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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Lacchè E, Pelotti S, Fais P. Motorcycle injuries: a systematic review for forensic evaluation. Int J Legal Med 2024; 138:1907-1924. [PMID: 38763926 PMCID: PMC11306388 DOI: 10.1007/s00414-024-03250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
The intricate interplay of exposure and speed leave motorcyclists vulnerable, leading to high mortality rates. During the collision, the driver and the passenger are usually projected away from the motorcycle, with variable trajectories or final positions. Injuries resulting from the crash can exhibit distinct and specific characteristics depending on the circumstances of the occurrence.The aim of this study is to provide a systematic review of the literature on injuries sustained by motorcyclists involved in road accidents describing and analyzing elements that are useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to June 2023. Eligible studies have investigated issues of interest to forensic medicine about during traffic accidents involving motorcycle. A total of 142 studies met the inclusion criteria and were classified and analyzed based on the anatomical regions of the body affected (head, neck, thoraco-abdominal, pelvis, and limb injuries). Moreover, also the strategies for preventing lesions and assessing injuries in the reconstruction of motorcycle accidents were examined and discussed.This review highlights that, beyond injuries commonly associated with motorcycle accidents, such as head injuries, there are also unique lesions linked to the specific dynamics of accidents. These include factors like the seating position of the passenger or impact with the helmet or motorbike components. The forensic assessment of injury distribution could serve as support in reconstructing the sequence of events leading to the crash and defining the cause of death in trauma fatalities.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
| | - Maria Paola Bonasoni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, 42122, Italy
| | - Elena Lacchè
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
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Kim EJ, Bustos VP, Lee BT. Sources of Facial Injury Across Age Groups: A Nationwide Overview Using the National Electronic Injury Surveillance System Database. J Craniofac Surg 2023; 34:1927-1930. [PMID: 37582255 DOI: 10.1097/scs.0000000000009582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/04/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Facial trauma comprises a significant portion of injuries that occur each year in the United States, with injuries ranging from lacerations to complex facial fractures. This study aims to provide a broad epidemiologic overview of facial trauma in the United States to direct preventative safety measures. METHODS A cross-sectional study was conducted utilizing the National Electronic Injury Surveillance System database to identify the weighted national incidence of facial injuries from 2017 to 2021. Descriptive and inferential statistical analysis was used to compare the demographics of patients, the settings where the injury occurred, and the products resulting in the injury. RESULTS A total of 8,465,538 out of 64,312,132 weighted encounters involved facial injuries. Less than 10 years was the highest-represented age group (36.8%). The most frequent disposition was treated and released (91.1%), with increasing age associated with higher rates of hospitalization (odds ratio: 1.04, P < 0.001). Cases predominantly occurred at home (49.0%), and the most common type of injury was laceration (36.5%). At-home injuries increased with age, comprising 39.2% of facial injuries for 21 to 40 years, 52.0% for 41 to 64 years, and 58.0% for older than 65 years. Building structures (21.4%) were the most prevalent source of injury, composed predominantly of floors (58.3%) and ceilings and walls (10.4%). CONCLUSIONS There is an understated burden of at-home facial injuries across all age groups, beyond the pediatric and geriatric population. Fall prevention and home environmental hazards education could benefit all ages, reducing the incidence of facial trauma.
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Affiliation(s)
- Erin J Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Pattern of associated brain injury in maxillofacial trauma: a retrospective study from a high-volume centre. Br J Oral Maxillofac Surg 2022; 60:1373-1378. [PMID: 36253321 DOI: 10.1016/j.bjoms.2022.09.002] [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: 05/23/2022] [Revised: 08/20/2022] [Accepted: 09/21/2022] [Indexed: 12/31/2022]
Abstract
The incidence of head injury in maxillofacial trauma patients varies widely in the literature. A good understanding of the patterns of association between these injuries would aid in efficient multidisciplinary treatment. The aim of this study therefore was to understand the associations between head injury and facial trauma by retrospectively analysing the records of patients seen at a tertiary care trauma centre. Demographic data were also described. Records of 4350 facial trauma patients over a five-year period were reviewed. A total of 3564 (81.9%) patients were victims of motor vehicle accidents (MVA). Male patients predominated, comprising 3711 (85.3%), and 36.6% were in the third decade of life. Facial fractures were seen in 2120 (48.7%), the most common being zygomatic fractures (60%). At the time of trauma, 2383 (57.3%) patients were under the influence of alcohol, and 2821 (87.8%) victims of two-wheeler MVAs were not using their helmet. Of all patients, 29.75% sustained a traumatic brain injury (TBI). Midface fractures were strongly associated with TBI. Maxillofacial injury may be considered a risk factor for TBI, and as such should immediately be suspected and investigated in all patients. Prompt recognition and management can improve outcomes in these patients.
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Chauhan D, Chattopadhyay P, Thakur A. Reconstruction of cranial defect with patient-specific implants: Four different cost-effective techniques. Natl J Maxillofac Surg 2022; 13:136-142. [PMID: 35911808 PMCID: PMC9326212 DOI: 10.4103/njms.njms_200_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/24/2020] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
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Tallal RE, Estawrow MA. Obliteration and Contouring of Comminuted Anterior Wall Frontal Sinus Fracture Using Pericranial Flaps. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3670. [PMID: 34386309 PMCID: PMC8352623 DOI: 10.1097/gox.0000000000003670] [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: 03/12/2020] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
One of the common postoperative complications of comminuted fractures of frontal sinus are contour deformity, hardware extrusion, adherence and/or palpability, and skin thinning. We are presenting our novel technique with pericranial flaps to decrease these complications. The study was performed from January 2019 to January 2020, on 40 cases of comminuted fractures of anterior wall of frontal sinus, 28 men and 12 women, with an average age of 41 years. Injury resulted from motor vehicle crashes (n = 25), motorcycle crashes (n = 11), and falling from heights (n = 4). Our novel technique involves the use of two anteriorly based pericranial flaps; one flap is used for obliteration of the frontal sinus and the other is used to overlay the hardware used to restore forehead contouring and to eliminate the possibility of early extrusion or late plates or mesh palpability. Two patients had postoperative minimal disruption of forehead lacerations healed with secondary intention and minimal scarring. Excellent patient compliance without any complaint of mesh palpability. No adherence occurred and no skin thinning. This technique (two anteriorly based pericranial flaps) may be more reliable to obliterate the frontal sinus also overlaying the hardware used to improve forehead contour and decrease the incidence of mesh palpability and skin adherence than using hardware without flap coverage.
