1
|
Shikha N, Reghunadhan P, Upasi AP, Rai KK, Kocher V. Simplified practice for ophthalmologist consultation in malar fractures: A retrospective study. J Craniomaxillofac Surg 2024; 52:297-301. [PMID: 38220496 DOI: 10.1016/j.jcms.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024] Open
Abstract
Zygomatic bone contributes to the orbital walls, and therefore associated injuries carry a high risk of severe dysfunction of the visual apparatus. The aim of our study was to retrospectively assess the spectrum and frequency of ophthalmic involvement in patients presenting with malar fracture, and the need for referral to an ophthalmologist for evaluation. In total, 102 patients presenting with malar fracture between January 2008 and August 2017 at Bapuji Dental College and Hospital, Davangere, Karnataka were enrolled in this study. Patients with confirmed malar fracture were categorized according to Henderson's classification, and associated ocular injuries were recorded. Assessment of the spectrum and frequency of ophthalmic involvement in patients presenting with different types of malar fracture was then carried out, followed by categorization of the need for referral to the ophthalmologist with regard to the associated ocular injury, as per the Al-Qurainy et al. (1991) scoring system, allocating the patients to early, routine, and non-referral categories. Statistically significant differences in proportions of various types of ophthalmic involvement were found between categories of malar fracture, and in degrees of ophthalmic involvement within each category of malar fracture, except in the Type II group of patients. The most severe ocular injuries were noted in Type VII followed by Type V, with the least severe injuries noted in Type II patients. According to the Al-Qurainy et al. (1991) scoring system, eight patients required early referral, 10 patients needed routine referral, and 84 patients were in the non-referral category. Categorization of referral of patients to an ophthalmologist in hospitals lacking ophthalmology departments can be based on the Al-Qurainy et al. classification of referral for Henderson's Type III, IV, and VI. Henderson's Type I and II patients need to be referred only in medicolegal cases. Henderson's Type VII and V patients require mandatory referral.
Collapse
Affiliation(s)
- Nirdhum Shikha
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India.
| | - Parvathy Reghunadhan
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Amarnath P Upasi
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Kirthi Kumar Rai
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Varun Kocher
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| |
Collapse
|
2
|
Bataineh AB, Khader Y. The Pattern of Midface Fractures in Jordan: A Retrospective Review of Medical Records. J Emerg Trauma Shock 2023; 16:167-170. [PMID: 38292280 PMCID: PMC10824217 DOI: 10.4103/jets.jets_42_23] [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: 05/07/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018-2021. Methods This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021. Results During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures. Conclusions Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.
Collapse
Affiliation(s)
- Anwar B. Bataineh
- Department of Oral Medicine and Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
3
|
Aleid AA, Al-Khudhairy MW, Bin Turaiky H, Bin Rubaia'an MA. Maxillofacial Traumatic Fractures in a Saudi Pediatric Subpopulation: A 10-Year Retrospective Study. Cureus 2023; 15:e46002. [PMID: 37900546 PMCID: PMC10602015 DOI: 10.7759/cureus.46002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
AIM The primary objective of this study was to analyze the patterns and etiology of maxillofacial fractures among hospitalized pediatric patients. METHODS A retrospective analysis was conducted on pediatric trauma cases admitted to King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 1, 2010 to December 31, 2020. Data extracted from medical records was utilized to identify and establish correlations with various variables, including age, gender, trauma etiology, and the type of sustained fracture. RESULTS The study involved a total of 167 patients. The mean age of the patients was 11.79 years, with the youngest and oldest patients being 2 and 17 years old, respectively. The majority of participants (70.7%, n = 118) were male. A total of 257 fractures were identified, with the highest number (n = 173, 67.3%) occurring in the lower third of the face. CONCLUSION Road traffic accidents (RTAs) emerged as the primary cause of trauma in our study, accounting for 73% (n = 122) of cases, followed by falls at 16.8% (n = 28). All instances of polytrauma were linked to RTAs. Fractures in the lower third of the face constituted over two-thirds (67.3%, n = 173) of the total fractures observed. Among the fractures, condyle fractures were the most frequently observed (19.8%, n = 51) in our study.
Collapse
Affiliation(s)
- Abdulazez A Aleid
- Oral and Maxillofacial Surgery and Diagnostic Sciences, Riyadh Elm University, Riyadh, SAU
- Oral and Maxillofacial Surgery, King Fahad Specialist Hospital, Tabuk, SAU
| | - May W Al-Khudhairy
- Oral and Maxillofacial Surgery and Diagnostic Sciences, Riyadh Elm University, Riyadh, SAU
| | | | | |
Collapse
|
4
|
Riekert M, Lentzen MP, Tiddens J, Zöller JE, Kreppel M, Schick V. Prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures - A retrospective cohort study. J Craniomaxillofac Surg 2023; 51:454-459. [PMID: 37453892 DOI: 10.1016/j.jcms.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/11/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
The aim of the study was to evaluate prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures. Complaints after fracture treatment and complications after plate removal were analyzed, retrospectively. A total of 205 patients were included. Plate removal was performed in 99 cases. Complaints related to the osteosynthesis material resulted in more frequent plate removal (p < 0.001). Complications were noted in 22 patients after plate removal. Duration of plate removal did not correlate with postoperative complications. In 69 patients, plates were removed without previous symptoms. Of these patients, postoperative complications were recorded in 15 cases. In patients with complaints after osteosynthesis, complications after plate removal occurred in seven (23.3%) patients. Ectropia developed significantly more often with increasing age (p < 0.05). CONCLUSION: Within the limitations of the study it seems that prophylactic plate removal is a treatment option that is not associated with an increased complication rate.
