Factors influencing the incidence of maxillofacial fractures

Isolated traumatic orbital floor fracture: An analysis of the National Trauma Data Bank

Objectives

To date, no study provides a comprehensive analysis of traumatic orbital floor fractures across the United States. We aimed to characterize patient demographics, injury-related variables, and operative management in this population.

Method

The National Trauma Data Bank was queried for open or closed orbital floor fractures from 2008 to 2016. Clinical data were extracted.

Results

Overall, 148,592 orbital floor fractures were identified, with 142,577 (95.9%) closed- and 6158 (4.1%) open-type fractures. A total of 106,243 (71.5%) patients were male and the median patient age was 41 years. The majority of patients (79.2%) had abbreviated injury scale scores of ≤2, indicating minor/moderate injury. Fracture mechanism of injury (MOI) differed by gender, with the most frequent being unarmed fights in men (34.3%) and falls in women (14.0%). There were 29,600 patients (19.9%) with isolated orbital floor (I-OF) fractures. The MOI most strongly associated with operative intervention of with I-OF fractures were penetrating injuries caused by a firearm (odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.62-5.20) and cuttings/piercings (OR: 2.17; 95% CI: 1.29-3.65).

Conclusion

This large epidemiological study reveals that orbital floor fractures tend to present with minor or moderate injuries and are more likely to require operative intervention in setting of firearm or cut/pierce injuries.

Novel Design of Interlocking 3-Dimensional Miniplate in Mandibular Angle Fractures: An In Vitro Study

The evolution of osteosynthesis has led to the development of novel miniplate designs, including 3-dimensional (3D) miniplates, which offer improved biomechanical stability. However, mandible fractures resulting from the high impact have a complex fracture configuration. Hence, the authors developed interlocking 3D miniplate to overcome the difficulty in miniplate and screw placement to avoid critical anatomic structures, that is, dental roots and nerve, while still providing stability for the fracture fragments. The interlocking 3D miniplates can be formed according to the specific needs by adjusting the horizontal and vertical cross struts configuration. This study describes a design process of interlocking 3D miniplates and evaluates biomechanical performance compared to standard miniplates. Finite element analysis was performed to evaluate the design's stress state using human and goat mandible models under various loading conditions. After the authors, established that our design was feasible for fabrication, the authors developed the prototype for biomechanical testing. Biomechanical testing was conducted on 10 goat mandibles to compare stability and displacement under various load between the interlocking 3D miniplate and the standard miniplate configuration. Biomechanical testing revealed reduced displacement in all directions with the interlocking 3D miniplate compared to the standard miniplate. Furthermore, there was a significant difference in all loads in the buccal-lingual displacement ( P <0.05). The novel interlocking 3D miniplate design shows an adequate ability to provide stability for fixation for mandibular fractures, as evidenced by finite element analysis and biomechanical testing. Further research is necessary to validate these findings and explore the clinical application of interlocking 3D miniplates in mandibular fracture management.

The State of Craniomaxillofacial Trauma Care in Low- and Middle-Income Countries: A Scoping Review

Objective

This scoping review aims to contribute a descriptive analysis of the craniomaxillofacial trauma (CMF trauma) literature in low- and middle-income countries (LMICs) to identify knowledge gaps, direct future research, and inform policy.

Data Sources

PubMed/MEDLINE, Cochrane Review, EMBASE, ClinicalTrials.gov, and Google Scholar from January 1, 2012 to December 10, 2023.

Review Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided reporting, and the PRISMA flowchart documented database searches. Specific, predefined search terms and inclusion criteria were used for screening, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used for quality assessment. The search yielded 54 articles, with 13 meeting the inclusion criteria. Key findings were summarized and divided into 7 categories.

Results

There were 10,420 patients (7739 [74.3%] male, 2681 [25.7%] female) with a male-to-female ratio of 2.9:1. The mean peak age of incidence of CMF trauma was 30.8 years, ranging from 20 to 40 years. Road traffic accidents were the leading cause (60.4%), followed by assault (27.2%) and falls (12.2%). The most common injuries were soft tissue injury (31.7%), isolated mandibular fracture (22.8%), and isolated middle-third of mandible fracture (18.1%). The most common treatments were closed reduction and immobilization (29.5%), conservative management (27.6%), and open reduction and internal fixation (19.6%). Most patients (77.8%) experienced a treatment delay due to a lack of fixation materials (54.8%) or surgeon unavailability (35.7%).

Conclusion

CMF trauma remains a significant cause of global morbidity, yet there remains a lack of high-quality, CMF trauma-specific data in LMICs. Country-specific investigations are required to enhance knowledge and inform novel interventions. Implementing policy change must be community-specific and account for unique cultural barriers, attitudes, and behaviors to maximize patient care outcomes.

Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients

PURPOSE

The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic.

METHODS

This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed.

RESULTS

The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

Changing trends in maxillofacial injuries among paediatric, adult and elderly populations: A 22-year statistical analysis of 3424 patients in a tertiary care centre in Northwest Italy

BACKGROUND

This retrospective study analysed the epidemiology of maxillofacial trauma over 22 years to assess whether there have been significant changes in the causes and characteristics of fractures in paediatric, adult and elderly populations.

MATERIALS AND METHODS

The following data were collected: age, sex, injury cause and mechanism, fracture site, Facial Injury Severity Scale, associated injuries, time of injury, type of treatment and length of hospital stay. The patients were analysed by age group (children [≤16 years], adults [17-60 years] and elderly [>60 years]) and divided into two time groups (group 1: 2001-2011; group 2: 2012-2022) that were compared to each other. Statistical analyses were performed using SPSS software.

