1
|
Bicsák Á, Dietmar A, Wruck Y, Hassfeld S, Bonitz L. Evaluation of Panfacial Fractures in a German Supraregional Trauma Center between 2015 and 2017 - A Retrospective Study. Ann Maxillofac Surg 2021; 11:97-102. [PMID: 34522662 PMCID: PMC8407637 DOI: 10.4103/ams.ams_418_20] [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: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Panfacial fractures represent the most severe injuries to the face. The combination of these fractures determines the treatment strategy. This study aims to retrospectively review the data of adult patients treated for complex facial skull fractures in a hospital in Dortmund, Germany from 2015-2017. Materials and Methods: We extracted related patient data from the hospital electronic repository and reviewed the patient files and radiological images. The fractures were classified based on the AO-Classification. The statistical analysis was performed by descriptive statistical methods. The main goal was to determine the most common fracture combinations. Results: A total of 188 patients with panfacial fractures were identified (181 adults, 7 children and adolescents). The gender and age distribution corresponded to the international literature (male-to-female ratio: 3.1:1, most common injuries among young men). 2–9 fracture sites were identified per patient, resulting in a fracture frequency of 3.13 per patient. 69 different fracture combinations have been identified. The most common ones were combinations of lateral and central mid-face fractures, and combinations of nasal bone fractures with lateral midface fractures or nasal bone fractures combined with mandibular fractures. Between 1 and 13 osteosynthesis implants per patient were used for osteosynthesis; the most commonly used plates were 2.0 mm and 1.5 mm straight plates. The average inpatient stay was 3 days (standard deviation [SD] = 3.0 days), and the average operation time (incision to suture) was 39.5 min (SD = 53.5 min). Discussion: Panfacial fractures are the most complex maxillofacial injuries. The complication rate in this study (4.5%) is below the international data. The treatment of panfacial fractures requires designated centers with experienced teams and good interdisciplinary cooperation.
Collapse
Affiliation(s)
- Ákos Bicsák
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Abel Dietmar
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Yannic Wruck
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Stefan Hassfeld
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Lars Bonitz
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| |
Collapse
|
2
|
Goedecke M, Thiem DGE, Schneider D, Frerich B, Kämmerer PW. Through the ages-Aetiological changes in maxillofacial trauma. Dent Traumatol 2019; 35:115-120. [PMID: 30615258 DOI: 10.1111/edt.12462] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/30/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022]
Abstract
AIMS The number of patients suffering maxillofacial trauma remains constant although the affected patients become older. The aim of this study was to illuminate the patterns of maxillofacial fractures in a University Medical Centre and to analyse potential changes in patient population and treatment methods during a 5-year period. MATERIALS AND METHODS In a retrospective analysis, the records of 573 patients with maxillofacial fractures treated in a level one trauma centre from January 2010 to December 2014 were analysed with regard to gender, age, date and time of hospitalization as well as discharge, aetiology, type of fracture, surgery details, complications and further injuries. Causes were subdivided into assaults, falls, epileptic seizure, work-related, traffic accident by car or bicycle, sport-associated or others (eg caused by explosions, horse kicks or unknown). RESULTS The most common causes for fractures were assaults (28.8%; n = 165), followed by falls (23.9%; n = 137), although falls became the main reason for maxillofacial fractures in 2013 and 2014. The mean age for patients suffering from facial fractures due to falls was significantly higher compared to those injured by other causes. Most commonly, fractures of the zygomatico-maxillary complex with or without orbital floor involvement were seen (31.6%; n = 291) followed by fractures of the mandible (20.6%; n = 190) and fractures of the nose (15.2%; n = 140). Most patients were treated surgically (89.5%; n = 513) even though an increase in non-surgical treatment was found over the examination period, especially in older patients. CONCLUSIONS Maxillofacial fractures are mostly seen in younger male patients. Assaults were the main pattern of injury during the whole examination period, although falls became the main cause in older patients over the last 2 years.