Collapse
Affiliation(s)
- Maximilian Riekert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany.
| | - Max-Philipp Lentzen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Jelle Tiddens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Joachim E Zöller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Matthias Kreppel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Volker Schick
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Germany
| |
Collapse
|
5
|
Wood Matabele KL, Seitz AJ, Doan TC, Poore SO. Risk Factors for Acute Postoperative Complications Following Operative Management of Le Fort Fractures-A NSQIP Study. J Craniofac Surg 2023; 34:1181-1184. [PMID: 36991535 DOI: 10.1097/scs.0000000000009297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/27/2022] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Le Fort fractures comprise a pattern of complex midfacial fractures that arise secondarily to craniofacial trauma. Although management of these fractures has been detailed within the literature, there is a paucity of research examining postoperative outcomes after surgical repair. The primary aim of this study is to assess patient outcomes after operative management of Le Fort fractures, and examine factors influencing the risk for developing postoperative complications, through utilization of the ACS-NSQIP database. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for cases recorded between 2012 and 2019 with International Classification of Disease (ICD)-9 and ICD-10 codes corresponding to Le Fort fractures. Patient demographics, clinical variables, and postoperative variables were recorded. Logistic regression analysis was conducted to identify independent risk factors for postoperative complications. RESULTS Identification of cases with appropriate ICD codes, and exclusion of those with missing data, yielded 562 patients for analysis. There were no cases of minor complications and 14 cases of severe complications (3 cases of wound dehiscence, 3 cases of transfusion requirement, 1 case of failure to wean from the ventilator for more than 48 h, 1 pulmonary embolism, and 8 cases of reoperation), corresponding to an overall complication rate of 2.49%. Logistic regression analysis revealed steroid use as an independent predictor of severe postoperative complications (OR =13.73, 95% CI: 1.08-128.02, P =0.02). CONCLUSION The present study is the first to conduct a risk factor analysis of patients with Le Fort fractures using the ACS-NSQIP national database. The overall postoperative complication rate was 2.49%, with 14 cases of complications recorded in 8 years. Although this may suggest that surgical management of Le Fort fractures is generally well-tolerated, it should be noted that this problem is frequently associated with other severe injuries of the head and neck that may influence patient prognosis. Given this, further analysis would benefit from a larger patient cohort and longer postoperative data as the ACS-NSQIP database only records outcomes within 30 days.
Collapse
Affiliation(s)
- Kasey Leigh Wood Matabele
- University of Wisconsin School of Medicine and Public Health, Division of Plastic Surgery, Madison, WI
| | | | | | | |
Collapse
|
6
|
Mani X, Johnson R. A case of sclerochoroidal calcification masquerading as a retained intraocular foreign body. Radiol Case Rep 2023; 18:2034-2038. [PMID: 37006837 PMCID: PMC10050674 DOI: 10.1016/j.radcr.2023.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 04/04/2023] Open
Abstract
A 41-year-old, New Zealand European male, was seen in the acute eye clinic as an in-patient from the trauma ward with multiple comorbidities including an orbital fracture from injuries sustained in a road traffic accident. It is not uncommon in emergency settings for emergency physicians to review polytrauma patients prior to Ophthalmologists, with Computerized Tomography being the imaging modality of choice. A hyper-dense lesion within the right globe was noted by radiology at the time and concerns were raised about the possibility of a retained intraocular foreign body. Upon Ophthalmic examination, a clinical diagnosis of sclerochoroidal calcification was made. This case highlights a rare case of sclerochoroidal calcification manifesting as a hyperdense lesion on computerized tomography masquerading as an intraocular foreign body.
Collapse
Affiliation(s)
- Xheida Mani
- School of Medicine, University of Auckland, Auckland, Aotearoa, 85 Park Road, Grafton, Auckland 1023, New Zealand
- Corresponding author at: Auckland University School of Medicine, 85 Park Road, Grafton, Auckland 1023, New Zealand.
| | | |
Collapse
|
7
|
Trends of maxillofacial and mandibular fractures in level I and II trauma patients in a tertiary hospital in Saudi Arabia. Saudi Dent J 2022; 34:772-778. [PMID: 36570582 PMCID: PMC9767832 DOI: 10.1016/j.sdentj.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Maxillofacial injury is a major health concern worldwide. Incidence of maxillofacial fractures is influenced by socio-demographic, economic, and cultural factor of the population investigated. Identifying the patterns of these fractures is crucial to establish effective treatments and prevention measures. The aim of the study was to to analyze the incidence, etiology, and types of maxillofacial fractures in a tertiary trauma center. Methods A retrospective analysis was conducted for all patients who were admitted with maxillofacial fractures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of of 422 patients with 978 maxillofacial fractures were enrolled over a 4-year period. Results Among the 422 patients, 387 (91.8%) were males, and 35 (8.2%) were females. The mean age of our population was 31.1 years old. Our study has shown that motor vehicle accidents are the leading cause of maxillofacial fractures, followed by pedestrian trauma. The most common maxillofacial fractures were orbital fractures, followed by maxillary fractures. The mandibular body was most fractured among mandibular fractures. Our data has shown that males have higher incidence of maxillofacial fractures than females. Conclusion Our study further validated that road traffic accidents are the most common cause of maxillofacial fractures in our region. These findings emphasized the importance of improving road safety protocols and enforcing traffic laws.
Collapse
|
8
|
Sinha V, Chaudhary N, Jha SG, Chaudhari NP, rathva KR. Management of Maxillofacial Trauma in Road Traffic Accident (RTA) at Tertiary Care Center. Indian J Otolaryngol Head Neck Surg 2022; 74:1246-1252. [PMID: 36452780 PMCID: PMC9702397 DOI: 10.1007/s12070-020-02299-6] [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: 10/15/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022] Open
Abstract
Road traffic accidents (RTA) are the major cause of maxillofacial injuries (MFIs) in developing countries (Akama et al. 2007). Road traffic accidents were reported to be the 9th most common cause of death and morbidity in the world and are expected to rise to 3rd position by 2020 (Peden et al. 2002). Maxillofacial injuries remain a serious clinical problem because of the involvement of complex anatomic region. Facial fractures occur most commonly in males in the third decade of life (Motamedi et al. 2014). The goal of treatment in facial fractures is to achieve anatomic reduction and restore function while increasing patient comfort and making postoperative care easier (Lachner et al. 1991). The aim of the study was to evaluate the cases of Maxillofacial injuries with the existing literature on its different presentation and management. An observational study was done from the patients of RTA with Maxillofacial injuries in ENT department and trauma centre of Sir T General hospital and Government Medical College, Bhavnagar for a period of 2 year. A total of 315 patients were included. Males are more commonly affected than females. The main etiological factor for RTA was motorcycle accidents. The trend of MFIs especially due to MCAs was on the rise after the age of 20 year. Anatomically the lower 1/3 section of the face was the most affected. Mandibular fractures were most common isolated fracture in MFIs. Open reduction and internal fixation (ORIF) by plating and screw was the treatment of choice for displaced, comminuted and multiple fractures of face. Facial trauma remains a major source of injury in all parts of the world. Its management involves many disciplines in the hospital setting, but knowledge of occlusion, the masticatory apparatus and anatomy is important for the best outcomes. This study was an analysis of demographic variables and outcome of the management adopted in patients presented to our department.