RESULTS

Between 01 January 2001 and 31 December 2022, 3535 patients (2690 males and 845 females, mean age 39.3 years) were admitted for facial fractures. The comparison of the two temporal periods showed a decrease in the prevalence of males (p = .02), in road traffic injuries (p < .001), and in fractures of the lower third of the face (p = .005); there were significant increases in the mean age (p < .001), prevalence of the elderly (p = .006) and in fall- and assault-related injuries (p < .001 and p = .03, respectively). Assault injuries increased only in the 17-60 age group (p = .02) while RTA-related fractures decreased in all age groups (p < .05 for all comparisons). Bicycle accidents increased significantly, with a parallel decrease in motor vehicle accidents (both p < .001). Fall-related fractures increased only in 17-60 and >60 age groups (p < .001 and p = .02, respectively).

CONCLUSIONS

This study shows significant changing trends in the epidemiology of maxillofacial trauma. While road traffic policies have been effective in the last years, preventive measures for falls in the elderly population and new legislative measures to prevent interpersonal violence should be advocated.

Prevalence and pattern of maxillofacial injuries associated with domestic violence: A retrospective study at a major trauma center

BACKGROUND/AIM

This study aimed to analyze the frequency and pattern of maxillofacial injuries associated with domestic violence.

MATERIALS AND METHODS

Medical records of victims of domestic violence between May 2016 and May 2023 were scrutinized retrospectively. The following data were analyzed: gender and age, history of previous abuse, hospital admission, pregnancy, type of facial injuries, anatomical location of injuries, side of injuries, concomitant injuries, mechanism of impact, treatment modality, and history of drug and alcohol abuse.

RESULTS

Seventy-eight patients were included, comprising of 75 (96.2%) women and 3 (3.8%) men. Domestic violence was an etiology of 2.7% of all maxillofacial injuries. The mean age was 27.06 ± 5.5 years. 33.3% of cases had a history of previous domestic violence. The assailant was drug addicted in 47.4% of cases. The attacker was the current partner of the victim in 79.5% of the victims. Soft tissue injuries were found in 96.1% of cases. Maxillofacial fracture was observed in 52.6% of victims among which zygoma was the most common (16.7%) followed by the nose and mandible (15.4%). Isolated fracture was observed in 85.3% of patients and 71.8% of the injuries were observed on the left. Concomitant injuries were present in 51.3% of patients with arms/hands being the most frequent (48.7%). Punch (67.9%) constituted the majority of the mechanism of impact. Based on the statistical analysis, punches resulted in significantly higher soft tissue contusion (p = .046), and injuries that required no intervention were significantly higher in punched victims (p = .002).

CONCLUSION

Maxillofacial soft tissue injuries with or without isolated fracture on the left side of the zygoma, mandibular angle, or nose in association with arms/hands injuries in young adult women could be clues of domestic violence. Appropriate care such as preventive programs for drug or alcohol abuse should be implemented to reduce domestic violence, thereby reducing these injuries.

A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement

INTRODUCTION

Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement.

MATERIALS AND METHODS

Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded.

RESULTS

OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT.

CONCLUSIONS

The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.

Manual versus rigid intraoperative maxillo-mandibular fixation in the surgical management of mandibular fractures: A European prospective analysis

PURPOSE

Intraoperative stabilisation of bony fragments with maxillo-mandibular fixation (MMF) is an essential step in the surgical treatment of mandibular fractures that are treated with open reduction and internal fixation (ORIF). The MMF can be performed with or without wire-based methods, rigid or manual MMF, respectively. The aim of this study was to compare the use of manual versus rigid MMF, in terms of occlusal outcomes and infective complications.

MATERIALS AND METHODS

This multi-centric prospective study involved 12 European maxillofacial centres and included adult patients (age ≥16 years) with mandibular fractures treated with ORIF. The following data were collected: age, gender, pre-trauma dental status (dentate or partially dentate), cause of injury, fracture site, associated facial fractures, surgical approach, modality of intraoperative MMF (manual or rigid), outcome (minor/major malocclusions and infective complications) and revision surgeries. The main outcome was malocclusion at 6 weeks after surgery.

RESULTS

Between May 1, 2021 and April 30, 2022, 319 patients-257 males and 62 females (median age, 28 years)-with mandibular fractures (185 single, 116 double and 18 triple fractures) were hospitalised and treated with ORIF. Intraoperative MMF was performed manually on 112 (35%) patients and with rigid MMF on 207 (65%) patients. The study variables did not differ significantly between the two groups, except for age. Minor occlusion disturbances were observed in 4 (3.6%) patients in the manual MMF group and in 10 (4.8%) patients in the rigid MMF group (p > .05). In the rigid MMF group, only one case of major malocclusion required a revision surgery. Infective complications involved 3.6% and 5.8% of patients in the manual and rigid MMF group, respectively (p > .05).

CONCLUSION

Intraoperative MMF was performed manually in nearly one third of the patients, with wide variability among the centres and no difference observed in terms of number, site and displacement of fractures. No significant difference was found in terms of postoperative malocclusion among patients treated with manual or rigid MMF. This suggests that both techniques were equally effective in providing intraoperative MMF.

The Causes and Prevalence of Maxillofacial Fractures in Iran: A Systematic Review

Background

Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes.

Methods

A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed.

Results

A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low.

Conclusion

Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.

The Effect of Covid-19-Related Social Distancing Restrictions on Maxillofacial Fractures Epidemiology

Background

The purpose of the present study was to evaluate the changes in maxillofacial fracture epidemiology and etiology regarding Covid-19-related social distancing restrictions in an Iranian population.

Methods

A retrospective cross-sectional study was undertaken in six major trauma center hospitals in Iran in a period of two years (March 2018 until March 2020). The primary outcome variable was the maxillofacial fractures incidence. Patients' demographic data, date of injury as well as fracture characteristics, fracture etiology, type, and site were all recorded, compared, and analyzed in the control and experimental groups.

Results

The patients consisted of 520 (83.6%) males and 102 (16.4%) females. Patients sustaining maxillofacial fractures over this two-year period displayed a mean age of 31.24±14.44, with an age range of 2 to 88 years. The incidence of maxillofacial fractures significantly decreased in all age groups (p<0.001). After social distancing restrictions were placed; there was a significant drop in the number of subjects attending due to motorcycle collisions and road traffic accidents, whereas the number of fractures caused by assaults and domestic violence significantly increased (p<0.001 for each).