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Affiliation(s)
- Raghda E Tallal
- Department of Plastic Surgery, Ain Shams University, Cairo, Egypt
| | - Mina A Estawrow
- Department of Plastic Surgery, Ain Shams University, Cairo, Egypt
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Azadani EN, Townsend J, Peng J, Wheeler K, Xiang H. The association between traumatic dental and brain injuries in American children. Dent Traumatol 2020; 37:114-122. [PMID: 33128842 DOI: 10.1111/edt.12611] [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: 07/18/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM It is crucial that dentists who treat traumatic dental injuries rule out concomitant brain injuries. Despite anatomic proximity, controversy exists regarding association between facial trauma and head injury. The aim of this study was to examine the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBI) using a national dataset of emergency department (ED) visits. MATERIAL AND METHODS Nationwide Emergency Department Sample (NEDS) data, one of the Healthcare Cost and Utilization Project (HCUP) datasets, were analyzed. Encounters of patients age 0-18 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with DAT and TBI in the 2010-2014 NEDS were identified. Data were analyzed using descriptive statistics, chi-square test, and logistic regression models to investigate the association between DAT and TBI and factors associated with TBI in DAT-positive patients. RESULTS During the study period, 6 281 658 ED visits were associated with traumatic injuries. DAT was recorded in 93 408 (1.5%) and TBI was recorded in 996 334 (15.9%) of these traumatic injury visits. Within the group of DAT-positive encounters, 7035 (7.5%) had codes associated with TBI. Of trauma encounters where a DAT was not involved (6 188 250 encounters), 989 299 (16%) had an associated TBI code. Patients with DAT had 0.20 odds of having TBI (95% CI, 0.19-0.20, P < .0001) compared with patients who did not have DAT when all other confounding variables were kept constant. Having multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT. CONCLUSIONS There was an inverse association between DAT and TBI in this study population.
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Affiliation(s)
- Ehsan N Azadani
- Department of Dentistry, Nationwide Children's Hospital and Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Janice Townsend
- Department of Dentistry, Nationwide Children's Hospital and Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Jin Peng
- Research Information Solutions and Innovation Research & Development, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Krista Wheeler
- Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.,Center for Pediatric Trauma Research and Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research and Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital and Division of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Abstract
The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent cause of damage to these structures. The authors review the literature on reconstructive techniques focusing on fractures of the orbital rim, orbital roof, orbital floor, medial orbital wall, and naso-orbito-ethmoid complex. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding orbital trauma presentation, diagnosis, management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Orbital trauma can result in a wide variety of complications in form and function. Not all orbital fractures require operative repair. However, bony disruption can cause enophthalmos, hypophthalmos, telecanthus, epiphora, cerebrospinal fluid leaks, orbital hematoma, and even blindness to name a few. Timing of operative repair as well as reconstructive method is dictated by the patient's individual presentation. Successful fracture management requires a detailed understanding of the anatomy and pathophysiology to ensure restoration of the patients' preoperative state. Orbital trauma encompasses a wide variety of mechanisms of injury and resulting fracture patterns. A variety of surgical approaches to the orbit exist as has been discussed allowing the surgeon access to all area of interest. Regardless of the fracture complexity, the principles of atraumatic technique, anatomic reduction, and stable fixation apply in all cases.
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Affiliation(s)
- Kirkland N Lozada
- Department of Otolaryngology Head & Neck Surgery, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Patrick W Cleveland
- Department of Otolaryngology Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jesse E Smith
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Rao SG, Paramesh RC, Bansal A, Shukla D, Sadashiva N, Saini J. A prospective computed tomography study of maxillofacial injuries in patients with head injury. Eur J Trauma Emerg Surg 2019; 48:2529-2538. [DOI: 10.1007/s00068-019-01099-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
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Reconstruction of Acquired Frontal Bone Defects Using Titanium Mesh Implants: A Retrospective Study. J Maxillofac Oral Surg 2019; 18:34-39. [PMID: 30728689 DOI: 10.1007/s12663-018-1083-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/12/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Frontal bone deformities can be acquired due to trauma or ablative tumor resection surgeries and osteomyelitis. It may also occur due to congenital malformations. Repair of these defects have long been a challenge to oral and maxillofacial surgeons. We report our experience in the reconstruction of acquired frontal bone defects by titanium mesh implant. PATIENTS AND METHODS Titanium mesh was used for reconstruction in 35 patients (18-55 years age-group) (34 males and 01 females) of acquired frontal bone defects secondary to trauma (RTA). All these patients have been referred to author by Department of Neurosurgery of the institute of Affiliation. RESULTS All these cases acquired defects as a result of trauma. Follow-up ranged from 12 to 18 months after the reconstruction. Patients were followed up for the progress of healing, stability of implants, infection, wound dehiscence, discharging sinus, exposure of implants, collections, patient satisfaction regarding esthetics and reaction to thermal changes. No postoperative complications were found. CONCLUSION In reconstruction of frontal bone defects, titanium mesh gives satisfactory results.
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Błaszczyk B, Studziński M, Ładziński P. Coincidence of craniocerebral and craniofacial injuries. J Craniomaxillofac Surg 2018; 47:287-292. [PMID: 30581084 DOI: 10.1016/j.jcms.2018.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/10/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the incidence of craniocerebral injuries in patients who experienced upper facial or midfacial traumas associated with the disorders of consciousness. To find which types of craniofacial traumas predisposed to craniocerebral injuries. To analyze a relationship between the site of the force application and the type of resultant craniocerebral injury. MATERIALS AND METHODS The study included 3,481 patients with upper facial and midfacial traumas. All 425 patients with craniofacial traumas and disorders of consciousness at the time of the event or hospital admission, were qualified for computed tomography (CT) of the head. RESULTS In 85/425 patients (20%), 70 men and 15 women (age 14-71 years), craniofacial trauma coincided with a craniocerebral injury. Upper facial dislocation and zygomatic-orbital-maxillary complex fracture significantly more often co-existed with skull, dura mater or cranial nerve injuries, and zygomatico-orbital fracture with the injuries of the brain. Application of force both centrally and laterally to the horizontal plane predisposed to skull, dura mater and cranial nerve injuries. CONCLUSION The recommendation to perform head CT in each patient with craniofacial trauma who experienced the disorders of consciousness is as simple as possible, yet provides high diagnostic sensitivity, facilitating proper management at initial stages post-injury.