Collapse
Affiliation(s)
- Vikas Sinha
- Department of Otorhinolaryngology Head and Neck Surgery, Sir T Hospital and Government Medical College, B-303, Himalaya skyz flat, behind Himalaya mall, Bhavnagar, 364001 Gujarat India
| | - Nitin Chaudhary
- Department of Otorhinolaryngology Head and Neck Surgery, Sir T Hospital and Government Medical College, Bhavnagar, Gujarat India
| | - Sushil G. Jha
- Department of Otorhinolaryngology Head and Neck Surgery, Sir T Hospital and Government Medical College, Bhavnagar, Gujarat India
| | - Nirav P. Chaudhari
- Department of Otorhinolaryngology Head and Neck Surgery, Sir T Hospital and Government Medical College, Bhavnagar, Gujarat India
| | - Kajalben R. rathva
- Department of Otorhinolaryngology Head and Neck Surgery, Sir T Hospital and Government Medical College, Bhavnagar, Gujarat India
| |
Collapse
|
9
|
Jain SM, Gehlot N, KV A, Prasad P, Mehta P, Paul TR, Dupare A, CVNS CS, Rahman S. Ophthalmic Complications in Maxillofacial Trauma: A Prospective Study. Cureus 2022; 14:e27608. [PMID: 36059327 PMCID: PMC9433813 DOI: 10.7759/cureus.27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives: To determine the incidence and types of ophthalmic complications associated with maxillofacial trauma over a period of 24 months. Methods: An institutional prospective study was conducted on 62 patients presenting with maxillofacial trauma to study the correlation between facial trauma and ophthalmic complications. Results: Road traffic accidents were reported to be the primary etiologic factor for most trauma cases studied. Zygomaticomaxillary complex (ZMC) fracture was associated with more ophthalmic complications while fractures involving the orbital rims and walls were associated with severe complications. Conclusions: Maxillofacial trauma, particularly those associated with midface, including ZMC fracture, Le Fort II, Le Fort III, and naso-orbito-ethmoidal fractures, can commonly cause ophthalmic complications and blindness in rare cases. Hence, every patient with maxillofacial trauma should undergo an ophthalmic examination and should be placed under close observation for necessary treatment when required.
Collapse
|
10
|
Retrospective Study of the Epidemiological Profile of Facial Trauma Related to Violence. J Craniofac Surg 2022; 33:e382-e384. [DOI: 10.1097/scs.0000000000008210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
11
|
Phuc LH, Tien CH, Ngoc DV, Tuan NV, Chanh LT, Phuong LH, Duc NM. A Novel Approach to the Treatment of Le Fort Fractures Using Internal Fixation to Achieve Mandibulomaxillary Fixation. Med Arch 2022; 75:366-370. [PMID: 35169359 PMCID: PMC8740663 DOI: 10.5455/medarh.2021.75.366-370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: We aimed to determine the minimum effective period of mandibulomaxillary fixation after the inadequate internal fixation of Le Fort I or Le Fort II fracture. Objective: The aim of this study was to investigate the stability of the skeleton after the treatment of Le Fort I or Le Fort II fractures by measuring bite forces and to determine the minimum time required for effective mandibulomaxillary fixation following treatment with internal fixation and mandibulomaxillary fixation. Method: A prospective study was performed to examine the treatment of Le Fort I or Le Fort II fracture in the Department of Maxillofacial Surgery at the National Hospital of Odonto-Stomatology in Ho Chi Minh City, Vietnam. A total of 31 patients were included, with up to 1 month of follow-up after discharge from the hospital. Midface bone stability and the mandibulomaxillary fixation time were evaluated using bite force criteria after 1, 2, and 4 weeks. Results: Midface bone stability values 1, 2, and 4 weeks after treatment were 87.1%, 100%, and 100%, respectively. After 1 week, 87.1% of patients achieved intermaxillary fixation, and 96.3% of these patients were treated with at least three rigid plates. The remaining 12.9% of patients achieved fixation after 2 weeks, and all of these patients were fixed only at zygomaticomaxillary sutures (p < 0.05). Bite forces increased significantly at 2 weeks compared with 1 week and at 4 weeks compared with 2 weeks (p < 0.05). Conclusion: When treated using only rigid fixation, through the placement of plates and screws at zygomaticomaxillary buttresses, patients with Le Fort I and Le Fort II fractures can achieve mandibulomaxillary fixation after 2 weeks. For Le Fort I fractures, rigid fixation using plates and screws at zygomaticomaxillary buttresses and canine buttress at three positions can achieve mandibulomaxillary fixation after only 1 week (p = 0.0001).
Collapse
Affiliation(s)
- Le Hoai Phuc
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Cao Huu Tien
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Doan-Van Ngoc
- Department of Radiology, VNU University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Nguyen-Van Tuan
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Department of Maxillofacial Surgery, Ho Chi Minh City National Hospital of Odonto-Stomatology, Vietnam
| | - Le Trung Chanh
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Ho Chi Minh City National Hospital of Odonto-Stomatology, Vietnam
| | - Lam Hoai Phuong
- Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| |
Collapse
|
12
|
Ngoc DV, Phuc LH, Tien CH, Tuan NV, Chanh LT, Phuong LH, Duc NM. Evaluation of Bite Force After Treatment of Le Fort Fractures by Internal Fixation and Mandibulomaxillary Fixation. Med Arch 2022; 75:371-374. [PMID: 35169360 PMCID: PMC8740670 DOI: 10.5455/medarh.2021.75.371-374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: Evaluation of bite force one, two, and four weeks after discharge following treatment of Le Fort I and/or Le Fort II fracture by rigid fixation and mandibulomaxillary fixation. Objective: The aim of this study was to evaluate bite force following treatment of Le Fort I and/or Le Fort II fractures by rigid fixation and mandibulomaxillary fixation at one, two, and four weeks after discharge. This provides valuable results to guide the development of a treatment protocol for Le Fort fractures. Method: This was a prospective study including 31 patients who underwent followup examination three times after being discharged from hospital. The examination evaluated bite force using a bite force meter in the right molar, left molar, and incisor regions. Results: One week after discharge, bite forces in the right molar, left molar, and incisor regions were 94.29 ± 58.80 N, 95.42 ± 57.34 N, and 39,94 ± 30,29 N, respectively. Two weeks after discharge, bite forces in the right molar, left molar, and incisor regions were 153.84 ± 89.14 N, 153.00 ± 78.55 N, and 65,9 ± 43.89 N, respectively. Four weeks after discharge, bite forces in the right molar, left molar, and incisor regions were 279.77 ± 95.46 N, 285.00 ± 90,47 N, and 123.42 ± 54.04 N, respectively. Conclusions: Bite forces in the right molar, left molar, and incisor regions were significantly increased one week, two weeks, and four weeks after discharge. Bite force may be a helpful parameter to confirm the stability of the midface bone after treatment of Le Fort fractures.
