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Canzi G, De Ponti E, Spota A, Mangini G, De Simone E, Cioffi SPB, Altomare M, Bini R, Virdis F, Cimbanassi S, Chiara O, Sozzi D, Novelli G. Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:198-204. [PMID: 38006474 DOI: 10.1007/s00586-023-08037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/12/2023] [Accepted: 10/29/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. METHODS We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. RESULTS We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). CONCLUSIONS Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.
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Affiliation(s)
- G Canzi
- Maxillofacial Surgery Unit, Department of Neuroscience - Head & Neck, ASST GOM Niguarda, Milan, Italy
| | - E De Ponti
- Medical Physics Department, Foundation IRCCS San Gerardo Hospital, 20900, Monza, Italy
| | - A Spota
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy.
- Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy.
| | - G Mangini
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | - E De Simone
- Postgraduate School of Maxillo-Facial Surgery, University of Milan, Milan, Italy
| | - S P B Cioffi
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
| | - M Altomare
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
| | - R Bini
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
| | - F Virdis
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
| | - S Cimbanassi
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - O Chiara
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - D Sozzi
- Chirurgia Maxillo Facciale, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, Monza, Italy
- Dipartimento di Medicina e Chirurgia, School of Medicine, Università Degli Studi di Milano-Bicocca, Milan, Italy
| | - G Novelli
- Chirurgia Maxillo Facciale, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, Monza, Italy
- Dipartimento di Medicina e Chirurgia, School of Medicine, Università Degli Studi di Milano-Bicocca, Milan, Italy
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Sanders T, Rhodes H, Boscia J, Biswas S. Predictors of Facial Fractures in Trauma Patients: Retrospective Review at a Level I Trauma Center. Am Surg 2023; 89:3803-3810. [PMID: 37526073 DOI: 10.1177/00031348231173974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND The incidence and causes of facial fractures differ between patients, but patterns arise within populations. These patterns vary by gender, age, and between countries. This study aims to determine variables to identify patients at risk for facial fractures in a United States trauma population. METHODS This is a single-center study of Trauma Registry data, inclusive of years July 1, 2016, to January 31, 2022. Inclusion criteria were based upon all trauma patients. Confirmation of a non-isolated facial fracture (dependent variable) was verified using ICD10 diagnosis codes. A logistic regression was performed in SPSS to ascertain the effects of predictor variables on the likelihood that a trauma patient will experience a facial fracture. RESULTS 20377 patients were included in the analysis based upon the requirements specified in the methods section; 1575 (7%) had a positive facial fracture. The logistic regression model was statistically significant (N = 18507, P < .01). Significant risk factors for facial fracture identified included helicopter transport (OR = 1.35, P < .01) and increasing injury severity scores (OR = 1.07, P < .01). Modes of injury most likely to predict facial fracture included assault (OR = 6.62, P < .01), moped (OR = 2.02, P < .01), and motorcycle trauma (OR = 1.55, P < .01). The discharge disposition most likely among facial fracture patients included short-term general hospital (OR = 1.71, P < .01) and intermediate care facility (OR = 4.47, P < .01). CONCLUSIONS Patients with traumatic injuries from assault, moped, and motorcycle accidents were more likely to present with facial fractures. These patients had more severe injuries, seen as increased ISS scores, higher likelihood of transport by helicopter, and the need for additional care after discharge.
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Affiliation(s)
- Thomas Sanders
- University of South Carolina School of Medicine, Columbia SC, USA
| | | | - Joseph Boscia
- University of South Carolina School of Medicine, Columbia SC, USA
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Shumynskyi I, Gurianov V, Kaniura O, Kopchak A. Prediction of mortality in severely injured patients with facial bone fractures. Oral Maxillofac Surg 2021; 26:161-170. [PMID: 34100159 DOI: 10.1007/s10006-021-00967-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Identify the most common concomitant injuries associated with facial trauma, and compare the efficacy of various scoring systems in estimation of mortality risks in this category of patients. METHODS The study evaluated patients with facial and concomitant injuries, who received the multidisciplinary treatment in a specialized trauma hospital. Values of New Injury Severity Score, Glasgow Coma Scale, Facial Injury Severity Scale, age, and length of hospital stay were statistically analysed to determine presence of relationships between these indicators and define factors that significantly associated with lethal outcome. RESULTS During 6-year observation period, 719 patients were treated with multiple or combined maxillofacial trauma, brain injuries and polytrauma. Mainly with isolated midface bones (49.7%), pan-facial (34.6%), mandible (12.9%), and frontal bone and walls (2.8%) fractures. Mortality was (2.2%). The mortality rates in patients with severe pan-facial fractures were higher (p = 0.008) than in single anatomical area (6% vs 1.5%). Age, GCS, and NISS were the most reliable indicator of lethal outcome. CONCLUSION Age, Glasgow Coma Scale and New Injury Severity Score main factors, that predicts lethal outcome with high accuracy. New Injury Severity Score value ≥ 41 is a critical level for survival prognosis and should be considered in treatment planning and management of this category of patients.