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Affiliation(s)
| | - Maciej Studziński
- Department of Maxillofacial Surgery, St. Barbara Regional Hospital, Sosnowiec, Poland
| | - Piotr Ładziński
- Department of Neurosurgery, St. Barbara Regional Hospital, Sosnowiec, Poland
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Agbara R, Obiechina AE, Ajike SO, Adeola DS. Pattern of maxillofacial injuries in patients with craniocerebral injuries: a prospective study. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: This prospective study highlights the pattern of oral and maxillofacial injuries in patients with associated craniocerebral injuries. Material and Methods: This was a prospective descriptive study conducted over a 22-month period. Information was collected using a structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) Version 13 (SPSS Inc., Chicago, IL, USA) and Microsoft Office Excel 2007 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05. Results: Three hundred and three consecutive patients were studied and this consisted of 254 males and 49 females. The difference in the gender distribution was statistically significant (p = 0.008). Road traffic crashes (n = 262; 86.5%) was the most common cause of injury and soft tissues orofacial injuries accounted for 61.7% of injuries. Le Fort II fractures were the major skeletal injuries. Glasgow Coma Score (GCS) of 13–15 had the highest frequency (n = 157; 53.4%). Intracerebral haemorrhage was the most common cerebral injury recorded and the commonest complication noted was dysocclusion. Discussion: Although middle third facial fractures were the most common skeletal injury, fractures of the upper third facial skeleton appear to be associated with lower GCS. Conclusion: Fractures of the facial skeleton are fairly common in craniocerebral injuries.
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Abstract
AIMS AND OBJECTIVES The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. MATERIALS AND METHODS This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test. RESULTS A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). CONCLUSION This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.
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Lalezari S, Lee C, Paydar KZ, Shaterian A. Age and Number of Surgeries Increase Risk for Complications in Polytrauma Patients with Operative Maxillofacial Fractures. World J Plast Surg 2018; 7:307-313. [PMID: 30560069 PMCID: PMC6290318 DOI: 10.29252/wjps.7.3.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 07/29/2018] [Accepted: 08/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Poly-trauma patients often sustain complex head/neck injuries requiring prolonged hospitalizations and multiple operations. Few studies have evaluated the associated injury patterns and risk factors for poor clinical outcomes. METHODS Consecutive poly-trauma patients with operative maxillofacial fractures treated at a level 1 trauma medical center between 1995 and 2013 were evaluated. Concomitant head/neck injuries to identify potential injury patterns were numerated. Lastly, a multivariate analysis was performed to determine independent risk factors for complications during the acute hospitalization period. RESULTS Totally, 232 poly-trauma patients presented with operative maxillofacial fractures, while 38.8% of patients had a secondary maxillofacial fracture, 16.4% had intracranial hemorrhage, 23.7% had skull fractures, and 12.1% had spinal fractures. The rate of complication during admission was 28.3%. Multivariate analysis revealed advanced patient age and increased number of operations to predict the rate of complication. Patients requiring more than one operation had a 1.8-fold increase in complication rate (p<0.01) and older patients had a 4.5% increase in complication rate (p<0.05) for every year of increased age. CONCLUSION Poly-trauma patients have a high incidence of secondary maxillofacial fractures, concomitant head/neck injury, and inpatient complication rate. Knowledge of associated injury patterns can help increased awareness and can guide physician decision-making to avoid missed/delayed injuries.
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Affiliation(s)
| | | | | | - Ashkaun Shaterian
- Department of Plastic Surgery, University of California, Irvine; Orange, CA, USA
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Eledeissi A, Ahmed M, Helmy E. Frontal Sinus Obliteration Utilizing Autogenous Abdominal Fat Graft. Open Access Maced J Med Sci 2018; 6:1462-1467. [PMID: 30159078 PMCID: PMC6108793 DOI: 10.3889/oamjms.2018.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Frontal sinus fractures have always been unique because of the controversy surrounding their ideal treatment protocol and the fatal complications that could follow if the wrong treatment opts. AIM: The purpose of this study was to assess clinically and radiographically frontal sinus obliteration technique utilising autogenous abdominal fat graft. PATIENTS AND METHODS: This study was carried out on 20 patients having anterior table fracture of their frontal sinuses indicated for sinus obliteration. All sinuses were obliterated using autogenous abdominal fat graft. Post-operatively, patients were clinically evaluated for any signs or symptoms of intracranial infections, wound dehiscence, sinus affections, or aesthetic deformity. Computerized tomography (CT) radiographic evaluations were carried out immediately and 12 months postoperatively to evaluate any uneventful healing of the graft. RESULTS: Clinical follow-up showed no cerebrospinal fluid leak, no postoperative infection or wound dehiscence in 18 cases. There were two cases however that showed infection. Radiographic follow-up revealed uneventful healing of the abdominal fat grafts with no abnormality detected in the sinus cavity throughout the whole postoperative period. CONCLUSION: Autogenous abdominal fat graft appears to be a successful obliteration material in the frontal sinus cavity and is beneficial in fractures of the anterior table.
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Affiliation(s)
- Abla Eledeissi
- Oral and Maxillofacial Surgery Department, Nasser Institute Hospital, Cairo, Egypt
| | - Mamdouh Ahmed
- Oral and Maxillofacial Surgery Department, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Emad Helmy
- Oral and Maxillofacial Surgery Department, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
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Buller J, Maus V, Grandoch A, Kreppel M, Zirk M, Zöller JE. Frontal Sinus Morphology: A Reliable Factor for Classification of Frontal Bone Fractures? J Oral Maxillofac Surg 2018; 76:2168.e1-2168.e7. [PMID: 30009786 DOI: 10.1016/j.joms.2018.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The frontal sinus shows a wide range of morphologic variations. The aim of this study was to evaluate the influence of frontal sinus size on fracture characteristics in frontal bone trauma. MATERIALS AND METHODS In this cross-sectional study, data from patients with traumatic fractures of the frontal bone were retrospectively collected from the institution's database. Radiometric analysis of computed tomography and cone-beam computed tomography datasets was performed. Frontal sinus size was measured as variables of height, width, and depth. The secondary predictor was morphologic sinus type according to Guerram's classification: hyperplasia, medium size, hypoplasia, or aplasia of the frontal sinus. To determine outcomes, we classified fractures into the following categories: fracture isolated to the anterior table, combined fractures of the anterior and posterior tables, fracture isolated to the posterior table, and frontal bone fracture without sinus involvement. Further study variables were patients' demographic characteristics, combined midfacial fractures, orbital rim involvement, fracture displacement, and surgical approach. For statistical analysis, fracture types were assessed for frontal sinus metric size and morphologic type using bivariate tests with P < .05 defined as significant. RESULTS We enrolled 53 consecutive patients with a mean age of 35 years; male patients comprised 91%. Fracture types differed significantly in sinus width and height (both P < .001), as well as depth (P = .002). Frontal sinus morphology was hyperplastic in 66%, medium in 30.2%, and hypoplastic in 3.8%. Patients with a hyperplastic frontal sinus had an increased likelihood of isolated anterior table fractures (odds ratio, 6.0; P = .007) compared with medium-sized types. Fractures without sinus involvement were more likely in hypoplastic and medium types (P < .001). CONCLUSIONS The morphology of the frontal sinus determines the probability of fracture types from craniofacial trauma. Thus the frontal sinus size appears to be a major factor for frontal bone resistance to traumatic force impingement.