Collapse
Affiliation(s)
- Doan-Van Ngoc
- Department of Radiology, VNU University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Le Hoai Phuc
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Cao Huu Tien
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Nguyen-Van Tuan
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Department of Maxillofacial surgery, Ho Chi Minh City National Hospital of Odonto-Stomatology, Vietnam
| | - Le Trung Chanh
- Faculty of Dentistry, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Ho Chi Minh City National Hospital of Odonto-Stomatology, Vietnam
| | - Lam Hoai Phuong
- Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| |
Collapse
|
13
|
Ocular Outcomes of Maxillofacial Trauma - A Decennary Descriptive Study. J Craniofac Surg 2021; 33:e81-e84. [PMID: 34967531 DOI: 10.1097/scs.0000000000008026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Maxillofacial trauma is amongst the most frequently encountered trauma seen in the hospital emergency setting. It may be life-threatening on rare occasions, and with concomitant injuries, it is often severely debilitating. OBJECTIVE The present study was conducted to determine the occurrence of concomitant orbital and ocular injuries amongst patients with maxillofacial trauma, and also helps in deriving a correlation between different patterns of maxillofacial fractures. METHODS All the records of the patients with maxillofacial trauma who were admitted to our institution over a 10-year period were analyzed. The files were screened to isolate the patients with concomitant ocular and orbital injuries. RESULTS Out of a total of 686 patients, 370 had associated ocular injuries. A total of 566 (82.5%) patients were males and 120 (17.5%) females. A total of 236 patients (34.4%) were in the 3rd decade. A total of 351 cases of orbital fracture (isolated + concomitant) were reported. About 44 (12.5%) cases of isolated orbital floor fractures were seen.Subconjunctival hemorrhage accounted for the maximum number of cases amounting to 59.19%. The least associated ocular injuries seen were of traumatic mydriasis (0.28%). Out of 370 cases of ocular injuries, 249 (67.3%) were associated with fractures of the zygomaticomaxillary complex. CONCLUSIONS The present study draws attention to the concomitant orbital and ocular injuries in maxillofacial trauma patients. This study is strongly suggestive of a very high probability of concomitant ocular injury in maxillofacial trauma patients which necessitates strong interdepartmental coordination for holistic management of the maxillofacial trauma patients.
Collapse
|
14
|
Balla SC, Jha KN, Ramanujam S, Srikanth K, Rajalakshmi AR. Maxillofacial trauma and ocular injuries: reports from a prospective study from Pondicherry, India. Orbit 2021; 41:457-463. [PMID: 34253120 DOI: 10.1080/01676830.2021.1939727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the spectrum and the factors affecting the visual outcome of ocular injuries associated with maxillofacial trauma. METHODOLOGY A prospective observational study was carried out from January 2019 to June 2020 on patients of maxillofacial trauma at a rural tertiary care centre, in Pondicherry, India. Detailed history was obtained. Investigations including imaging was done as indicated. Predictors of eye injuries and prognostic factors for vision were assessed. RESULTS A total of 135 eyes of 126 patients were evaluated. Males constituted 92.06%. Road traffic accident (RTA), domestic injuries, assault, and work-place-related injuries accounted for 86.5%, 4.7%, 2.3%, and 2.3%. Alcohol consumption (42.06%) and lack of eye protective device (94.4%) and injury to posterior segment were the major risk factors. On presentation 80.6% had visual acuity ≥ 6/12. Orbital and maxillofacial fractures were noted in 70.6% of cases. Closed-globe injury was seen in 83 (61.4%) and open-globe injury in 2 (1.4%). Majority (86.7%) suffered soft tissue injuries. Common sight-threatening injuries were traumatic optic neuropathy (4.4%), vitreous haemorrhage (0.7%), retrobulbar haemorrhage (0.7%), and commotio retinae (0.7%). CONCLUSION Most of the injuries in this population occurred from RTA, with associated fractures, adnexal and globe injuries. Alcohol consumption and lack of eye protective device were the major risk factors. Patients with open-globe injuries and injuries with posterior segment involvement had poor visual outcome.
Collapse
Affiliation(s)
- Shravya Choudhary Balla
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Kirti Nath Jha
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Sathyanarayanan Ramanujam
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Krishnagopal Srikanth
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Adithyapuram Ramachandran Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| |
Collapse
|
15
|
Biomechanics of midface trauma: A review of concepts. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2021. [DOI: 10.1016/j.ajoms.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Fomete B, Adebayo ET, Agbara R, Osunde DO, Abah ER. Pattern of Ocular Involvement in Midface Injuries Seen at a Tertiary Care Hospital in Northern Nigeria. Niger J Surg 2021; 27:33-37. [PMID: 34012239 PMCID: PMC8112374 DOI: 10.4103/njs.njs_21_20] [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: 03/02/2020] [Revised: 06/19/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria. Patients and Methods: This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria. Cases were seen at the oral and maxillofacial clinic for those presenting with midfacial fractures, whereas those presenting with ocular injuries due to midfacial injuries were referred from the ophthalmology department. Data were collected on their demographics, etiology of injuries, body part(s) involved, and treatment. Results: A total of 256 patients had midfacial injuries during the period, of which 219 patients had 357 associated ocular injuries. The age range was between 3 and 76 years. There were more males (83.8%) than females (16.2%), giving a male-to-female ratio of 5.2:1; the 21–30 years' age bracket was most frequently affected (38.4%). The predominant etiology of injuries was road traffic accidents (RTAs) (90.1%), followed by assault (4.9%). Zygomatic complex fractures (38.6%) and orbital wall fractures (24.7%) were the common midfacial injuries. There were 357 ocular injuries, giving a patient: injury ratio of 1:1.6, with subconjunctival hemorrhage (32.5%) and ruptured globe (20.0%) being common. Treatments performed were reduction and immobilization of midfacial fractures plus evisceration (32.0%), followed by reduction and immobilization of fractures alone (23.9%) and reduction and immobilization plus grafting of soft tissues (21.2%). Conclusion: Ocular injuries are quite common in patients with midfacial injuries, with a ratio of 1.6:1. RTA was the most common etiology, with zygomatic complex fractures as the most common midfacial injury. Subconjunctival hemorrhage was the most common ocular injury manifestation, with young adults (21–30 years of age) being most affected. Treatment often involved reduction and immobilization of midface fractures with evisceration and grafting of ocular tissues.
