-traumatic orofacial reports (n = 2622) included 234 TMJ-injury and 149 TMJ-sequelae.Epidemiological data was presented regarding age,gender, professional status and etiology. There was a statistically significant association between TMJ injury and TMJ sequela, despite a weak relation (ƛ = 0.170). No statistically significant association was identified between TMJ-injury/TMJ-sequelae and the professional status, etiology. CONCLUSION The TMJ sequela group is smaller than the TMJ-injury, reflecting that 2/3 of the injuries have been cured without a monetary compensation value and without Health costs. The association between TMJ injury and TMJ sequelae reinforces the necessity of preventive measures in TMJ trauma, namely in physical violence context and in medico-legal impairment.
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Affiliation(s)
- Cristina Figueiredo
- Universidade Católica Portuguesa, Center for Interdisciplinary Research in Health (CIIS), Faculty of Dental Medicine, Viseu, Portugal.
| | | | - Francisco Caramelo
- Faculty of Medicine, Biostatistics and Medical Informatics Laboratory, Coimbra University, Portugal.
| | - Ana Corte-Real
- Faculty of Medicine, Forensic Dentistry Laboratory, Coimbra University, Portugal.
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Tortures alleged by migrants in Italy: compatibility and other medicolegal challenges. Int J Legal Med 2021; 135:2489-2499. [PMID: 34228193 PMCID: PMC8523510 DOI: 10.1007/s00414-021-02646-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
Background Illegal immigration to Europe is a well-known phenomenon whose numbers are being steadily increasing in recent years. Most of the immigrants in Italy come from war zones, and many of them submit an asylum application supported by the complaint to have been victims of persecutory acts in their home countries. Material and methods One hundred ninety-six medicolegal reports are analyzed considering the different country of origin, the type of the lesions claimed, tools used, evidenced effects, location of the perpetration of the physical abuses, and the possible motivation of the alleged torture. Results Greater than 80% of the assessed asylum seekers are over 18-year males coming from African countries. Fifty-eight percent of migrants were tortured or abused in countries of transit, 95% in Libya. Economic, familial, politic, and ethnic reasons prevail in some countries of origin, while tortures or abuses perpetrated in transit countries are mainly linked to forced labor and detention. In the 42.2% of cases, no physical evidence of tortures was detected. The Istanbul Protocol resulted to have been only partly applicable and about 40% of the medicolegal reports are “inconclusive” about the compatibility of physical evidence with the alleged tortures. Conclusions The medicolegal and forensic experts involved in torture and ill-treatment cases should seek specific education and training to lower the risks of underestimation and the rate of inconclusive reports. More extensive implementation of the Istanbul Protocol in daily practice should be pursued by the authorities in charge of asylum or protection releasement.
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Favaretto N, Lionello M, Boscolo-Berto R, Giacomelli L, Rondinelli R, Marioni G. Video-nystagmographic evidence in more than 700 consecutive cases of road traffic whiplash injury. Am J Otolaryngol 2021; 42:102909. [PMID: 33476974 DOI: 10.1016/j.amjoto.2021.102909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.
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Affiliation(s)
- Niccolò Favaretto
- Department of Neurosciences DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Rafael Boscolo-Berto
- Institute of Human Anatomy, Department of Neuroscience DNS, Padova University, Padova, Italy
| | - Luciano Giacomelli
- Department of Neurosciences DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - Gino Marioni
- Department of Neurosciences DNS, Otolaryngology Section, Padova University, Padova, Italy.