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Affiliation(s)
- Johannes Buller
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Volker Maus
- Senior Physician, Department of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany; and Radiologist, Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Grandoch
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Assistant Professor, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Zirk
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Professor and Head, Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
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Harris M, Brantley T, Hammond D, Kalamchi S. Demographic features of patients with concomitant facial fractures and closed head injuries in Maricopa, Arizona. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2017.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lee HJ, Kim YJ, Seo DW, Sohn CH, Ryoo SM, Ahn S, Lee YS, Kim WY, Lim KS. Incidence of intracranial injury in orbital wall fracture patients not classified as traumatic brain injury. Injury 2018; 49:963-968. [PMID: 29503015 DOI: 10.1016/j.injury.2018.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/07/2018] [Accepted: 02/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The detection of intracranial injury in patients with facial injury rather than traumatic brain injury (TBI) remains a challenge for emergency physicians. This study aimed to evaluate the incidence and risk factors of intracranial injury in patients with orbital wall fracture (OWF), who were classified with a chief complaint of facial injury rather than TBI. METHODS This retrospective case-control study enrolled adult OWF patients (age ≥18 years) who presented at the hospital between January 2004 and March 2016. Patients with definite TBI were excluded because non-contrast head computed tomography (CT) is recommended for such patients. RESULTS A total of 1220 patients with OWF were finally enrolled. CT of the head was performed on 677 patients, and the incidence of concomitant intracranial injury was found to be 9% (62/677). Patients with definite TBI were excluded. Symptoms raising a suspicion of TBI, such as loss of consciousness, alcohol intoxication, or vomiting, were present in 347 of the patients, with 44 of these patients (13%) showing a concomitant intracranial injury. Of the 330 patients without such symptoms, 18 (6%) demonstrated a concomitant intracranial injury. In OWF patients, superior wall fracture (odds ratio [OR], 4.15; 95% confidence interval [CI], 2.06-8.34; P < 0.001), associated frontal bone fracture (OR, 4.38; 95% CI, 2.08-9.23; P < 0.001), and older age (decades) (OR, 1.03; 95% CI, 1.01-1.04; P = 0.002) were independent risk factors for concomitant intracranial injury. CONCLUSIONS Emergency physicians should maintain a high degree of suspicion of TBI, even when their primary concern is facial trauma with OWF. Head CT is recommended for OWF patients with a superior OWF, frontal bone fracture, or increased age.
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Affiliation(s)
- Hyung-Joo Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Dong-Woo Seo
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Shin Ahn
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Yoon-Seon Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Kyoung Soo Lim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
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Rothweiler R, Bayer J, Zwingmann J, Suedkamp NP, Kalbhenn J, Schmelzeisen R, Gutwald R. Outcome and complications after treatment of facial fractures at different times in polytrauma patients. J Craniomaxillofac Surg 2017; 46:283-287. [PMID: 29292128 DOI: 10.1016/j.jcms.2017.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/31/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022] Open
Abstract
Finding the correct point of time for operative treatment of facial fractures in multiply injured people remains one of the most important challenges in modern emergency medicine. Findings relating to pathophysiological mechanisms after severe trauma argue against the early operative treatment of non-life-threatening injuries. Our retrospective analysis investigated the effects on complications and outcome of different time points for operative treatment of maxillofacial fractures in multiply injured patients. Over a period of 10 years (2003-2012) we could identify 1543 patients, of whom 553 had fractures of the facial skull. 168 of the facial fracture patients were operated on their fractures, 97 at a time later than 72 h. Despite the delayed time of operation, the patients showed fewer complications (21.6% vs 25.4%). This resulted in fewer additional stays in hospital (9.3% vs 11.3%), and also in fewer plate removals (23.7% vs 33.8%). We conclude that delayed operative fracture treatment does not lead to more complications. The optimal time for operative treatment has to be determined individually as the earliest point at which no adverse effects from comorbidities are expected.
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Affiliation(s)
- Rene Rothweiler
- Department of Oral and Maxillofacial Surgery, (Chairman: Prof. Dr. Dr. Rainer Schmelzeisen), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Joerg Bayer
- Department of Orthopedics and Traumatology, (Chairman: Prof. Dr. Norbert P. Suedkamp), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Joern Zwingmann
- Department of Orthopedics and Traumatology, (Chairman: Prof. Dr. Norbert P. Suedkamp), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Norbert P Suedkamp
- Department of Orthopedics and Traumatology, (Chairman: Prof. Dr. Norbert P. Suedkamp), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, (Chairman: Prof. Dr. Hartmut Buerkle), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, (Chairman: Prof. Dr. Dr. Rainer Schmelzeisen), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Ralf Gutwald
- Danube Private University (DPU), Faculty of Medicine/Dentistry, Steiner Landstraße 124, 3500 Krems-Stein, Austria.