Conclusion

The investigators realized that social distancing restrictions were able to change the trends and patterns in maxillofacial fracture incidence and etiology.

Cases of Maxillofacial Trauma Treated at Hospitals in a Large City in Northeastern Brazil: Cross-Sectional Study

Maxillofacial trauma is associated with facial deformation, loss of function, emotional and social impacts, and high financial costs. This study investigated cases of maxillofacial trauma in a large Brazilian city through a cross-sectional study conducted at two public and two private hospitals. Primary data of 400 patients were collected through a questionnaire, clinical examination, and tomography. Statistical analysis at the 5% significance level was performed. Motorcycle accident was the major cause of trauma (41%); the most frequent trauma and treatment were mandibular fracture (24.3%) and surgery (71%), respectively. The female sex was more affected only regarding domestic accidents (p = 0.041) and falls (p < 0.001). Motorcycle accidents were more prevalent among 20 to 29 year-olds (p < 0.001), followed by physical aggression (p < 0.001) and sports accidents (p = 0.004). Falls were more frequent among 40 to 59 year-olds (p < 0.001). Mandibular fracture affected males and 20 to 29 year-olds more and was mainly associated with motorcycle accidents (48.2%) and physical aggression (22.7%) (p = 0.008). Nose fracture was more frequent in falls (29.6%), physical aggression (22.5%), and sports accidents (21.1%) (p < 0.001). Compound fracture was associated with motorcycle accidents (84.2%; p = 0.028). Maxillofacial trauma (mandibular, nasal, and zygomatic fractures) was associated with motorcycle accidents, physical aggression, and falls. Surgical treatment, hospital care, and public services were the most frequent.

A Demographic Analysis of Craniomaxillofacial Trauma in the Era of COVID-19

Study Design

Retrospective cohort study.

Objective

The challenges of COVID-19 could magnify socioeconomic vulnerability for craniomaxillofacial (CMF) trauma. This study compares subjects who presented with CMF fractures to a regional healthcare system during the pandemic with those in 2019. We hypothesized societal circumstances of 2020 would correlate with disproportionately more CMF fractures in vulnerable patients compared to pre-pandemic trends.

Methods

An IRB approved retrospective study of CMF fracture presentations in 2019 and 2020 was performed. Demographics, injury details, and management details were collected. A residence-based poverty index was calculated for each subject utilizing census data. Pre-pandemic and pandemic cases were compared to identify differences between cohorts.

Results

A large decrease in presentations was noted between pre-pandemic and pandemic cohorts. There was significantly greater poverty the pre-pandemic cohort as compared to the pandemic cohort (P = .026). Overall, there was a significant correlation between higher poverty and violent MOI (P < .001). This association was maintained pre-pandemic, (P = .001) but was insignificant in the pandemic cohort (P = .108). Difference between cohorts with respect to violent injury was non-significant (P = .559) with non-significant difference in demographics including age (P = .390), place of injury (P = .136), employment status (P = .905), insurance status (P = .580), marital status (P = .711), ethnicity (P = .068), and gender (P = .656). Management was not significantly different between cohorts including percent hospital admission (P = .396), surgical intervention (P = .120), and time to operation (P = .109).

Conclusions

Contrary to our hypothesis, this analysis indicates that the societal changes brought on by the COVID-19 pandemic did not magnify vulnerable populations. Some changes were noted including in volume of presentation, demographic distribution, and injury detail.

World Oral and Maxillofacial Trauma (WORMAT) project: A multicenter prospective analysis of epidemiology and patterns of maxillofacial trauma around the world

BACKGROUND/AIM

The World Oral Maxillofacial Trauma (WORMAT) project was performed to analyze the causes and characteristics of maxillofacial fractures managed in 14 maxillofacial surgery divisions over a 1-year period.

METHODS

The following data were collected: age, sex, cause and mechanism of maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score (FISS), associated injury, day of trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software.

RESULTS

Between 30 September 2019 and 4 October 2020, 2,387 patients (1,825 males and 562 females [ratio 3.2:1], 47.6% aged 20-39 years [mean age 37.2 years, median 33.0 years]) were hospitalised. The main cause of maxillofacial fracture was road traffic accidents (RTA), which were statistically associated with male adults as like as assault, sport, and work (p<0,05). Half of the fractures involved the middle third of the face, statistically associated with fall and assault (p<0.05). Trauma in multiple locations was significantly associated with longer hospital stay (p<0.05). The mean length of hospitalization was 3.9 days (95% Confidence Interval 3.7-4.2).

CONCLUSIONS

This prospective, multicenter epidemiological study confirmed that young adult males were the ones most commonly affected by maxillofacial fracture. RTAs and assaults are statistically associated with the adult population, while falls are associated with females and older population.

A multicentric, prospective study on oral and maxillofacial trauma in the female population around the world

BACKGROUND/AIMS

Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1-year period.

METHODS

The following data were collected: age (0-18, 19-64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization.

RESULTS

Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20-39 years. The main causes were falls (43% [median age, 60.5 years]), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% [median age, 29.5 years]). Assaults (15% [median age, 31.5 years]) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction.

CONCLUSION

Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19-64 years, and they are related to alcohol use.

A multicentric prospective analysis of maxillofacial trauma in the elderly population

BACKGROUND/AIMS

The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world.

METHODS

The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non-parametric and association tests, as well as linear regression.

RESULTS

Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2-7.2). Statistical analysis showed that women were more involved in fall-related trauma compared with males (p < .001). It was also shown that road traffic accidents cause more fractures in the lower third (p < .001) and in the middle third-lower third complex compared with upper third (p < .001).

CONCLUSIONS

Maxillofacial fractures in the elderly were more frequent in European and Australian centres and affected men slightly more than women. Falls were the leading cause of fractures, especially among women. The middle third of the face was most often affected, and conservative treatment was the most common choice for the management of such patients.