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Monaro M, De Rosario H, Baydal-Bertomeu JM, Bernal-Lafuente M, Masiero S, Macía-Calvo M, Cantele F, Sartori G. A model to differentiate WAD patients and people with abnormal pain behaviour based on biomechanical and self-reported tests. Int J Legal Med 2021; 135:1637-1646. [PMID: 33774707 PMCID: PMC8205908 DOI: 10.1007/s00414-021-02572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/11/2021] [Indexed: 11/12/2022]
Abstract
The prevalence of malingering among individuals presenting whiplash-related symptoms is significant and leads to a huge economic loss due to fraudulent injury claims. Various strategies have been proposed to detect malingering and symptoms exaggeration. However, most of them have been not consistently validated and tested to determine their accuracy in detecting feigned whiplash. This study merges two different approaches to detect whiplash malingering (the mechanical approach and the qualitative analysis of the symptomatology) to obtain a malingering detection model based on a wider range of indices, both biomechanical and self-reported. A sample of 46 malingerers and 59 genuine clinical patients was tested using a kinematic test and a self-report questionnaire asking about the presence of rare and impossible symptoms. The collected measures were used to train and validate a linear discriminant analysis (LDA) classification model. Results showed that malingerers were discriminated from genuine clinical patients based on a greater proportion of rare symptoms vs. possible self-reported symptoms and slower but more repeatable neck motions in the biomechanical test. The fivefold cross-validation of the LDA model yielded an area under the curve (AUC) of 0.84, with a sensitivity of 77.8% and a specificity of 84.7%.
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Affiliation(s)
- Merylin Monaro
- Department of General Psychology, University of Padova, via Venezia 8, 35131, Padova, Italy.
| | - Helios De Rosario
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain.,CIBER de Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - José María Baydal-Bertomeu
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain
| | - Marta Bernal-Lafuente
- MAZ, Academia General, Mutua Colaboradora con la Seguridad Social nº 11. AvenidaMilitar 74, 50015, Zaragoza, Spain
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 5, 35128, Padova, Italy
| | - Mónica Macía-Calvo
- MAZ, Academia General, Mutua Colaboradora con la Seguridad Social nº 11. AvenidaMilitar 74, 50015, Zaragoza, Spain
| | - Francesca Cantele
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 5, 35128, Padova, Italy
| | - Giuseppe Sartori
- Department of General Psychology, University of Padova, via Venezia 8, 35131, Padova, Italy
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Improving the staging of neck injuries using a new index, the Neck Functional Holistic Analysis Score: Clustering approach to determine degrees of impairment. PLoS One 2020; 15:e0238424. [PMID: 32903259 PMCID: PMC7480840 DOI: 10.1371/journal.pone.0238424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Traumatic cervical spine injuries are amongst the traffic injuries that can cause most harm to a person. Classifying subtypes of clinical presentations has been a method used in other pathologies to diagnose more efficiently and to address the appropriate treatment and the prognosis. The management of patients suffering from cervical injuries could be improved by classifying the severity of the impairment. This will allow clinicians to propose better treatment modalities according to the severity of the injury. Materials and methods The present study is a retrospective cohort study performed with the clinical data from 772 patients stored at Fisi-(ON) Health Group. All the patients treated for cervical spine injuries are evaluated using the EBI-5® system, which is based on inertial measurement unit (IMU) technology. The normalized range of motion of each patient was incorporated into a single index, the Neck Functional Holistic Analysis Score (NFHAS). Results Clustering analysis of the patients according to their NFHAS resulted in five groups. The Kruskal-Wallis H test showed that there were statistically relevant differences in the ROM values and NFHAS of the patients depending on the cluster they were assigned to: FE X2(4) = 551.59, p = 0.0005; LB ROM X2(4) = 484.58, p = 0.0005; RT ROM X2(4) = 557.14, p = 0.0005; NFHAS X2(4) = 737.41, p = 0.0005. Effect size with ηp2 for the comparison of groups were: FE = 0.76, LB = 0.68, RT = 0.76 and NFHAS = 0.96. Conclusion The NFHAS is directly correlated to the available ROM of the patient. The NFHAS serves as a good tool for the classification of cervical injury patients. The degree of impairment shown by the cervical injury can now be staged correctly using this new classification.