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Samieirad S, Aboutorabzade MR, Tohidi E, Shaban B, Khalife H, Hashemipour MA, Salami HR. Maxillofacial fracture epidemiology and treatment plans in the Northeast of Iran: A retrospective study. Med Oral Patol Oral Cir Bucal 2017; 22:e616-e624. [PMID: 28809369 PMCID: PMC5694185 DOI: 10.4317/medoral.21809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background The epidemiology of facial injuries varies based on lifestyle, cultural background and socioeconomic status in different countries and geographic zones. This study evaluated the epidemiology of maxillofacial fractures and treatment plans in hospitalized patients in Northeast of Iran (2015-2016). Material and Methods In this retrospective study, the medical records of 502 hospitalized patients were evaluated in the Department of Maxillofacial Surgery in Kamyab Hospital in Mashhad, Iran. The type and cause of fractures and treatment plans were recorded in a checklist. Data were analyzed with Mann–Whitney test, chi-squared test and Fisher’s exact test, using SPSS 21. Results The majority of patients were male (80.3%). Most subjects were in 20-30-year age range (43.2%). The fractures were mostly caused by accidents, particularly motorcycle accidents (MCAs), and the most common site of involvement was the body of the mandible. There was a significant association between the type of treatment and age. In fact, the age range of 16-59 years underwent open reduction internal fixation (ORIF) more than other age ranges (P=0.001). Also, there was a significant association between gender and fractures (P=0.002). Conclusions It was concluded that patient age and gender and trauma significantly affected the prevalence of maxillofacial traumas, fracture types and treatment plans. This information would be useful for making better health policy strategies. Key words:Epidemiology, treatment, facial injuries, maxillofacial fractures, trauma.
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Affiliation(s)
- S Samieirad
- Department of Oral Medicine, School of Dentistry Kerman University of Medical Sciences, Kerman, Iran,
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Krishnan UC, Byanyima RK, Faith A, Kamulegeya A. Maxillofacial injuries among trauma patients undergoing head computerized tomography; A Ugandan experience. Int J Crit Illn Inj Sci 2017; 7:236-240. [PMID: 29291177 PMCID: PMC5737066 DOI: 10.4103/2229-5151.219950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: The aim of this study was to investigate epidemiological features of maxillofacial fractures within trauma patients who had head and neck computed tomography (CT) scan at the Mulago National referral hospital. Methods: CT scan records of trauma patients who had head scans at the Department of Radiology over 1-year period were accessed. Data collected included sociodemographic factors, type and etiology of injury, and concomitant maxillofacial injuries. Results: A total of 1330 trauma patients underwent head and neck CT scan in the 1-year study period. Out of these, 130 were excluded due to incomplete or unclear records and no evidence of injury. Of the remaining 1200, 32% (387) had maxillofacial fractures. The median age of the patients with maxillofacial fractures was 28 (range = 18–80) years and 18–27 age group was most common at 47.5%. Road traffic accidents constituted 49.1% of fractures. The single most affected isolated bone was the frontal bone (23%). The number of maxillofacial bones fractured was predicted by age group (df = 3 F = 5.358, P = 0.001), association with other fractures (df = 1 F = 5.317, P = 0.03). Conclusions: Good matched case–control prospective studies are needed to enable us tease out the finer difference in the circumstances and pattern of injury if we are to design appropriate preventive measures.
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Affiliation(s)
| | | | - Ameda Faith
- Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adriane Kamulegeya
- Department of Dentistry, Makerere University College of Health Sciences, Kampala, Uganda
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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.
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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
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Sane VD, Kadam P, Jadhav A, Saddiwal R, Merchant Y. Multidisciplinary approach for reconstruction of cranial defect with polymethyl methacrylate resin reinforced with titanium mesh. J Indian Prosthodont Soc 2016; 16:294-7. [PMID: 27621551 PMCID: PMC5000570 DOI: 10.4103/0972-4052.167942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cranial defects occur most commonly as a sequelae to trauma, the incidence being as high as 70%. The successful management of a case of trauma in an emergency situation requires quick evacuation of the hematoma, repair of the dura, and the scalp but not necessarily the integrity of the calvarial segment as an immediate measure. So the reconstruction of the calvarial defect in these cases is mostly carried out as a secondary procedure. Various materials are used for reconstruction of cranial defects, polymethyl methacrylate (PMMA) resin being one of them. In this article, we report a case which was successfully treated by PMMA resin in combination with a titanium mesh for reconstruction of the cranial defect as a secondary procedure.
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Affiliation(s)
- Vikrant Dilip Sane
- Department of OMFS, Bharati Vidyapeeth University Dental College and Hospital, Pune, Maharashtra, India
| | - Pankaj Kadam
- Department of Prosthodontics, Bharati Vidyapeeth University Dental College and Hospital, Pune, Maharashtra, India
| | - Aniket Jadhav
- Department of Endodontics, Bharati Vidyapeeth University Dental College and Hospital, Pune, Maharashtra, India
| | - Rashmi Saddiwal
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth University Dental College and Hospital, Pune, Maharashtra, India
| | - Yash Merchant
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth University Dental College and Hospital, Pune, Maharashtra, India
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Application of a Novel Semi-Automatic Technique for Determining the Bilateral Symmetry Plane of the Facial Skeleton of Normal Adult Males. J Craniofac Surg 2016; 26:1997-2001. [PMID: 26355983 DOI: 10.1097/scs.0000000000001937] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The accurate assessment of symmetry in the craniofacial skeleton is important for cosmetic and reconstructive craniofacial surgery. Although there have been several published attempts to develop an accurate system for determining the correct plane of symmetry, all are inaccurate and time consuming. Here, the authors applied a novel semi-automatic method for the calculation of craniofacial symmetry, based on principal component analysis and iterative corrective point computation, to a large sample of normal adult male facial computerized tomography scans obtained clinically (n = 32). The authors hypothesized that this method would generate planes of symmetry that would result in less error when one side of the face was compared to the other than a symmetry plane generated using a plane defined by cephalometric landmarks. When a three-dimensional model of one side of the face was reflected across the semi-automatic plane of symmetry there was less error than when reflected across the cephalometric plane. The semi-automatic plane was also more accurate when the locations of bilateral cephalometric landmarks (eg, frontozygomatic sutures) were compared across the face. The authors conclude that this method allows for accurate and fast measurements of craniofacial symmetry. This has important implications for studying the development of the facial skeleton, and clinical application for reconstruction.