The effect of lockdown during SARS-CoV-2 pandemic on maxillofacial injuries in a level I trauma centre: a comparative study

INTRODUCTION

The SARS-CoV-2 pandemic forced many governments to impose nation-wide lockdowns. Government legislation forced limited travel on the population with restrictions on the normal way of life to limit spread of the SARS-CoV-2 virus. The aim of this study is to explore the effects of lockdown on the presentation of maxillofacial trauma in a level I trauma centre.

METHODS

Comparative analysis was carried out using prospective and retrospective review of all consecutive patients admitted with any maxillofacial fracture in the lockdown period between 15th March and 15th June 2020 with the same period in 2019 to a Regional Trauma Maxillofacial Surgery Unit. Data included basic demographics and mechanism of injury including alcohol/drug influence, polytrauma, site of injury and treatment modality including escalation of care.

RESULTS

Across both periods, there were a total of one hundred and five (n = 105) recorded episodes of traumatic fractures with fifty-three (n = 53) in the pre-lockdown cohort and fifty-two (n = 52) in the lockdown. Included patients were significantly (p = 0.024) older during lockdown (mean age 41.44 years SD 20.70, range 5-96) with no differences in gender distribution between cohorts (p = 0.270). Patients in lockdown were more likely to be involved in polytrauma (p < 0.05) and have sustained their injury by cycling/running or any outdoor related activity (p = 0.013). Lockdown saw a significant reduction in alcohol and drug related violence (p < 0.05). Significantly more patients required operative management (p = 0.038).

CONCLUSION

Local lockdowns form part of the governments public health strategy for managing future outbreaks of SARS-CoV-2. Our study showed no significant reduction in volume of trauma during lockdown. It is vital that hospitals maintain trauma capacity to ensure that patients are treated in a timely manner.

Surgical Management of Facial Fractures in Geriatric Patients

ABSTRACT

Facial fractures comprise a substantial part of traumatology. Due to aging of the population, over the last 20 years, there has been a pattern of redistribution of these fractures with a higher incidence at an older age. The aim of this study was to retrospectively analyze the epidemiology, pattern, and surgical management of facial fractures in geriatric patients presenting at a single tertiary trauma center.This study included patients aged ≥70 years who presented with facial bone fractures between 2008 and 2017 and were treated with surgical interventions. Parameters such as age, sex, American Society of Anesthesiologists classification, Glasgow Coma Scale score, fracture type, fracture mechanism, concomitant injuries, duration of hospitalization, and postoperative complications were evaluated.A total of 300 patients were included: 118 men (39.3%) and 182 women (60.7%). The mean age was 78.8 years. An orbital floor fracture was the most common injury (35.1%). The most common cause of fracture was a fall at home (67%). A total of 113 patients (37.7%) had 162 concomitant injuries, 35 patients (11.7%) suffered from polytrauma, and 7 patients developed postoperative complications. The average length of stay was 1.67 days in the intensive care unit and 5.50 days in the standard ward. Polytrauma, pre-existing medical conditions, and oral anticoagulation had a significant impact on the duration of hospitalization.Facial fractures are common in combination with other injuries. Women are more often affected than men, and falling at home is the most common cause of facial injuries. Postoperative complications are rare.

Protective Effects of Helmet Type on Facial Injuries

ABSTRACT

The compulsory use of helmet by motorcyclists has lowered the incidence of facial trauma, but there are few studies evaluating the effects of different helmet types on such injuries. The authors collected retrospective data from the medical records of 287 motorcyclists presenting facial injuries treated at the maxillofacial surgery department of the "University Magna Graecia" of Catanzaro city in South Italy between 1 January 2007 and 1 August 2018. Patients were wearing 2 types of crash helmets at the time of the trauma, full face ones or open-face ones, and were compared using the Facial Injury Severity Scale (FISS). Those wearing open-face helmet were 3 times more than those wearing full-face helmet, with a higher FISS score.The purpose of this study was to investigate the impact of Italy's compulsory helmet law on the change in helmet use and in particular if protection offered by helmets w4as different according to helmet type. The authors correlated the FISS scores among motorcyclists wearing these 2 tipologies of crash helmet.

Assault-related facial fractures: does the injury mechanism matter?

This study clarified the injury characteristics and occurrence of associated injuries in patients with assault-related facial fractures. Data from 840 assault-related facial fracture patients were included; demographic factors, facial fracture type, associated injuries, alcohol use, and injury mechanisms were recorded. Assault mechanisms most often included combinations of different mechanisms (57.5%) and resulted in the victim falling (50.1%). The perpetrator was most commonly a stranger (52.5%) and acted alone (57.7%). A total of 123 patients (14.6%) had associated injuries, with the most common being traumatic brain injury. Associated injuries occurred most frequently in patients with combined fractures of the facial thirds (24.2%) and upper third fractures (42.9%). The most significant differentiating factors for associated injuries were the number of perpetrators, falling, the use of an offensive weapon, and if the events of the assault remained unknown. In adjusted logistic regression analyses, statistically significant associations with associated injuries were found for age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.07; P < 0.001), falling due to the assault (OR 2.87, 95% CI 1.49-5.50; P = 0.002), and upper third facial fractures (OR 6.93, 95% CI 2.06-23.33; P = 0.002). A single punch also caused severe injuries and should therefore not be overlooked, as this can be as dangerous as other assault mechanisms.