Collapse
Affiliation(s)
- Benjamin Fomete
- Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Ezekiel Taiwo Adebayo
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Medical Sciences, Ondo, Nigeria
| | - Rowlan Agbara
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Jos, Jos, Nigeria
| | - Daniel Otasowie Osunde
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Calabar, Calabar, Nigeria
| | - Emmanuel R Abah
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| |
Collapse
|
17
|
Umarane S, Kale T, Tenagi A, Manavadaria Y, Motimath AS. A Clinical Study of the Evaluation and Assessment of the Etiology and Patterns of Ocular Injuries in Midfacial Trauma in a Tertiary Care Hospital. Cureus 2020; 12:e10216. [PMID: 33042662 PMCID: PMC7537660 DOI: 10.7759/cureus.10216] [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] [Indexed: 11/08/2022] Open
Abstract
Aims The aim is to study the pattern of ocular injuries in midfacial trauma and to evaluate the overall incidence of ophthalmic injury of any severity following maxillofacial trauma. Methods and Materials The maxillofacial surgeon conducted routine facial examination of patients with midfacial fractures, which also included a detailed ophthalmologic examination of patients, at the time of initial presentation. These patients were then further evaluated by an ophthalmologist for thorough examination of the eye. Results The total number of recorded midface maxillofacial trauma cases was 181. Out of 181 patients, 161 had ocular injuries. Among 181 cases, 161 (88.95%) cases were due to road traffic accidents, which was the prime etiologic factor. Out of total 181 patients, 172 (95.03%) were males and 9 (4.97%) were females. The maximum number of cases were of zygomaticomaxillary complex fractures (44.75%) followed by nasal bone fractures (21.5%). Periorbital ecchymosis accounted for the maximum number of cases, amounting to 61.88%. Loss of vision or blindness was seen in eight (4.42%) patients. Conclusions The study stresses further on the importance of long-term and continuous data collection and record management of trauma patients, which may help health care providers with necessary information to develop treatment protocols and device measures for the prevention of complications.
Collapse
Affiliation(s)
- Shrikar Umarane
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Tejraj Kale
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Arvind Tenagi
- Ophthalmology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Yash Manavadaria
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Abhishek S Motimath
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
| |
Collapse
|
18
|
Assiri ZA, Salma REG, Almajid EA, Alfadhel AK. Retrospective radiological evaluation to study the prevalence and pattern of maxillofacial fracture among Military personal at Prince Sultan Military Medical City [PSMMC], Riyadh: An institutional study. Saudi Dent J 2020; 32:242-249. [PMID: 32647471 PMCID: PMC7336016 DOI: 10.1016/j.sdentj.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of the present study was to analyze the prevalence, causes, and patterns of maxillofacial fractures retrospectively in patients who were treated at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Methods Patients′ medical records were reviewed from 2005 to 2014. Patient′s age, gender, cause, and the pattern of maxillofacial fractures were studied. Associated body injuries were also recorded. Results Out of 263 patients, 207 (78.7%) were male and 56 (21.3%) were female. The age range was from 3 to 67 yr with a mean age of 26.21 yr. Road traffic accidents 236 (89.8%) were the most commonly reported cause of maxillofacial fractures, followed by falls 14 (5.3%), assaults 4 (1.5%), gunshot 3 (1.1%), and sport accidents 2 (0.8%). Most of the cases of maxillary fracture were Le Fort II 27 (36.5%), followed by LeFort I 23 (31.1%), LeFort III 20 (27.0%) and palatal fractures 4 (5.4%). Of the mandibular fractures, parasymphysis fractures constituted 61 (27.4%), body 50 (22.4%), condyle 45 (20.2%), angle 40 (17.9%), symphysis 16 (7.2%), ramus 7 (3.1%) and coronoid 4 (1.8%). Zygomatic complex fractures 110 (94.8%) were the most commonly reported fractures in the mid and upper facial region. Other facial fractures included orbital floor 61 (97.0%), naso-orbito-ethmoidal 18 (19.8%), and frontal 12 (13.2%). Conclusion Road traffic accidents were the most common cause of maxillofacial fractures. Spreading awareness among young drivers regarding road safety regulations is highly recommended.
Collapse
Affiliation(s)
- Zayed Ali Assiri
- Department of Oral and Maxillofacial Surgery, Saudi Ministry of Health, Aseer Region, Saudi Arabia
| | - Ra Ed Ghaleb Salma
- Department of Oral and Maxillofacial Surgery, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
19
|
Sreedharan S, Veeramuthu V, Hariri F, Hamzah N, Ramli N, Narayanan V. Cerebral white matter microstructural changes in isolated maxillofacial trauma and associated neuropsychological outcomes. Int J Oral Maxillofac Surg 2020; 49:1183-1192. [PMID: 32224001 DOI: 10.1016/j.ijom.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 02/15/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022]
Abstract
Isolated traumatic maxillofacial injury without concomitant brain injury may cause delayed post-concussive symptoms. Early identification allows optimal diagnosis, prognostication, and therapeutic intervention. The aim of this prospective observational study was to investigate longitudinal microstructural changes of the white matter (WM) tracts based on diffusion tensor imaging (DTI) indices in patients with isolated maxillofacial injuries, immediately and 6 months post-trauma, and to correlate these DTI indices with neuropsychological changes observed. Twenty-one patients with isolated maxillofacial injuries and 21 age-matched controls were recruited. DTI was performed and indices were calculated for 50 WM tracts. The neuropsychological evaluation was done using the screening module of the Neuropsychological Assessment Battery. Patients were subjected to repeat DTI and neuropsychological evaluation at 6 months post-trauma. Reduced fractional anisotropy (FA) and increased median (MD) and radial diffusivity (RD) in the acute phase were seen in major association, projection, and commissural fibre bundles, indicative of vasogenic oedema. These changes correlated with attention and executive function deficits in the acute phase, as well as improvement in memory and visuospatial function in the chronic phase. Isolated maxillofacial trauma patients develop WM microstructural damage, which may impair cognitive performance acutely and over time. DTI indices can serve as predictive imaging biomarkers for long-term cognitive deficits in isolated maxillofacial injuries.