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Samieirad S, Tohidi E, Shahidi-Payam A, Hashemipour MA, Abedini A. Retrospective study maxillofacial fractures epidemiology and treatment plans in Southeast of Iran. Med Oral Patol Oral Cir Bucal 2015; 20:e729-36. [PMID: 26116845 PMCID: PMC4670254 DOI: 10.4317/medoral.20652] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/01/2015] [Indexed: 11/19/2022] Open
Abstract
Background The epidemiology of facial injuries varies in different countries and geographic zones. Population concentration, lifestyle, cultural background, and socioeconomic status can affect the prevalence of maxillofacial injuries. Therefore, in this study, we evaluated the maxillofacial fractures epidemiology and treatment plans in hospitalized patients (2012-2014) which would be useful for better policy making strategies. Material and Methods In this retrospective study, the medical records of 386 hospitalized patients were evaluated from the department of maxillofacial surgery at Bahonar Hospital of Kerman, Iran. The type and cause of fractures and treatment plans were recorded in a checklist. For data analysis, ANOVA, t-test, Chi-square, and Fisher’s exact test were performed, using SPSS version 21. Results The majority of patients were male (76.5%). Most subjects were within the age range of 20-30 years. Fractures were mostly caused by accidents, particularly motorcycle accidents (MCAs), and the most common site of involvement was the mandible (parasymphysis). There was a significant association between the type of treatment and age. In fact, the age group of 16-59 years under went open reduction internal fixation (ORIF) more than other age groups (P=0.02). Also, a significant association was observed between gender and the occurrence of fractures (P=0.01). Conclusions Considering the geographic and cultural indices of the evaluated population, it can be concluded that patients age and gender and trauma causes significantly affect the prevalence of maxillofacial traumas and fracture kinds and treatment plans. Key words:Epidemiology, treatment, facial injuries, face fractures, maxillofacial trauma, trauma.
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Affiliation(s)
- Sahand Samieirad
- Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran,
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Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:385-91. [DOI: 10.1016/j.oooo.2014.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/15/2014] [Accepted: 12/02/2014] [Indexed: 11/23/2022]
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Roumeliotis G, Ahluwalia R, Jenkyn T, Yazdani A. The Le Fort system revisited: Trauma velocity predicts the path of Le Fort I fractures through the lateral buttress. Plast Surg (Oakv) 2015; 23:40-2. [PMID: 25821772 DOI: 10.4172/plastic-surgery.1000899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To examine the effect of trauma velocity on the pattern of Le Fort I facial fractures. METHOD A retrospective medical record review was conducted on a consecutive cohort of craniofacial traumas surgically treated by a single surgeon between 2007 and 2011 (n=150). Of these cases, 39 Le Fort fractures were identified. Patient demographic information, method of trauma and velocity of impact were reviewed for these cases. Velocity of impact was expressed categorically as either 'high' or 'low': high-velocity fractures were those caused by a fall from >1 story or a motor vehicle collision; low-velocity fractures were the result of assaults with a blunt weapon, closed fist or falls from standing height. The vertical position of each fracture was measured at its point of entry on the lateral buttress and its point of exit on the piriform aperture. To allow for comparison across individuals, values were expressed as ratios based on their location on the face relative to these landmarks. A Wilcoxon rank-sum test was used to compare the fracture heights caused by high- and low-velocity trauma. RESULTS The results revealed that high-velocity traumas to the face create Le Fort I fractures at a higher point in the lateral buttress compared with low-velocity traumas. There was no difference between heights at the piriform aperture. CONCLUSION High-velocity trauma resulted in higher Le Fort I fracture patterns compared with low-velocity trauma.
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Affiliation(s)
- Grayson Roumeliotis
- The Department of Surgery, Division of Plastic Surgery, University of Ottawa, Ottawa
| | | | - Thomas Jenkyn
- The Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario
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Roumeliotis G, Ahluwalia R, Jenkyn T, Yazdani A. The Le Fort system revisited: Trauma velocity predicts the path of Le Fort I fractures through the lateral buttress. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To examine the effect of trauma velocity on the pattern of Le Fort I facial fractures. Method A retrospective medical record review was conducted on a consecutive cohort of craniofacial traumas surgically treated by a single surgeon between 2007 and 2011 (n=150). Of these cases, 39 Le Fort fractures were identified. Patient demographic information, method of trauma and velocity of impact were reviewed for these cases. Velocity of impact was expressed categorically as either ‘high’ or ‘low’: high-velocity fractures were those caused by a fall from >1 story or a motor vehicle collision; low-velocity fractures were the result of assaults with a blunt weapon, closed fist or falls from standing height. The vertical position of each fracture was measured at its point of entry on the lateral buttress and its point of exit on the piriform aperture. To allow for comparison across individuals, values were expressed as ratios based on their location on the face relative to these landmarks. A Wilcoxon rank-sum test was used to compare the fracture heights caused by high- and low-velocity trauma. Results The results revealed that high-velocity traumas to the face create Le Fort I fractures at a higher point in the lateral buttress compared with low-velocity traumas. There was no difference between heights at the piriform aperture. Conclusion High-velocity trauma resulted in higher Le Fort I fracture patterns compared with low-velocity trauma.
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Affiliation(s)
- Grayson Roumeliotis
- The Department of Surgery, Division of Plastic Surgery, University of Ottawa, Ottawa
| | | | - Thomas Jenkyn
- The Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario
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Zhou HH, Liu Q, Yang RT, Li Z, Li ZB. Traumatic head injuries in patients with maxillofacial fractures: a retrospective case-control study. Dent Traumatol 2015; 31:209-14. [PMID: 25721373 DOI: 10.1111/edt.12165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyse and evaluate the correlation between traumatic head injuries (THIs) and maxillofacial fractures (MF). Age, gender and trauma mechanism correlated with THI were also investigated. PATIENTS AND METHODS We conducted a hospital-based retrospective case-control study at Stomatology College and Hospital, Wuhan University. From January 2000 to December 2009, a total of 1131 patients with MF were enrolled in the statistical study to evaluate the association of THI and other risk factors with MF. Among these patients, 86 presented with THI. We utilized binary logistic regression and risk analysis to investigate the associations among MF and other risk factors with HI. RESULTS Head injuries (103 injuries) were sustained by 86 patients (7.6%), with male-to-female ratio of 4.1:1.0. Most of the patients (52 patients, 50.5%) also exhibited cranial bone fractures. The age group with most patients was the 30-39 years age group (26 patients, 30.2%), followed by the 19-29 years age group (22 patients, 25.6%). Motor vehicle accident (MVA) was the most common mechanism of injury (49 patients, 74.1%). Patients older than 50 years showed the highest risk for head injury (OR, 2.0; 95% confidence interval, 1.1-3.7; P = 0.025). MVA had a sixfold risk of head injury (OR, 6.2; 95% confidence interval, 1.5-26.1; P = 0.013). Head injuries were more prone to occur in patients who had combined fracture of the mid-face and mandible (OR = 4.6, P < 0.001), and only a 0.3-fold risk of multimandible fractures (P < 0.001), 0.5-fold risk of single mandibular fracture (P = 0.017) and 0.3-fold risk of patients who sustained only single mandibular condylar fracture (P = 0.019). CONCLUSIONS The occurrence of head injuries is significantly related to age, aetiology and the pattern and position of maxillofacial fractures.