The Role of a Deep Neuromuscular Block in the Treatment of Mandibular Subcondylar Fractures

ABSTRACT

Mandibular fractures are the third most frequents maxillo-facial fractures. Most frequent site is the subcondylar region. Different approaches to reach subcondylar region, have been described. In the study was evaluated the advantages of neuromuscular block during endoscopic surgery for subcondylar fractures. Twenty-five patients affected by subcondylar fractures were enrolled in this study and divided in 2 groups; group A: patients who received an intraoperative booster of curare during surgical procedure and group B patients who underwent surgery treated without the intraoperative booster of curare. All patients were treated successfully by endoscope-assisted transoral approach. The analysis of time required for surgery showed a reduction in group A comparing to group B. The mean time for surgery for the patients in group B with displacement between 0° and 45° was 170 minutes, and for 45° to 90° was 230 minutes. In group A, the mean time was 117.5 minutes for patients with condylar displacement between 0° and 45°, and 147.5 minutes for the other group. In conclusion, deep neuromuscular block seems to improve the surgical conditions in patients undergoing subcondylar endoscopic assisted surgery, further study needs to assess this surgical technique in order to better define this surgical protocol.

Maxillofacial trauma in the gulf countries: a systematic review

PURPOSE

The objective of this review was to determine the prevalence, major causative factors and the most common sites of Maxillofacial Trauma in the Gulf Cooperation Council (GCC) Countries.

METHODS

All articles that were published in the English language in the databases such as Google Scholar, EBSCO, PubMed, NCBI, Medline, COCHRANE, ELSEVIER and SCOPUS were reviewed for MFT from GCC during the last 23 years.

RESULTS

A total of 19,151 patients (16,567 males and 2584 females) (86-14%) with an age range between 0 and 97 years were included in the study. In all of the Gulf countries males outnumber females in terms of maxillofacial injuries with a ratio of 6.4:1. The mandible was the most common site of trauma followed by the maxilla. Road Traffic Accidents (RTA) was the most common cause of injury in the GCC followed by falls.

CONCLUSION

Maxillofacial injuries are highly prevalent, distributed among the Gulf countries, and is mainly caused by RTAs especially among males who are highly prone to MFT in the gulf. The reasons are due to lack of road safety culture and weak enactment of traffic legislation, other possible factors include intrinsic car safety features, high speed driving and the amount/use of highways in these societies.

An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients

Background

Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention.

Methods

A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients’ medical records. Statistical analysis was performed. A value of p < 0.05 was considered statistically significant.

Results

The incidence of maxillofacial fractures was high among patients in the 20–29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions (p = 0.001, p = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks (p = 0.001).

Conclusions

Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20–29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01503-5.

Epidemiology of facial fractures: incidence, prevalence and years lived with disability estimates from the Global Burden of Disease 2017 study

BACKGROUND

The Global Burden of Disease Study (GBD) has historically produced estimates of causes of injury such as falls but not the resulting types of injuries that occur. The objective of this study was to estimate the global incidence, prevalence and years lived with disability (YLDs) due to facial fractures and to estimate the leading injurious causes of facial fracture.

METHODS

We obtained results from GBD 2017. First, the study estimated the incidence from each injury cause (eg, falls), and then the proportion of each cause that would result in facial fracture being the most disabling injury. Incidence, prevalence and YLDs of facial fractures are then calculated across causes.

RESULTS

Globally, in 2017, there were 7 538 663 (95% uncertainty interval 6 116 489 to 9 493 113) new cases, 1 819 732 (1 609 419 to 2 091 618) prevalent cases, and 117 402 (73 266 to 169 689) YLDs due to facial fractures. In terms of age-standardised incidence, prevalence and YLDs, the global rates were 98 (80 to 123) per 100 000, 23 (20 to 27) per 100 000, and 2 (1 to 2) per 100 000, respectively. Facial fractures were most concentrated in Central Europe. Falls were the predominant cause in most regions.

CONCLUSIONS

Facial fractures are predominantly caused by falls and occur worldwide. Healthcare systems and public health agencies should investigate methods of all injury prevention. It is important for healthcare systems in every part of the world to ensure access to treatment resources.

A Retrospective Study of Condylar Fracture Management in a Tertiary Care Hospital-A 10-Year Experience

Introduction

Since the advent of rigid fixation, there has been a paradigm shift in the management of condylar fractures from closed treatment options to open reduction and rigid internal fixation.

Materials and Method

Sixty-eight cases of condylar fractures reporting to Vydehi Institute of Dental Sciences, Bangalore, between 2009 and 2018 were reviewed in terms of age, sex, type of fracture, position of the mandibular third molar and the treatment rendered.

Results

The majority of the patients were males (60). There was an involvement of the right side in 34, left in 21 and bilateral involvement in 13 cases. Forty-three of the fractures were subcondylar, and 25 were intracapsular. Significantly in most cases, the mandibular third molar was either fully erupted (42) or missing (12). Sixty-one cases were subjected to surgical management including 49 cases of rigid internal fixation, and 12 of the intracapsular fractures had the condylar stump/segment removed. Only seven cases were not treated surgically. Most of the cases (44) were in the age group of 21-40, 12 were in the age group of 41-60, 9 were in the age group of 1-20, and 3 patients were above 60.

Conclusion

Condylar fractures more often do not require surgical intervention, and their incidence is more likely to occur when the third molar is either fully erupted or missing.

Comprehensive analyses of maxillofacial fractures due to non-professional sports activities in Italy

BACKGROUND/AIM

Sports activities have become increasingly popular among amateurs and this has led to an increase in maxillofacial fractures. The aim of this study was to investigate the management of amateur sport-related maxillofacial fractures and appropriate preventive measures.

METHODS

A trauma database was used to analyze 3231 patients with maxillofacial fractures admitted to the Maxillofacial Surgery Division of Città della Salute e della Scienza Hospital, Turin, Italy, from January 2001 to December 2019. Only patients with non-professional sports-related maxillofacial fractures were included. The following data were collected: age, gender, type of sport, mechanisms of injury, sites of fracture, Facial Injury Severity Scale, associated injuries, month of trauma, time to treatment, treatment, length of stay, and interval before return to sport.