Collapse
Affiliation(s)
- S Sreedharan
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - V Veeramuthu
- ReGen Rehabilitation International Hospital, Petaling Jaya, Selangor, Malaysia; Department of Psychology, University of Reading Malaysia, Iskandar, Malaysia.
| | - F Hariri
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - N Hamzah
- Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N Ramli
- University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - V Narayanan
- Division of Neurosurgery, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
20
|
Lin Q, Hong X, Zhang D, Jin H. Involvement of orbit in maxillofacial fractures: "Evaluation of its spectrum, characteristics, and treatment in 200 patients"-Prospective study. J Cosmet Dermatol 2020; 19:3302-3306. [PMID: 32227574 DOI: 10.1111/jocd.13385] [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: 02/02/2020] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the orbital involvement epidemiology in facial fractures, the clinical distribution and effects of orbital involvement in these patients, the frequency and nature of treatment procedures performed for these involvements, and the immediate- and intermediate-term effects of these treatment procedures. METHODS Two hundred patients with hard tissue maxillofacial injuries were included in this study. Clinical examination was performed in-depth. Images were taken to determine and confirm clinical observations and to finalize treatment modality. Orbital involvement in patients was noted as present or absent. The clinical effects and features in postoperative imaging studies were noted until 3 months after trauma in each patient. RESULTS Out of 200 patients, about one-third patients (58;29%) had orbital involvement and out of which 49 were males. Regarding clinical-radiological signs in orbit involved fractures, the incidences were variable, that is, periorbital ecchymosis (77.6%), periorbital edema (74.1%), subconjunctival hemorrhage (67.2%), palpable step/crepitus in orbital rim (62.1%), infraorbital nerve paresthesia (46.6%), restricted globe movement (5.2%), orbital rim discontinuity/step (72.4%), maxillary sinuses (51.7%), orbital wall/floor/roof rupture (55.2%), and infraorbital foramen involvement (36.2%). Palpable step/crepitus in orbital rim was recovered remarkably earlier in patients of open reduction internal fixation (ORIF) group, and features of restricted globe movements, orbital rim discontinuity/step, orbital wall/floor/roof rupture, and infraorbital foramen involvement in patients were recovered immediately after open reduction and internal fixation treatment. CONCLUSION Early repair of the maxillofacial injuries with orbital involvement has better functional and esthetic outcome.
Collapse
Affiliation(s)
- Quan Lin
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Xingyu Hong
- Department of Vascular Surgery, China Japan Hospital of Jilin University, Changchun, China
| | - Duo Zhang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Hongjuan Jin
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
21
|
Is the pure and impure distinction of orbital fractures clinically relevant with respect to ocular and periocular injuries? A retrospective study of 473 patients. J Craniomaxillofac Surg 2019; 47:1935-1942. [DOI: 10.1016/j.jcms.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/17/2019] [Accepted: 10/13/2019] [Indexed: 11/21/2022] Open
|
22
|
The Characteristics and Cost of Le Fort Fractures: A Review of 519 Cases From a Nationwide Sample. J Oral Maxillofac Surg 2019; 77:1218-1226. [PMID: 30853420 DOI: 10.1016/j.joms.2019.01.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE The aims were to report the characteristics of Le Fort fractures and to quantify the associated hospital costs. MATERIALS AND METHODS From October 2015 to December 2016, the National Inpatient Sample was searched for patients admitted with a primary diagnosis of a Le Fort fracture. Predictor variables were drawn from demographic, admission, and injury characteristics. The outcome variable was hospital cost. Summary statistics were calculated and compared among Le Fort patterns. Univariate comparisons and multivariate regression analyses were conducted to determine predictors associated with cost. RESULTS A total of 519 patients were identified in this cohort. Associated injuries included skull fractures (28%), intracranial hemorrhage (13%), cervical spine injury (9.8%), and concussion (9.1%). Seventy-three percent of patients received open reduction and internal fixation (ORIF) for their facial fractures during their admission, 13% received a tracheostomy, and 10% were mechanically ventilated for at least 1 day. The ventilation (P < .01) and tracheostomy (P < .01) rates increased with Le Fort complexity, as did length of stay (LOS; P < .01), costs (P < .01), and charges (P < .01). The mean costs of treating Le Fort I, II, and III fractures were $25,836, $28,415, and $47,333, respectively. Increased cost was independently associated with younger age, male gender, African-American ethnicity, Le Fort II and III patterns, motor vehicle accident etiology, mechanical ventilation requirement, tracheostomy, ORIF, transfer to an outside facility, and increased LOS. CONCLUSIONS The prevalence of head injuries and the need for respiratory support substantially increased with Le Fort complexity. Hospital costs were not markedly influenced by the diagnosis and management of associated injuries. Instead, costs were predominantly driven by fracture complexity and the need for necessary procedures, such as ORIF, tracheostomy, and mechanical ventilation.
Collapse
|
23
|
Chandra L, Deepa D, Atri M, Pandey SM, Passi D, Goyal J, Sharma A, Gupta U. A retrospective cross-sectional study of maxillofacial trauma in Delhi-NCR Region. J Family Med Prim Care 2019; 8:1453-1459. [PMID: 31143738 PMCID: PMC6510095 DOI: 10.4103/jfmpc.jfmpc_89_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim and Objectives To evaluate the pattern, prevalence, etiology, site of fractures, and their management in patients with maxillofacial injury in Delhi-NCR region. Materials and Methods A total of 1278 maxillofacial trauma patients visiting different registered hospitals from Delhi-NCR region from January 2012 to December 2017, treated by open reduction and internal fixation under general anesthesia (GA)/local anesthesia (LA) or closed reduction/conservatively, were taken into the study. The parameters considered in the study were age and sex distribution, etiological factors and incidence of maxillofacial trauma, pattern and site distribution of maxillofacial fractures, and management. Results From a total of 2250 trauma patients, 1278 patients (1053 males and 225 females) had maxillofacial injury. The average prevalence rate was 56.8%. Yearly incidence rate was 20.4%. Road traffic accident (RTA) was the most common cause of trauma in 1029 (80.5%) patients, followed by physical assault [158 (12.3%)] with significant male predominance in different age groups. Isolated mandibular fractures were the most common [48.6% (parasymphysis 31.6%, condyle 28.2%)], followed by midface with maxilla fracture [27.6% (zygomatic bone and arch 50.2% and Lefort II fractures 18%)]. Treatment modalities were conservative management, closed reduction, and open reduction with internal fixation under GA/LA. Conclusion RTA followed by physical assault is still the leading cause of maxillofacial trauma in young males in Delhi-NCR region. Mini plate osteosynthesis is the main treatment procedure for maxillofacial trauma. We need to enforce strict traffic rules, road safety law, and preventive measures along with improvement in education and socioeconomic status in the population to avoid maxillofacial injuries.
