A retrospective analysis of 189 patients of maxillofacial injuries presenting to a tertiary care hospital in Punjab, India

A Novel Method for Quantitative Three-Dimensional Analysis of Zygomatico-Maxillary Complex Symmetry

To develop a reliable and accurate method to quantify the symmetry of the zygomaticomaxillary complex (ZMC).

Epidemiological Profile of ENT Emergencies: Our Experience

Emergencies in otorhinolaryngology are common occurrence. Early diagnosis and management result in reduction in morbidity and mortality. To assess the epidemiology, pattern and distribution of ENT emergencies at a tertiary level hospital. Cross sectional, retrospective, descriptive study over a period of 5 years. Medical records of these patients were studied, noting the age, sex, diagnosis on admission and outcome of emergency care. A total of 38,793 patients, age ranging from 15 days to 85 years were included in the study. The number of male and female patients were 25,971 (66.95%) and 12,822 (33.05%) respectively and the male to female ratio 2:1. The most commonly encountered emergency was epistaxis, which accounted for 25.58% of the emergencies attended. This was followed by ear ache and ear discharge. The ENT emergency ward plays a key role in the management of life-threatening conditions requiring immediate evaluation and management by specialized physician. It is important to prioritize and reduce the number of non-urgency/emergency cases attending the emergencies in order to ensure proper care is given to the emergency cases.

Natural variation of the zygomaticomaxillary complex symmetry in normal individuals

OBJECTIVE

The study aim was to investigate variations in the symmetry of the zygomaticomaxillary complex (ZMC) in normal individuals.

METHOD

Computed tomography datasets of 200 individuals without facial fractures were analyzed using a validated three-dimensional analysis technique. The absolute average distance (AD) and 90th percentile distance (NPD) were calculated, representing respectively the overall and maximum symmetry between bilateral ZMCs.

RESULTS

The mean AD and NPD of the total study group was 0.9 ± 0.3 mm (95% CI 0.3-2.3) and 1.7 ± 0.5 mm (95% CI 0.5-3.9), respectively. The mean AD and NPD in males were 1.0 ± 0.3 mm (95% CI 0.28-2.34) and 1.9 ± 0.5 mm (95% CI 0.5-3.9) versus 0.8 ± 0.3 mm (95% CI 0.4-1.7) and 1.6 ± 0.5 mm (95% CI 0.8-2.9), respectively, for females. A statistically significant difference between male and female was found for both AD and NPD (p < 0.01). The male population <40 years had a mean AD and NPD of 1.0 ± 0.3 mm and 1.8 ± 0.5 mm, which was not statistically significant when compared with males >40 years.

CONCLUSION

The naturally occurring anatomic variation in ZMC symmetry described in this study is proposed as a benchmark for evaluating the amount of preoperative displacement and postoperative reduction of ZMC in trauma cases.

Submental intubation for airway management of patients with complex caniomaxillofacial injuries: Our experience

Context:

There is paucity of data regarding the role of submental intubation (SI) in the airway management of patients with craniomaxillofacial trauma from India.

Aims:

To study the characteristics of patients presenting with craniomaxillofacial injuries requiring submental intubation, the duration of SI procedure and complications of this technique.

Settings and Design:

Tertiary level, teaching institute, retrospective, observational study.

Materials and Methods:

Forty patients requiring submental intubation between June, 2007 and December, 2009. The primary outcome measure was the time required for submental intubation defined as starting from the completion of the orotracheal intubation to the fixation of the submental tube. The secondary outcome measures included characteristics of patients with craniomaxillofacial injuries, intraoperative and postoperative complications of the SI technique.

Statistical Analysis Used:

Data are presented as mean± standard deviation and frequency and percentages, where relevant.