RESULTS

There were 432 patients, 378 males and 54 females, with a mean age of 29.2 (5-76 years). Sport-related maxillofacial fractures' relative percent ranged from 11.1% in 2001 to 17.5% in 2019. Soccer was the most common cause of sport-related maxillofacial fractures (54.2%), and impact with a player/opponent was the main mechanism of injury (72%). An intentional violent act (player hit by a fist) was the cause of fracture in 8.5% of the soccer-related injuries. Fractures of the middle third of the face occurred in 61.2% of patients. Maxillofacial fractures were treated within 24 h in 25% of patients. There were 343 out of 412 patients who received open reduction and internal fixation (mean length of hospital stay: 3.7 days). There was no contraindication to resuming sport activities at 30/40 days after treatment, except for combat sports.

CONCLUSIONS

This study provided further evidence of a relative increase in sports-related maxillofacial fractures. Soccer is related to the majority of sport maxillofacial fractures. Adherence to the rules is necessary to limit violent acts that cause such injuries. In non-professional players, resumption of the full activity is allowed after 40 days for non-combat sports.

Maxillofacial and dental-related injuries from a Brazilian forensic science institute: Victims and perpetrators characteristics and associated risk factors

Background

Trauma due to external causes represents one of the greatest challenges for public health services in different regions around the world. This study aimed to determine the prevalence of facial trauma, associated risk factors, and classification of body injuries in individuals who underwent forensic examination in a Brazilian center.

Material and Methods

Data were collected at the Ceará State Forensic Medicine unit in a 12-year period. Sociodemographic data related to the etiological agent and lesions resulting from the bodily injury were recorded.

Results

Among 1,031 physical injury exams, physical aggression (p<0.001), male victims aged between 21 and 30 years (p<0.001), salaried workers (p<0.001), and soft tissue and dentoalveolar injuries were significant findings. Regarding aggression, domestic violence was prevalent (p<0.001), perpetrated by the victim's partner (p<0.001), using a blunt instrument during the aggression (p<0.001), and directly associated with soft tissue injury (p<0.001). In traffic accidents, the most common type was motorcycle accident (p<0.001), on weekdays (p=0.036), at nighttime (p=0.134), showing a significant association with bone fractures (p=0.001).

Conclusions

Oral and maxillofacial injuries obtained from a Brazilian forensic science center were significantly associated with sociodemographic and etiological factors. Key words:Forensic dentistry, facial trauma, violence, public health.

Head and neck injury in major trauma in Ireland: a multicentre retrospective analysis of patterns and surgical workload

PURPOSE

Head and neck injuries are common in major trauma patients, but the prevalence is poorly documented in the literature. This study aims to investigate this further, particularly in the context of increasing development of Irish and European trauma systems.

AIMS

To determine the prevalence of, and patterns behind head and neck injury in major trauma in an Irish population.

MATERIALS AND METHODS

The Trauma Audit Research Network database was analysed for major trauma patients (injury severity score > 15) with head and neck injuries admitted to any of the 26 participating hospitals in the Republic of Ireland between 2014 and 2017. The data was studied for patterns in the epidemiology of injuries and outcomes.

RESULTS

A total of 5364 patients were identified. Males were affected more than females (M:F 2.1:1). The most common mechanism of injury was falls. There were 1272 counts of soft tissue injury, and 5814 counts of bony injury recorded within the cohort. Twenty-six percent of patients underwent some form of surgical procedure. Median length of hospital stay was 8 days, and the 30-day survival rate was 90%.

CONCLUSIONS

A substantial number of Irish major trauma patients of all ages and genders sustain some form of head and neck injury. It produces significant injury and surgical workload involving input from multiple disciplines.

Epidemiological Analysis of Zygomatic Bone Fractures in North-Western Romanian Population: A 10-Year Retrospective Study

BACKGROUND/AIM

Midface fractures represent a challenge for medical practitioners due to the severe esthetic and functional consequences. This study aimed to determine the causes and to provide a demographic analysis of zygomatic bone fractures in our geographical area, with a view to implementing the necessary prevention methods, training the medical staff for a certain type of patients and decreasing the required costs.

PATIENTS AND METHODS

A retrospective statistical epidemiological analysis of 242 patients with zygomatic bone fractures over a 10-year period was performed.

RESULTS

The most affected age group was 20-29 years (27.27%). The most affected were men (n=211, 87.19%) from urban areas (n=140, 57.85%), and without education (n=122, 50.41%). The most frequent cause was interpersonal violence (54.04%), followed by falls (17.36%) and road traffic accidents (16.53%).

CONCLUSIONS

Interpersonal violence as a cause of zygomatic bone fractures is currently reaching epidemic proportions. Taking legal measures to prevent aggression is a public health emergency that would considerably decrease the incidence of these fractures in our population.

Epidemiological pattern of maxillofacial fractures in northern China: A retrospective study of 829 cases

This study was performed to examine the epidemiological features of maxillofacial fracture, including the incidence, causes, age and sex distribution, methods of treatment, and prognosis, in a local area.A retrospective study was performed to investigate the epidemiological characteristics of 829 patients with maxillofacial fractures treated in a hospital in northern China from August 2011 to July 2019. Sex, age, etiology, fracture site, and treatment method were obtained from the medical records.The average age of all 829 patients was 36.1 years, and most patients were in the 20- to 29-year age group. The male to female ratio was 3.04:1.00. Traffic accidents were the main cause of the maxillofacial fractures. The mandible was the most commonly fractured bone, and the parasymphysis was the most frequently affected site. Head injury was the most common associated injury. Open surgery with internal fixation was the first-choice treatment for most cases.Traffic accidents were the main cause of maxillofacial fractures, followed by falling. Open surgery with internal fixation was the leading treatment choice. Both functional and esthetic outcomes should be considered in the treatment of maxillofacial fractures.

Smoking and alcohol drinking and risk of non-union or delayed union after fractures: A protocol for systematic review and dose-response meta-analysis

INTRODUCTION

To the best of our knowledge, there is no consensus on dose-response between smoking, alcohol drinking, and bone healing. The aim of the present study is to conduct a comprehensive systematic review and dose-response meta-analysis of studies to estimate the influence of smoking and alcohol use on the success of non-pathologic bone fracture healing in adult patients.