Collapse
Affiliation(s)
- Lokesh Chandra
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, Delhi, India
| | - D Deepa
- Department of Oral and Maxillofacial Surgery, NSVK Sri Venkateshwara Dental College and Hospital, Bengaluru, Karnataka, India
| | - Mansi Atri
- Department of Public Health Dentistry, ESIC Dental College and Hospital, Rohini, Delhi, India
| | - Souvir Mohan Pandey
- Department of Prosthodontics, Teerthankar Mahaveer Dental College and Hospital, Moradabad, Uttar Pradesh, India
| | - Deepak Passi
- Department of Dentistry, Subdivisional Hospital, Bundu, Ranchi, Jharkhand, India
| | - Jyoti Goyal
- Department of Public Health Dentistry, ITSCDSR, Ghaziabad, Uttar Pradesh, India
| | - Abhimanyu Sharma
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, Delhi, India
| | - Utkarsh Gupta
- Department of Public Health Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| |
Collapse
|
24
|
Abstract
INTRODUCTION Yet uncommon, blindness is a potential associated injury of facial fractures. METHODS Epidemiology, mechanisms, fracture types, and outcome of facial fractures-associated blindness in a 10-year period are retrospectively reviewed. RESULTS Out of 907 facial fractures patients, 10 had blindness, giving a frequency of 1.1%. There were 9 men and 1 woman whom age range was 6 to 59 years (mean: 31.2 years). Intentional injury patients were significantly the most at risk of blindness (P = 0.02). In all the patients, the fracture involved at least 1 of the orbit walls. Risk of blindness was significantly higher in naso-fronto-orbito-ethmoidal complex fractures (P = 0.03). The vision loss was recorded in 13 eyes (unilateral in 7 patients and bilateral in 3). Its predominant mechanism was a globe rupture or perforation, recorded in 8 eyes. A treatment with intention to improve the vision was attempted in 1 patient only. None of the patients had vision recovery. DISCUSSION The findings of this study commend comprehensive ophthalmologic evaluation in any patient with an orbit wall fracture.
Collapse
|
25
|
Johnson NR, Singh NR, Oztel M, Vangaveti VN, Rahmel BB, Ramalingam L. Ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex. Br J Oral Maxillofac Surg 2018; 56:221-226. [PMID: 29506872 DOI: 10.1016/j.bjoms.2018.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
Our aim was to evaluate ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex that required operative treatment, and we collected data retrospectively over a period of five years (2012-2016 inclusive). Of the 190 patients, 162 were male with a median age of 31 (IQR 25 -39) years. Assault was the most common mechanism of injury (125/190, 66%). Minor ophthalmic injuries (those unlikely to cause permanent visual disturbance) and major ophthalmic injuries (those with the potential to cause permanent visual disturbance) were recorded. The common minor ophthalmic injuries were: diplopia, enophthalmos, proptosis, subconjunctival haemorrhage, and restriction of the extraocular muscles. Commotio retinae, traumatic mydriasis, retro-orbital haemorrhage, and hyphaema were the common major ophthalmic injuries. All 13 different major ophthalmic injuries were recorded in the group who had had orbital fractures reconstructed, which suggested that more intraocular damage can be caused by this type of fracture than by others. Visual acuity was reduced in 26/190 patients with only four having persistent postoperative changes at six weeks. The odds ratio for those patients who had a major ophthalmological injury and were unable to drive was 0.07 (95% CI 0.02 to 0.21, p=0.001), which was highly significant. Ophthalmological assessment is strongly recommended for patients with fractures of the orbitozygomaticomaxillary complex.
Collapse
Affiliation(s)
- Nigel R Johnson
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
| | - Navin R Singh
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Mehmet Oztel
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Venkat N Vangaveti
- James Cook University, College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Benjamin B Rahmel
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Lakshmi Ramalingam
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| |
Collapse
|
26
|
Kaštelan S, Gverović Antunica A, Salopek Rabatić J, Gotovac M, Orešković D, Kasun B. Traumatic Optic Neuropathy - Case Report with Discussion on Diagnostic Procedures and Therapy. Acta Clin Croat 2018; 57:166-172. [PMID: 30256027 PMCID: PMC6400363 DOI: 10.20471/acc.2018.57.01.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Traumatic optic neuropathy (TON) is a serious vision threatening condition that can be caused by ocular or head trauma. Indirect damage to the optic nerve is the most common form of TON occurring in 0.5% to 5% of all closed head trauma cases. Although the degree of visual loss after indirect TON may vary, approximately 50% of all patients are left with 'light perception' or 'no light perception' vision, making TON a significant cause of permanent vision loss. We present a 47-year-old male patient with a history of right eye keratoconus following a motorcycle crash. Visual acuity was of 'counting fingers at 2 meters' on the right eye due to keratoconus and 'counting fingers at 1 meter' on the left eye as a consequence of trauma. The Octopus visual field showed diffuse re-duction in retinal sensitivity and the Ishihara color test indicated dysfunction of color perception on the left eye. Relative afferent pupillary defect was also present. Computed tomography revealed multifragmentary fracture of the frontal sinus and the roof of the left orbit without bone displacement. Based on the findings, conservative corticosteroid therapy without surgery was conducted. The patient responded well to treatment with complete ophthalmologic recovery.
Collapse
Affiliation(s)
| | | | | | - Marta Gotovac
- Department of Ophthalmology, Požega General Hospital, Požega, Croatia
| | - Darko Orešković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Boris Kasun
- Stubičke Toplice Special Hospital for Medical Rehabilitation, Stubičke Toplice, Croatia
| |
Collapse
|
27
|
|
28
|
Abstract
Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of the evaluation, the assessment, the management, and the prevention of further injury when dealing with these fractures is vital. This second of a two-part series detailing the management of midfacial fractures serves as a guide for the appropriate workup and management of the wide variety of fracture patterns that are commonly encountered.