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Affiliation(s)
- Hai-Hua Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
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Salentijn EG, Collin JD, Boffano P, Forouzanfar T. A ten year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: Complications and treatment. J Craniomaxillofac Surg 2014; 42:1717-22. [DOI: 10.1016/j.jcms.2014.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/09/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022] Open
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Patil RS, Kale TP, Kotrashetti SM, Baliga SD, Prabhu N, Issrani R. Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study. Acta Odontol Scand 2014; 72:984-8. [PMID: 25227590 DOI: 10.3109/00016357.2014.933252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the changing mid-face fracture patterns using a computed tomography scan. METHODOLOGY Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). CONCLUSION With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.
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Affiliation(s)
- Rashmi S Patil
- Karnataka Cancer Therapy and Research Institute , Hubli, Karanataka , India
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Neuropsychologic Outcomes in Patients Treated for Complex Maxillofacial Trauma. J Craniofac Surg 2014; 25:1164-7. [DOI: 10.1097/scs.0000000000000779] [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
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Abstract
Fractures of the orbitozygomatic complex are one of the most common facial fractures encountered by plastic surgeons. Many would consider this to be primarily a cosmetic deformity; however, these injuries can be associated with acute life-threatening complications. Intracranial pseudoaneurysm, although rare, is a well-documented complication of blunt facial trauma, which most plastic surgeons are unaware of. We present the case of a 20-year-old woman who developed an intracranial pseudoaneurysm after blunt facial trauma to illustrate the importance of (1) understanding this rare but highly morbid complication, (2) assessing high-risk patients for pseudoaneurysm, and (3) delaying reconstruction in high-risk patients.
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Monnazzi M, Gabrielli M, Pereira-Filho V, Hochuli-Vieira E, de Oliveira H, Gabrielli M. Frontal sinus obliteration with iliac crest bone grafts. Review of 8 cases. Craniomaxillofac Trauma Reconstr 2014; 7:263-70. [PMID: 25383146 DOI: 10.1055/s-0034-1382776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/04/2013] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED This study evaluated postoperative results of 8 cases of frontal sinus fractures treated by frontal sinus obliteration with autogenous bone from the anterior iliac crest. PATIENTS AND METHODS The medical charts of patients sequentially treated for frontal sinus fractures by obliteration with autogenous cancellous iliac crest bone in the Oral and Maxillofacial Surgery Division of this institution were reviewed. From those, eight had complete records and adequately described long-term follow-up. All were operated by the same surgical team. Those patients were recalled and independently evaluated by 2 examiners. Radiographs and/or CT scans were available for this evaluation. Associated fractures and complications were noted. The average postoperative follow-up was 7 years, ranging from 3 to 16 years. The main complication was infection. Four patients (50%) had uneventful long-term follow-ups and four (50%) experienced complications requiring reoperation. Based on the studied sample studied the authors conclude that the obliteration with autogenous bone presented a high percentage of complications in this series.
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Affiliation(s)
- Marcelo Monnazzi
- Department of Diagnosis and Oral and Maxillofacial Surgery, Dental School of Araraquara (UNESP)
| | - Marisa Gabrielli
- Department of Diagnosis and Oral and Maxillofacial Surgery, Dental School of Araraquara (UNESP)
| | - Valfrido Pereira-Filho
- Department of Diagnosis and Oral and Maxillofacial Surgery, Dental School of Araraquara (UNESP)
| | - Eduardo Hochuli-Vieira
- Department of Diagnosis and Oral and Maxillofacial Surgery, Dental School of Araraquara (UNESP)
| | - Henrique de Oliveira
- Department of Diagnosis and Oral and Maxillofacial Surgery, Dental School of Araraquara (UNESP)
| | - Mario Gabrielli
- Department of Diagnosis and Oral and Maxillofacial Surgery, Dental School of Araraquara (UNESP)
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A ten-year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: incidence and aetiology. J Craniomaxillofac Surg 2014; 42:705-10. [PMID: 24703508 DOI: 10.1016/j.jcms.2013.12.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/04/2013] [Accepted: 12/31/2013] [Indexed: 11/21/2022] Open
Abstract
In the literature it is questioned if the presence of maxillofacial trauma is associated with the presence of brain injury. The aim of this study is to present a 10-year retrospective study of the incidence and aetiology of maxillofacial trauma associated with brain injury that required both oral and maxillofacial and neurosurgical intervention during the same hospital stay. Forty-seven patients from a population of 579 trauma patients undergoing maxillofacial surgery were identified. The main cause of injury was road traffic collision, followed by falls. Interpersonal violence correlated less well with traumatic brain injury. Most of the patients were males, aged 20-39 years. Frontal sinus fractures were the most common maxillofacial fractures (21.9%) associated with neurosurgical input, followed by mandibular fractures and zygomatic complex fractures. In the general maxillofacial trauma population, frontal sinus fractures were only found in 2.2% of the cases. At presentation to the Emergency Department the majority of the patients were diagnosed with severe traumatic brain injury and a Marshall CT class 2. Intracranial pressure monitoring was the most common neurosurgical intervention, followed by reconstruction of a bone defect and haematoma evacuation. Although it is a small population, our data suggest that maxillofacial trauma does have an association with traumatic brain injury that requires neurosurgical intervention (8.1%). In comparison with the overall maxillofacial trauma population, our results demonstrate that frontal sinus fractures are more commonly diagnosed in association with brain injury, most likely owing to the location of the impact of the trauma. In these cases the frontal sinus seems not specifically to act as a barrier to protect the brain. This report provides useful data concerning the joint management of oral and maxillofacial surgeons and neurosurgeons for the treatment of cranio-maxillofacial trauma and brain injury patients in Amsterdam.