METHODS

A systematic search will be performed using MEDLINE, EMBASE and Cochrane CENTRAL, CINAHL, and AMED databases to identify randomized controlled trials and observational studies which have assessed the effect of smoking or alcohol drinking on fracture healing. Primary outcomes include delayed union or nonunion rate and time to union. Secondary outcomes are common complications which occur during bone healing including malunion and wound infection. Risk of bias will be evaluated using the Quality In Prognosis Studies (QUIPS) tool for quality assessment of each study. Dose-response meta-analysis will be performed between smoking, alcohol drinking, and bone healing. Evaluation of the quality of evidence will be conducted using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

RESULTS

The present study will assess the effects of smoking and alcohol drinking on non-pathologic bone fracture healing in adult patients.

CONCLUSION

We hope that this systematic review and dose-response meta-analysis will provide high quality evidence on dose-response between smoking, alcohol drinking, and bone fracture healing.

PROSPERO REGISTRATION NUMBER

CRD42019131454.

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.

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.

Risk of Ischemic Stroke After a Facial Bone Fracture in Elderly Patients

BACKGROUND

Ischemic stroke is a major disease in our aging society, and the incidence of facial bone fractures among the elderly has increased. However, there have been few studies evaluating stroke after facial bone fractures. The purpose of this study was to investigate the frequency and risk of stroke after facial bone fractures.

METHODS

This study included patients 65 years or older with a diagnosis of facial bone fracture (study group) and patients who had previously undergone plastic surgery procedures such as mass excisions or cosmetic surgery (control group) from 2006 to 2015. We evaluated the incidence of new-onset ischemic stroke and its associated risk factors during a 1-year follow-up period. Patients were excluded if they had a history of stroke or if they were lost to follow-up during the course of the study period.

RESULTS

There were no demographic differences between the 2 groups except in age. According to the hazard ratio, the study group had a significantly higher risk of ischemic stroke than did the control group during the follow-up period. There was an identified interaction between the sexes. Only the women in our study group had an increased risk of ischemic stroke that was statistically significant. After adjusting for the risk factors, the increased stroke risk in patients in the study group persisted at about the same level as in the unadjusted analysis. Regarding the stroke-free survival rates, the curve also showed that the study group had a significantly lower 1-year stroke-free survival rate.

CONCLUSIONS

Facial bone fractures are associated with increased risk of stroke at 1-year follow-up among elderly patients, particularly women.

[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.

Immune Response in Patients with Mandibular Fracture Complicated with Suppuration of a Bone Wound

Modern clinical observations focused on the increasing complications at the open mandible fracture, which indicated about severe immune suppression in patients with this pathology. For estimation cellular immunity in a peripheral blood there were examined 25 patients in basic group (15 men, 10 women) with mandible fracture, complicated with abscess of a bone wound; control group included 20 practically healthy persons (10 men and 10 women). To assess cellular immunity in the peripheral blood were determined: absolute number of leukocytes, relative amount of lymphocytes; phagocytic activity. Determination relative number of T–lymphocytes (phenotype CD2+, СD3+) and B – lymphocytes (phenotype СD22+) was performed by method of immunofluorescence with monoclonal antibodies. In a case of mandible fracture, complicated with abscess of bone wound and leukocytosis, in the patients were reduced parameters of cellular immunity: on 40.3% – phagocytic index, on 47.7% – phagocytic number, on 43.9% – content of CD2+– and CD3+– lymphocytes. Content of null cells was increased on 76.8 %

3D reconstruction images of cone beam computed tomography applied to maxillofacial fractures: A case study and mini review

Maxillofacial injuries can be complex and are clinically important due to their functional and cosmetic significance. Maltreated and missed fractures might cause deformity of the face; thus, accurate evaluation of the fracture provided by X-ray images is critical. In this study, we explore the application of cone-beam computed tomography (CBCT) for diagnosis of severe maxillofacial traumas. A patient with a complex fracture that affects the maxilla, mandible, wall of the maxillary sinus, zygoma, zygomatic arch and nasal bone was diagnosed using 3D reconstruction of CBCT images. This diagnostic approach provides detailed information obtained by static images and a systematic model with unique advantages for the following pre-surgical evaluation, surgical treatment and prognostic assessment of complex maxillofacial fractures.

Occupational group, educational level, marital status and deleterious habits among individuals with maxillofacial fractures: retrospective study

Background

To investigate the occupational profile, educational level, marital status and deleterious habits to the health of patients with maxillofacial fractures of a population of northeastern Brazil.

Material and Methods

A retrospective study of patients records admitted to the Division of Oral and Maxillofacial Surgery at the Walter Cantídio University Hospital (Fortaleza, Brazil) who sustained maxillofacial fractures was conducted in the period between 2006 and 2015.

Results

A total of 338 patients rendered 355 fractures. Males were the most affected (p<0.001), with prevalence in the third decade of life (p<0.001). There was a predominance of motorcycle accidents (p<0.001), home workers (p<0.001), low educational status (p = 0.032), and no cigarette use (p<0.001) or alcohol (p = 0.023). Fractures of the zygomatic-orbital complex were the most prevalent in the sample (p<0.001).

Conclusions

The sociodemographic profile exerted a significant influence on the epidemiological profile of maxillofacial fractures in a Brazilian population during the study period.

Key words:Epidemiological studies, trauma, facial bones.

Epidemiology and patterns of facial fractures due to road traffic accidents in Taiwan: A 15-year retrospective study

OBJECTIVE

The facial region is a commonly fractured site, but the etiology varies widely by country and geographic region. To date, there are no population-based studies of facial fractures in Taiwan.

METHODS

We conducted a retrospective study of patients diagnosed with facial fracture and registered in the National Health Insurance Research Database of Taiwan between 1997 and 2011. The epidemiological characteristics of this cohort were analyzed, including the etiology, fracture site, associated injuries, and sex and age distributions.