Collapse
Affiliation(s)
- Maximilian Goedecke
- Department of Oral and Maxillofacial Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, Mainz, Germany
| | - Daniel Schneider
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Schwerin, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, Mainz, Germany
| |
Collapse
|
3
|
Bai L, Li L, Su K, Bleyer A, Zhang Y, Ji P. 3D reconstruction images of cone beam computed tomography applied to maxillofacial fractures: A case study and mini review. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2018; 26:115-123. [PMID: 29480233 DOI: 10.3233/xst-17342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
Collapse
Affiliation(s)
- Liyun Bai
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Linlin Li
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Kexin Su
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Anthony Bleyer
- Division of Nephrology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA
| | - Ping Ji
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| |
Collapse
|
4
|
Malik S, Singh G, Kaur G, Yadav S, Mittal HC. Orofacial trauma in rural India: A clinical study. Chin J Traumatol 2017; 20:216-221. [PMID: 28330802 PMCID: PMC5555248 DOI: 10.1016/j.cjtee.2016.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/08/2016] [Accepted: 10/17/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Orofacial trauma is becoming a leading medical problem worldwide. Most of the studies pertaining to orofacial trauma have been done in urban areas but very little scientific literature is available for rural areas. METHODS A prospective medical institute-based study of orofacial injury patients was carried out from May 2013 to April 2016 (36 Months). Data regarding incidence, age and sex distribution, causes, types and site of injury, treatment modalities and trauma associated complications were collected and analysed. RESULTS A total of 784 patients were studied. Males outnumbered females by a ratio of 2.9:1. Age range was 9 months-75 years with the peak incidence in the age-group of 18-34 years. Most injuries were caused by road-side accidents (72.7%), followed by assault and falls in 11.6% and 8% respectively. Soft tissue injuries and mandibular fractures were the most common type of injuries. Head/neck (50.29%) and limb injuries (27.2%) were the most prevalent associated injuries. Surgical debridement and soft tissue suturing was the most common emergency procedure. Closed reduction was performed in 61% of patients and open reduction and internal fixation in 30% of cases and 9% were managed conservatively. Complications occurred in 6.88% of patients, mainly due to infection and malocclusion. The mean duration of hospital stay was (10.12 ± 6.24) days. CONCLUSION This study highlights the importance of department of dental surgery along with other disciplinaries in the management of orofacial injuries. Road-side accident remains the major etiological factor of orofacial injuries in our setting.
Collapse
Affiliation(s)
- Sunita Malik
- BPS Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India,Corresponding author.
| | - Gurdarshan Singh
- BPS Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Gagandeep Kaur
- Aadesh Institute of Dental Sciences and Research, Bathinda, Punjab, India
| | - Sunil Yadav
- BPS Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Hitesh C. Mittal
- BPS Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
| |
Collapse
|
5
|
Regmi KP, Tu J, Ge S, Hou C, Hu X, Li S, Du J. Retrospective Clinical Study of Maxillary Sagittal Fractures: Predictors of Postoperative Outcome. J Oral Maxillofac Surg 2016; 75:576-583. [PMID: 27986471 DOI: 10.1016/j.joms.2016.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Because of less attention to the sagittal component of maxillary fractures, these fractures are often misdiagnosed or the reduction is missed leading to maxillary transverse discrepancies. Therefore, the purpose of this study was to identify factors associated with good or adverse postoperative outcomes of maxillary sagittal fractures. MATERIALS AND METHODS This study was a single-center retrospective cohort study. The sample was composed of cases of maxillary sagittal fractures treated at the Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Trauma Unit of Xi'an Jiaotong University (Xi'an, China) from January 2008 through December 2013. The predictor variables were age, gender, occupation, cause of injury, injury severity, treatment timing, treatment method, and quality of fracture reduction. The outcome variable was the postoperative treatment effect index. Descriptive, bivariate, and multivariate statistics were computed. The P value was set to .05. RESULTS The sample was composed of 40 cases. The male-to-female ratio was 4:1; the most vulnerable age group was 20 to 30 years (30%); laborers (72.5%) were more prone to injury; and the main cause of injury was motor vehicle accident (62.5%). No cases of isolated sagittal fracture were found and most (35%) occurred with other maxillary fractures, including Le Fort fractures. A statistically significant association between treatment timing and quality of fracture reduction and the postoperative treatment effect index (P < .05) was found. CONCLUSION The results of this study suggest that better results are achieved when fractured bone is treated sooner. Anatomic repositioning of the fractured bone is the important predictor for good postoperative outcomes.
Collapse
Affiliation(s)
- Krishna Prasad Regmi
- Resident, Oral and Maxillofacial Surgery, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research and the Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Disease, College of Stomatology, and the Research Center of Stomatology, Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - JunBo Tu
- Professor, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research and the Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Disease, College of Stomatology, and the Research Center of Stomatology, Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - SuMeng Ge
- Resident, Oral and Maxillofacial Surgery, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research and the Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Disease, College of Stomatology, and the Research Center of Stomatology, Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - ChengQun Hou
- Associate Professor, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research and the Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Disease, College of Stomatology, and the Research Center of Stomatology, Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - XiaoYi Hu
- Associate Professor, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research and the Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Disease, College of Stomatology, and the Research Center of Stomatology, Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - ShiXian Li
- Resident Doctor, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research and the Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Disease, College of Stomatology, and the Research Center of Stomatology, Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - JingTing Du
- Resident, Oral and Maxillofacial Surgery, Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research and the Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Disease, College of Stomatology, and the Research Center of Stomatology, Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| |
Collapse
|