Results:

Most of the patients were young (average age = 35.15 ± 12.02 years), males (75%) and sustained craniomaxillofacial injuries due to road traffic accidents (85%). The 40 patients included in this audit had 56 injuries recorded at the time of admission including, orthopedic injuries in 65% and head injuries in 55% of patients. The mean time required for completion of SI was 8.90 min. The complications observed included, intraoperative tube migration, development of extra oral fistula, and sialocele, in one patient each.

Conclusions:

Submental intubation is a simple, safe, quick, and relatively harmless alternative to tracheostomy for securing the airway in selected patients with craniofacial trauma. Familiarity with the submental intubation technique will help the anesthesiologist to avoid tracheostomy in selected patients with craniofacial trauma who do not require long-term mechanical ventilation.

Etiology, incidence and patterns of mid-face fractures and associated ocular injuries

A prospective study on mid-face fractures was carried out in the Department of Oral and Maxillofacial Surgery at College of Dentistry, Indore, from August 2007 to September 2009 to analyze etiology, incidence and patterns of midface fractures and associated ocular injuries. Two hundred patients were included in this study, amongst those who reported to the Department of OMFS, College of Dentistry, Indore. After confirmed diagnosis of mid face fracture all the patients were stratified according to age, sex, cause of the accident, influence of alcohol, location, type of fractures and associated ocular injuries. The study included 200 patients with a mean age of 29.6 years. The most frequently injured patients belonged to the 21-30 year-old age group. The male predilection was 76 %. Road traffic accident was the most common causative factor (64 %), followed by assault (21 %), cases of fall (9.5 %) and other causes (5.5 %). The most common fracture in this study was found to be zygomatic complex fractures (62.5 %) (more in the age group of 21-30 years). This was followed by Lefort II fractures (23 %), multiple fractures (10 %) and Lefort I fractures (6 %), Lefort III fractures (4.5 %) and Naso-ethmoidal fractures (4 %) in descending order. 84.5 % subjects were having ocular involvement. Subconjunctival hemorrhage was present mostly in 83.5 % followed by remaining as corneal injury 15 %, reduced acuity 11.5 %, diplopia 10.5 %, enophthalmos 8.5 %, telecanthus 5 %, hyphema 3.5 %, blindness 3 % and proptosis 0.5 %. Zygomatic complex fractures were the most frequent type of injury that was complicated by blindness or a serious eye injury (61 %). Collection of data regarding the epidemiology of maxillofacial fractures is important because it may assist healthcare providers to provide necessary information for the development and evaluation of preventive measures. Ocular injuries should have an early ophthalmological examination at the time of trauma to detect any kind of ocular dysfunction.

Epidemiological profile of otorhinolaryngological emergencies at a medical college, in rural area of gujarat

Otorhinolaryngological (ORL) emergencies are common in all communities and their early diagnosis and management will result in reduction in morbidity and mortality. As the horizons of otorhinolaryngology are widening, management of patients with protocol based quality care becomes prime priority. This study has been done to study the (a) Prevalence of ENT emergencies in TEC (trauma and emergency care), (b) Pattern and distribution of ENT emergencies in relation to age, sex and diagnosis, (c) Outcome in terms of disposition from TEC ward. This will help us in identifying preventive measure for some of ENT emergencies and to improve treatment protocols if required.

TYPE OF STUDY

Cross sectional retrospective descriptive study of 1 year duration. Records of patients who attended trauma care from 1st July 2009 to 30 June 2010 were studied under various parameters like age, sex and diagnosis and outcome. Major section was of facio-maxillary trauma (84.0%) followed by foreign bodies (5.8%), then others. 145 patients were discharged from the casualty, 518 were admitted and five were expired due to causes other then ENT e.g. head or abdominal injury. Different problems, their mode of management and outcomes are discussed here. With urbanization, facio-maxillary trauma constitutes the maximum workload amongst other emergencies like foreign body, ENT infections and burns and owing to the complex anatomy of face and neck, it is need of the hour for ORL surgeons to widen their scope of cases addressed and managed in emergency wards.