RESULTS

A total of 6,013 cases were identified that involved facial fractures. Most patients were male (69.8%), aged 18-29 years (35.8%), and had fractures caused by road traffic accidents (RTAs; 55.2%), particularly motorcycle accidents (31.5%). Falls increased in frequency with advancing age, reaching 23.9% among the elderly (age > 65 years). The most common sites of involvement were the malar and maxillary bones (54.0%), but nasal bone fractures were more common among those younger than 18 years.

CONCLUSION

Most facial injuries in Taiwan occur in young males and typically result from RTAs, particularly involving motorcycles. However, with increasing age, there is an increase in the proportion of facial injuries due to falls.

Functional Treatment of a Child with Extracapsular Mandibular Fracture

Condylar fractures are among the most frequent fractures in the context of traumatic lesions of the face. The management of condylar fractures is still controversial, especially when fractures occur in children: if overlooked or inappropriately treated, these lesions may lead to severe sequelae, both cosmetic and functional. The therapy must be careful because severe long-term complications can occur. In this case report, the authors present a case of mandibular fracture in which the decision between surgical therapy and functional therapeutic regimen may be controversial due to the particular anatomy of the fracture line and the age of the patient.

The epidemiological analysis of maxillofacial fractures in Italy: The experience of a single tertiary center with 1720 patients

PURPOSE

Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable, and its analysis is crucial to establish effective treatment and prevention of these injuries. However only two works have been published about maxillofacial fracture epidemiology in Italy.

MATERIALS AND METHODS

The records of 1720 patients diagnosed with maxillofacial fractures in a 15-years period (2001-2015) in our department were retrospectively reviewed.

RESULTS

A total of 1108 male and 612 female patients were included in the study. The most frequent aetiology of fracture was road traffic injuries (57.1%), followed by assault (21.7%), falls (14.2%), work accidents (3.5%), sport accidents (3.3%) and other causes (0.2%). Significant variations of aetiology were detected between males and females and between Italians and individuals from other countries. The most frequently observed fracture involved the mandible (861 cases, 36%), followed by zygoma (489 cases, 20.4%), orbital walls (386 cases, 16.1%) and maxilla (282 cases, 11.8%).

CONCLUSION

Road traffic legislation enforcement and continuous public education regarding the use of security devices remain an ongoing problem in our region and should be encouraged. In the same way, as migration flows influence and change the epidemiology of facial traumas, it is crucial to establish social support programs that avoid these disadvantaged categories of victims of violence and crime.

Maxillofacial fractures in a budding teaching hospital: a study of pattern of presentation and care

INTRODUCTION

Previous reports indicated that there is geographic and sociodemographic variation in the epidemiology of maxillofacial fractures. Audit of maxillofacial injuries managed at any institution is therefore necessary to understand the trends and proffer strategies for prevention. We therefore embarked on this study to determine the pattern of maxillofacial fractures and concomitant injuries in our institution.

METHODS

We carried out a retrospective review of information on demography, aetiology and type of maxillofacial fracture, patients' status, type of crash, level of consciousness and concomitant injuries. The data collected was analysed with SPSS Version 20.

RESULTS

A total of 233 patients aged 2 to 66 years were reviewed. A higher male preponderance (M:F 3.4:1) was observed. Road traffic crashes (RTC) accounted for 78.5% of injuries. Motorcycle related crashes were responsible for 69.4% of RTC and 54.5% of all fractures. Fracture of the mandible (63.2% n=172) was the most predominant skeletal injury and the body (25% n=43) was the most common site of fracture while the zygoma (29%) was predominantly affected in the midface. Ninety three patients (40%) suffered loss of consciousness. The relationship between aetiology of injuries and consciousness level of the patients was statistically significant (p=0.001). Of the 43 patients who had concomitant injuries, craniocerebral affectation (60.5%) was the commonest.

CONCLUSION

RTC remains the major aetiology of maxillofacial fractures. The mandible was mostly affected and nearly half of the patients have associated loss of consciousness. There is need for continual advocacy and enforcement of laws on preventive measures among road users.

Analysis of Fractured Mandible Over Two Decades

Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects such as chewing, speaking, and swallowing become very important.In this study, a retrospective analysis of 419 mandible fractures in 283 patients was performed in relation to epidemiologic factors, treatment strategies, and complications. The average age was 32.14 years (4-69 years). The male/female ratio was 4/1. The most frequent etiologic factor was interpersonal violence (104 patients, 36.7%). The parasymphysis region was the mostly affected site (28.4%). A total of 157 patients (55.5%) were presented with single fracture and the rest with 2, 3, or 4 fracture lines on the mandible. The most common fracture combination was angulus-parasymphysis fracture combination (24.6%). Open reduction and fixation with mini plates and screws was the most preferred treatment strategy (48.2%). Transient short arch bars were not used intraoperatively for any of the patients. There was not any difference in terms of complications between the patients treated with plating systems and plating systems plus intermaxillary fixation.In conclusion, proper treatment of mandible fractures is critical. Except certain fracture types, the usage of intermaxillary fixation as an adjunct to fixation with plating systems is not necessary.

Mandibular Subcondylar Fractures: A Review on Treatment Strategies

Condylar injuries are often subjected to discussion and controversy in maxillofacial surgery as they constitute many of the facial fractures. The condylar area has a great clinical value due to its important components. Vital components in this area are susceptible to functional disability due to either the fracture itself or the subsequent surgical intervention. Each of the strategies for the management of these fractures has its advantages and disadvantages. As there are controversies around management of condylar fractures, different treatment modalities are suggested in literature, so this paper reviews different treatment strategies of the following types of fractures in adults: 1-Closed reduction with maxillomandibular fixation, 2-Open reduction with internal fixation, 3-Endoscopic-assisted reduction with internal fixation. In conclusion, we declare that the endoscopic surgery is certainly a good replacement for approaches through the skin, for subcondylar fractures, but still more randomized clinical trials are needed to be carried out on this issue.