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Favaretto N, Gheller F, Boscolo-Berto R, Tealdo G, Giacomelli L, Rondinelli R, Marioni G. Road traffic whiplash injury in the elderly: Clinical and video-nystagmographic features. Am J Otolaryngol 2020; 41:102497. [PMID: 32345445 DOI: 10.1016/j.amjoto.2020.102497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Whiplash is a type of trauma typically caused by a rear end collision in a road accident. About one in two patients who experience whiplash report dizziness and balance problems, which can severely affect their activities in daily life. In industrialized countries, the number of elderly people with a driving license has increased in recent years. The aims of the present study were to describe the video-nystagmographic features in a consecutive series of elderly patients experiencing whiplash injury in a road accident, comparing them with similar injuries in a group of young adults. METHODS Twenty-seven patients aged 65 years or more and a control group of 32 young adults between 18 and 21 years old were retrospectively selected. All patients underwent oto-vestibular assessment and video-nystagmography. RESULTS After whiplash trauma, vertigo was more common in elderly patients with decreased peak velocity during the saccadic ocular motricity test (p = 0.017) and with evidence of bilateral vestibular hypofunction after caloric stimulation (p = 0.033). Comparing the two age groups, neck pain after the trauma was reported significantly more by young adults (p = 0.003), who also showed more frequently bilateral vestibular hypofunction (p = 0.025). CONCLUSION Clinical and instrumental findings seem to support the hypothesis of a functional lesion to the brainstem regions after a whiplash injury. There is an undeniable need, however, for tools capable of objectively assessing the functional or anatomical damage resulting from whiplash-associated disorders, for both clinical and medico-legal reasons.
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Affiliation(s)
- Niccolò Favaretto
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Flavia Gheller
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Rafael Boscolo-Berto
- Institute of Human Anatomy, Department of Neuroscience DNS, Padova University, Padova, Italy
| | - Giulia Tealdo
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Luciano Giacomelli
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy.
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Can a Chronic BPPV With a History of Trauma be the Trigger of Symptoms in Vestibular Migraine, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Whiplash Associated Disorders (WAD)? A Retrospective Cohort Study. Otol Neurotol 2020; 40:96-102. [PMID: 30303941 DOI: 10.1097/mao.0000000000002020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In patients with chronic benign paroxysmal positional vertigo (BPPV), i.e., chronic vestibular multicanalicular canalithiasis (CVMCC), abnormal signals are transmitted from diseased labyrinths via the healthy vestibular nuclei complex to their end organs. The vestibulo-thalamo-cortical reflex as proposed in vestibular migraine is just one of these reflexes. In a group of patients diagnosed with CVMCC otolith repositioning maneuvers specific for each semicircular canal (SCC) ameliorated pain and other symptoms in 90%. Increased awareness of CVMCC may reduce suffering and continuous medication. OBJECTIVE To evaluate if CVMCC can be the trigger of symptoms in vestibular migraine, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and whiplash associated disorders (WAD). STUDY DESIGN Retrospective consecutive observational cohort study. SETTING Ambulatory at a private Otoneurology Centre. PATIENTS One hundred sixty-three patients with CVMCC and a history of trauma. INTERVENTION Based on the symptoms (structured symptom questionnaire), the patients are post hoc sub grouped according to the criteria of the different diagnoses. MAIN OUTCOME MEASURE Frequency of patients with CVMCC who fulfill the criteria of the different diagnoses. RESULTS 98% of all patients with CVMCC fulfill the Barany Society criteria of a probable vestibular migraine; 17% fulfill the International Classification of Headache Disorders defined vestibular migraine criteria; 63% fulfill the Fukuda criteria of ME/CFS; 100% of the patients with WAD suffer from CVMCC. CONCLUSION This survey supports the hypothesis that CVMCC can be the trigger of symptoms in vestibular migraine, ME/CFS, and WAD. The actual diagnosis the patient receives is often in accordance with the patient's dominant symptom.