Collapse
Affiliation(s)
- Matthew Louis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nikhil Agrawal
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tuan A Truong
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
29
|
Singaram M, G SV, Udhayakumar RK. Prevalence, pattern, etiology, and management of maxillofacial trauma in a developing country: a retrospective study. J Korean Assoc Oral Maxillofac Surg 2016; 42:174-81. [PMID: 27595083 PMCID: PMC5009190 DOI: 10.5125/jkaoms.2016.42.4.174] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/07/2016] [Accepted: 02/11/2016] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This retrospective study aims to evaluate the prevalence of maxillofacial trauma in a developing country, along with its pattern, etiology and management. Data for the present study were collected from the Department of Dentistry, ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai in India. MATERIALS AND METHODS The medical records of patients treated for maxillofacial injuries between May 2014 and November 2015 were retrospectively retrieved and analyzed for prevalence, pattern, etiology, and management of maxillofacial trauma. SPSS software version 16.0 was used for the data analysis. RESULTS Maxillofacial fractures accounts for 93.3% of total injuries. The mean and standard deviation for the age of the patients were 35.0±11.8 years and with a minimum age of 5 years and maximum age of 75 years. Adults from 20 to 40 years age groups were more commonly involved, with a male to female ratio of 3:1. There was a statistically significantly higher proportion of males more commonly involved in accident and injuries (P <0.001). CONCLUSION The most common etiology of maxillofacial injury was road traffic accidents (RTA) followed by falls and assaults, the sports injuries seem to be very less. In RTA, motorized two-wheelers (MTW) were the most common cause of incidents. The majority of victims of RTA were young adult males between the ages of 20 to 40 years. The malar bone and maxilla were the most common sites of fracture, followed by the mandible. The right side of the zygomatic complex was the predominant side of MTW injury. The majority of the zygomatic complex fractures were treated by conservative management. Open reduction and internal fixation were performed for indicated fracture patients.
Collapse
Affiliation(s)
- Mohanavalli Singaram
- Department of Dentistry, ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai, India
| | - Sree Vijayabala G
- Department of Dentistry, ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai, India
| | - Rajesh Kumar Udhayakumar
- Department of Dentistry, ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai, India
| |
Collapse
|
30
|
Ocular Injuries in Patients of Zygomatico-Complex (ZMC) Fractures. J Maxillofac Oral Surg 2016; 16:243-247. [PMID: 28439168 DOI: 10.1007/s12663-016-0907-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 04/05/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Mid face injuries commonly destroy the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7 and 90.6 % as reported in literature. The eye injuries range from simple subconjunctival haemorrhage to globe rupture. The paper aims to study the types of ocular injuries in patients with ZMC fractures. PATIENTS AND METHODS A study of 67 patients, who had sustained facial trauma sufficient to lead to a facial bone fracture, was undertaken in the department of Oral and Maxillofacial Surgery, Govt Dental College, Srinagar from 2008 to 2014 and the patients received a comprehensive examination by an ophthalmologist within 1 week of injury. All the patients sustaining confirmed ZMC fracture were examined by an ophthalmologist for any associated ocular injury. A thorough ophthalmologic examination included assessment of visual acuity, pupillary reactivity, anterior and posterior segment examination and extraocular motility. The variables reviewed included patient's gender, mechanism of injury, visual acuity, pupillary reactivity, extra ocular motility, presence or absence of diplopia, ocular and orbital findings, and intraorbital hypoesthesia. RESULTS The most common etiology of trauma was RTA (64.1 %), followed by falls (14.9 %) in our study. In our study 83.5 % of the patients were males. Minor ocular injuries such as subconjunctival haemorrhage and corneal injury accounted for most of the cases. Subconjunctival haemorrhage was the most common injury, present in 86.5 % of the cases. Hyphema was present 13.4 %, vitreous haemorrhage 2.98 %, retinal haemorrhage 1.49 %, corneal abrasion 4.47 %, mydriasis 1.49 %, choroidal rupture 5.97 %, retinal detachment 2.98 %, decreased visual activity 13.4 %, retinal tear and angle recession was present 7.46 % times. CONCLUSION ZMC fractures are associated with higher incidence of ocular injuries. The incidence of traumatic optic neuropathy and other ocular injuries warrants a prompt ophthalmologic examination of all patients with ZMC fractures as quickly as possible to prevent morbidity.
Collapse
|
31
|
Mohanavalli S, Suma E, Senthamarai G, Vijayabala GS. Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study. ACTA ACUST UNITED AC 2016. [DOI: 10.5005/jp-journals-10015-1382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Introduction
The middle third of the face is the most common site of injury and is frequently complicated by associated ocular injuries. It may be simple laceration, ecchymosis, circumorbital edema, or severe as globe injury or injury to the optic nerve and vision loss. Even severe injury like internal bleeding causes increased intraocular pressure and damages the optic nerve; if managed earlier, it could prevent further damage and dysfunction of the eye. Midfacial fractures associated with ocular injuries should have an early ophthalmological examination to detect ocular injuries. Little is known about the current epidemiology of midface fractures and associated ocular injuries in Tamil Nadu, the state of India. The aim was to study the etiology and pattern of middle third fracture and associated ocular injuries.
Materials and methods
This prospective study on midface fractures was carried out in the Department of Dentistry to analyze etiology, incidence, and patterns of midface fractures and associated ocular injuries. A total of 201 patients who reported with the history of midface injuries were included in the study. These patients were examined clinically and routine radiographs and computerized tomography magnetic resonance imaging (MRI) were taken to confirm the diagnosis. All the patients sustaining confirmed middle third fractures with or without eye signs were referred to an ophthalmology department for the evaluation and management of associated ophthalmic injury. Statistical Package for the Social Sciences software version 16.0 was used for data analysis. The outcome of the study was measured using percentages, mean, standard deviation, and test of proportion as appropriate.
Results
Traffic accident was the major cause of injury, mainly by motorized two wheelers (MTWs). Males in the 21 to 40 age group were common victims. Zygomatic complex fracture was the most common fracture type. Subconjunctival hemorrhage and infraorbital nerve injuries were common clinical findings.
Conclusion
Midthird facial injury cases should have an early ophthalmological examination for timely management to prevent dysfunction of the eye.
How to cite this article
Mohanavalli S, Suma E, Senthamarai G, Vijayabala GS. Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study. World J Dent 2016;7(3):135-140.
Collapse
|
32
|
Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
Collapse
Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
| | | |
Collapse
|
33
|
Haworth S, Bates AS, Beech A, Knepil G. Quality improvement in documentation for patients with suspected facial fractures: use of a structured record keeping tool. Emerg Med J 2015; 33:268-72. [DOI: 10.1136/emermed-2015-205141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/16/2015] [Indexed: 11/03/2022]
|