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Affiliation(s)
- Ievgen Shumynskyi
- Department of Dentistry, Institute of Postgraduate Education, O. Bogomolets National Medical University, 34, Peremohy Avenue, the 2nd floor of the "physical-chemical" building, Kyiv, Ukraine.
| | - Vitaliy Gurianov
- Health Management Department, O. Bogomolets National Medical University, 13, T. Shevchenko Blvd., Kyiv, 01601, Ukraine
| | - Oleksandr Kaniura
- Department of Orthodontics and Prosthetic Dentistry, O. Bogomolets National Medical University, 13, T. Shevchenko Blvd., Kyiv, 01601, Ukraine
| | - Andrey Kopchak
- Department of Dentistry, Institute of Postgraduate Education, O. Bogomolets National Medical University, 34, Peremohy Avenue, the 2nd floor of the "physical-chemical" building, Kyiv, Ukraine
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Petridou E, Skalkidou A, Ioannou N, Trichopoulos D. Fatalities from non-use of seat belts and helmets in Greece: a nationwide appraisal. Hellenic Road Traffic Police. ACCIDENT; ANALYSIS AND PREVENTION 1998; 30:87-91. [PMID: 9542548 DOI: 10.1016/s0001-4575(97)00065-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
It has been established that seat belt use by car occupants and helmet use by motorcycle riders substantially reduces the risk of serious and fatal injuries following accidents. No study, however, has evaluated the motor vehicle deaths that could be prevented in Greece by general use of these devices, even though this country has the highest mortality from motor vehicle accidents in the European Union. We have estimated the odds ratios (OR) for death rather than injury in a motor vehicle accident by seat belt use among occupants of passenger cars or helmet use among motorcycle riders, using a nationwide database in which persons killed or injured in road traffic accidents in 1985 and 1994 were recorded. The study base included 910 dead and 19,511 injured persons for 1985 and 1203 dead and 22,186 injured persons for 1994. The OR and 95% confidence intervals (CI) for death rather than injury was 0.69 (CI: 0.58 to 0.81, p < 10(-5)) for seat belt users versus non-users and 0.64 (CI: 0.51 to 0.81; p < 10(-3)) for helmet users versus non-users. There was evidence that the protective effect of these passive safety devices increased from 1985 to 1994 probably reflecting technological improvements. The proportion of all deaths that could have been avoided if all car occupants used seat belts was estimated to 27%, whereas 38% of motorcycle deaths could have been avoided if all motorcycle riders used helmets. These proportions translate to about 500 deaths per year, mostly deaths among young men.
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Affiliation(s)
- E Petridou
- Department of Hygiene and Epidemiology, Athens University Medical School, Greece
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Rogers S, Hill JR, Mackay GM. Maxillofacial injuries following steering wheel contact by drivers using seat belts. Br J Oral Maxillofac Surg 1992; 30:24-30. [PMID: 1550802 DOI: 10.1016/0266-4356(92)90132-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Maxillofacial injuries are common sequelae in road traffic accidents. For the restrained driver, impact against the steering wheel is the most prevalent cause of injury. A sample of drivers restrained by seat belts with facial injury caused by the steering wheel was taken from data at the Accident Research Unit, University of Birmingham, UK. Two hundred and forty facial injuries occurred in 135 drivers, and these are described. Superficial contusion, laceration and nasal fractures predominated. There were 504 injuries at other body regions, and these were often caused by other vehicle components. These were, for 57% of drivers, no more serious than the facial injury caused by steering wheel contact. The role of steering wheel design in maxillofacial trauma is discussed and new solutions briefly reviewed.
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Affiliation(s)
- S Rogers
- Queen Elizabeth Hospital, University of Birmingham
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Abstract
Facial contact with the steering wheel was the most common source of maxillofacial injuries sustained by vehicle occupants. Maxillofacial injuries to non-restrained occupants, especially children, most commonly resulted from contact with the vehicle's seats. In contrast to previous studies, contact with the windscreen by non-restrained occupants produced only a small number of minor facial injuries. Serious fractures of the facial skeleton were rare and no maxillofacial injury was fatal. A relationship between impact speed and the severity of facial injury sustained was demonstrable. Total compliance with seat belt legislation could be expected to save the National Health Service in excess of 5 pounds million/year from the reduction in maxillofacial injuries alone.
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Affiliation(s)
- S F Worrall
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, UK
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Zachariades N, Papavassiliou D, Koumoura F. Fractures of the facial skeleton in children. J Craniomaxillofac Surg 1990; 18:151-3. [PMID: 2358503 DOI: 10.1016/s1010-5182(05)80509-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Among 3,908 patients with fractures of the facial skeleton hospitalized in a 25-year period, 202 were children. 69% were boys and 31% girls. A child is most active at the age of fourteen. Fractures of the upper alveolar bone and the condyle were the most common. We compared the pattern of fractures in children and those in adults recorded at the same period of time.
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Affiliation(s)
- N Zachariades
- Oral and Maxillofacial Dept. General Peripheral Hospital of Attica-K.A.T., Kifissia, Athens, Greece
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Abstract
Between the period 1 February 1981 and 31 January 1985, 678 patients with maxillofacial injuries were referred to the Department of Oral and Maxillofacial Surgery, at Southampton General Hospital. The commonest two aetiological factors in this group of patients were alleged assaults and road traffic accidents. Seat belt legislation in the United Kingdom was introduced on 1 February 1983. The compliance with seat belt usage rose to 90-95% for all front seat occupants after the legislation. The incidence of maxillofacial trauma cases arising in the front seat occupant group of patients dropped from 20.9% (78 patients) in the 2 years before the legislation to 5.9% (18 patients) in the 2 years after the legislation. The difference is statistically significant (p less than 0.001).
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Affiliation(s)
- C S Perkins
- Department of Oral and Maxillofacial Surgery, Southampton General Hospital, Hampshire
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