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Tenenbaum A, Nordeman L, Sunnerhagen KS, Gunnarsson R. A risk stratification tool for prehospital triage of patients exposed to a whiplash trauma. PLoS One 2019; 14:e0216694. [PMID: 31086405 PMCID: PMC6516661 DOI: 10.1371/journal.pone.0216694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/26/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our aim was to develop a risk stratification model to predict the presence of a potentially more sinister injury in patients exposed to a whiplash trauma. METHODS The study base comprised of 3,115 residents who first sought healthcare contact within one week after being exposed to a whiplash trauma between 1999-2008, from within a defined geographical area, Skaraborg County in south-western Sweden. Information about gender, age, time elapsed prior to seeking care, type of health care contact, and hospitalisation was retrieved. Seventeen potential risk factors were identified and evaluated using multivariable logistic regression. RESULTS Of 3,115 patients, 215 (6.9%) required hospital admission so theoretically 93% could have been initially assessed by primary health care. However, only 46% had their first contact in primary health care. All patients had symptoms resulting in a diagnosis of whiplash injury. Four risk factors were found to be associated with hospital admission: commotio cerebri (OR 31, 19-51), fracture / luxation (OR 11, 5.1-22), serious injury (OR 41, 8.0-210), and the patient sought care during the same day as the trauma (OR 5.9, 3.7-9.5). These four risk factors explained 27% of the variation for hospital admission and the area under curve (AUC) was 0.77 (0.74-0.80). Ninety-six percent of patients (2,985) had only a whiplash injury with no other injury. These could be split into those attending health care the same day as the trauma, 1,737 (56%) with a 7.1% risk for hospital admission, and those attending health care later, 1,248 (40%) with a 1.3% risk for hospital admission. CONCLUSION Patients with no signs of commotio cerebri, no fracture/luxation injury, no serious injury, comprising 96% of all patients exposed to a whiplash trauma can initially be referred to primary health care for initial assessment. However, those contacting the health care the same day as the trauma should be referred to a hospital for evaluation if they can't get an appointment with a general practitioner the same day.
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Affiliation(s)
- Artur Tenenbaum
- Hälsan & Arbetslivet, Occupational Health Care Unit, Region Västra Götaland, Alingsås, Sweden
- Department of Public Health and Community Medicine Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Nordeman
- Research and Development Center Södra Älvsborg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Institute of Clinical Neuroscience—Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ronny Gunnarsson
- Department of Public Health and Community Medicine Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Center Södra Älvsborg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Cutilli T, Scarsella S, Di Fabio D, Oliva A, Continenza MA, Sollecchia G, Necozione S, Bernardi S. Cervical injury related to mandibular fractures. A retrospective study of 315 cases. Cranio 2017; 37:188-195. [PMID: 29115190 DOI: 10.1080/08869634.2017.1398921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective To define the association between mandibular fractures and alterations of the cranio-atlo-axial joint (CAAJ). Methods 315 cases of displaced mandibular fractures were retrospectively evaluated by CT scan and cervical X-ray for associated alterations of the CAAJ. Statistical analysis employed the chi-square and Cohen's kappa coefficient. Results Single fractures amounted to 69.84% and multiple fractures to 30.16% of total fractures. CT scans showed a rotation of the atlas on the same side of single fractures and subluxation of the CAAJ. Vertical derangement of the joint was observed in 79.65% of single fractures and in 20.35% of multiple fractures. Approximately16.19% of all displaced mandibular fractures showed cervical disorders at long-term follow-up. Discussion The outcomes of this study revealed an association between traumatic mandibular fractures and CAAJ, accompanied by clinical disorders. These conditions require clinical attention due to their effects on long-term craniocervical functionality and future forensic issues.
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Affiliation(s)
- Tommaso Cutilli
- a Department of Life, Health & Environmental Sciences - Maxillofacial Surgery Operative Unit , "San Salvatore" City Hospital , L'Aquila , Italy
| | - Secondo Scarsella
- a Department of Life, Health & Environmental Sciences - Maxillofacial Surgery Operative Unit , "San Salvatore" City Hospital , L'Aquila , Italy
| | - Desiderio Di Fabio
- a Department of Life, Health & Environmental Sciences - Maxillofacial Surgery Operative Unit , "San Salvatore" City Hospital , L'Aquila , Italy
| | - Antonio Oliva
- a Department of Life, Health & Environmental Sciences - Maxillofacial Surgery Operative Unit , "San Salvatore" City Hospital , L'Aquila , Italy
| | | | - Giacomo Sollecchia
- a Department of Life, Health & Environmental Sciences - Maxillofacial Surgery Operative Unit , "San Salvatore" City Hospital , L'Aquila , Italy
| | - Stefano Necozione
- b Department of Life, Health & Environmental Sciences , University of L'Aquila , L'Aquila , Italy
| | - Sara Bernardi
- b Department of Life, Health & Environmental Sciences , University of L'Aquila , L'Aquila , Italy
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Methodology for the identification of vulnerable asylum seekers. Int J Legal Med 2017; 131:1719-1730. [DOI: 10.1007/s00414-017-1645-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/04/2017] [Indexed: 12/28/2022]
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