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Facial Fractures of the Upper Craniofacial Skeleton Predict Mortality and Occult Intracranial Injury After Blunt Trauma. J Craniofac Surg 2013; 24:1922-6. [DOI: 10.1097/scs.0b013e3182a30544] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zandi M, Seyed Hoseini SR. The relationship between head injury and facial trauma: a case-control study. Oral Maxillofac Surg 2013; 17:201-207. [PMID: 23100036 DOI: 10.1007/s10006-012-0368-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/17/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION In spite of anatomic proximity of the facial skeleton and cranium, there is paucity of information in the literature regarding the relationship between head injuries and facial trauma. The objective of our investigation was to evaluate the pattern of head injuries in patients with maxillofacial trauma, and to study their relationship. MATERIAL AND METHODS We evaluated 2,692 patients with maxillofacial trauma admitted to the Besat hospital, Hamedan, Iran between 2007 and 2010. Patients with associated head injury (302 cases; study group) were compared with those without head injury (2,390 cases; control group). RESULTS In our cohort, the rate of head injuries associated with facial bone fractures was 23.3 %. The most common associated head injury was concussion, followed by cerebral contusion and skull fractures. In the unadjusted analysis, motorcycle and car accidents were significantly more frequent in the study group, while stumbling, sports injuries, and work-related injuries were significantly more common in the control group (p < 0.001). Except for Lefort III fractures which was not significantly different between groups, all facial fractures occurred more frequently in the study group (p < 0.001). Logistic regression analysis demonstrated that motorcycle accidents (211-fold), car accidents (139-fold), violence (69-fold), falls (66-fold), frontal sinus fractures (84.5-fold), and Lefort II fractures (27-fold) were the strongest predictors of head injuries. DISCUSSION Present study revealed that fracture of facial bones, especially bones that are in anatomic proximity to the cranium and need a high magnitude of trauma energy to be fractured, was marker for an increased risk of head injuries.
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Affiliation(s)
- Mohammad Zandi
- Department of Oral and Maxillofacial Surgery, Hamedan University of Medical Sciences, Iran.
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Bellamy JL, Mundinger GS, Reddy SK, Flores JM, Rodriguez ED, Dorafshar AH. Le Fort II fractures are associated with death: a comparison of simple and complex midface fractures. J Oral Maxillofac Surg 2013; 71:1556-62. [PMID: 23866783 DOI: 10.1016/j.joms.2013.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 04/03/2013] [Accepted: 04/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate whether complex midface fractures have a greater association with death and intracranial injury than simple midface fractures. MATERIALS AND METHODS A retrospective chart review was performed for patients with blunt-mechanism midface fractures who had presented to an urban trauma center from 1998 to 2010. The survival and intracranial injury status was evaluated for patients with simple and complex midface fractures, including Le Fort, naso-orbitoethmoid, and/or zygomaticomaxillary fractures. Intracranial injury included hemorrhage and brainstem injury. Patients with upper face fractures were excluded to minimize confounding. Adjusted relative risk estimates were obtained using multivariate regression analysis. RESULTS Of 3,291 patients with midface fractures, 213 (6.3%) died and 693 (21.3%) had an intracranial injury. The cumulative mortality reached 11.6% in patients with complex midface fractures and 5.1% in those with simple midface fractures (P < .001). Patients with complex midface fractures were 57% more likely to die (relative risk = 1.57; P < .005). Specifically, Le Fort II fractures independently conferred a 94% increased risk of death (relative risk = 1.94; P < .01), but Le Fort I and III fractures were not significantly associated with death. Among patients presenting without neurologic impairment, those with Le Fort II and III fractures remained 2.88-fold (P < .01) and 2.54-fold (P < .001) more likely to have an underlying intracranial injury, respectively. CONCLUSIONS Le Fort II fractures are associated with increased mortality. Furthermore, Le Fort II and III fractures are associated with serious intracranial injury, even in the absence of alterations in consciousness. These patients should be monitored with heightened vigilance and followed up closely during hospitalization, regardless of the presenting clinical findings.
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Sphenoid sinus and sphenoid bone fractures in patients with craniomaxillofacial trauma. Craniomaxillofac Trauma Reconstr 2013; 6:179-86. [PMID: 24436756 DOI: 10.1055/s-0033-1343778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 08/25/2012] [Indexed: 10/26/2022] Open
Abstract
Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures.
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Anaesthesia of the inferior alveolar and lingual nerves following subcondylar fractures of the mandible. J Craniomaxillofac Surg 2013; 41:e137-45. [PMID: 23453271 DOI: 10.1016/j.jcms.2012.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 12/03/2012] [Accepted: 12/03/2012] [Indexed: 11/21/2022] Open
Abstract
A retrospective chart review of 387 patients with condylar and subcondylar fractures revealed 2 cases of inferior alveolar nerve (IAN) and lingual nerve (LN) anaesthesia following the subcondylar fracture. Only 5 cases have been reported previously. The mechanism of action remains unknown but a review of the literature and an analysis of 120 dry human skulls supported the hypothesis that compression of the mandibular nerve at a high level, close to the foramen ovale, could cause anaesthesia. This complication is rare, because it requires compression at a particular angle. The antero-median angulation of the condyle must be close to the foramen ovale, and the fracture must be a unilaterally displaced fracture. The presence of an enlarged lateral pterygoid plate appeared to enhance the risk of compression. The IAN and LN anaesthesia could be resolved after open reduction of the fracture and IAN and LN anaesthesia constitute a strict indication for an early open fracture reduction.
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Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. Characteristics of associated craniofacial trauma in patients with head injuries: An experience with 100 cases. J Emerg Trauma Shock 2011; 2:89-94. [PMID: 19561967 PMCID: PMC2700599 DOI: 10.4103/0974-2700.50742] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 12/06/2008] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Facial fractures and concomitant cranial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults. AIMS AND OBJECTIVES To analyze the characteristics of head injuries and associated facial injuries, the management options and outcome following cranio-facial trauma. METHODS This retrospective review was performed at Justice K. S. Hegde Charitable Hospital, and associated A. B. Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore. Following Ethical Committee approval, hospital charts and radiographs of 100 consecutive patients of cranio-facial trauma managed at the Department of Oral and Maxillofacial Surgery and Neurosurgery between January 2004 and December 2004 were reviewed. RESULTS Majority of the patients were in the 2nd to 4th decade (79%) with a male to female ratio of -8.09:1. Road traffic accidents were the common cause of craniofacial trauma in present study (54%) followed by fall from height (30%). Loss of consciousness was the most common clinical symptom (62%) followed by headache (33%). Zygoma was the most commonly fractured facial bone 48.2% (alone 21.2%, in combination 27.2%). Majority of patients had mild head injury and managed conservatively in present series. Causes of surgical intervention for intracranial lesions were compound depressed fracture, contusion and intracranial hematoma. Operative indications for facial fractures were displaced facial bone fractures. Major causes of mortality were associated systemic injuries. CONCLUSION Adult males are the most common victims in craniofacial trauma, and road traffic accidents were responsible for the majority. Most of the patients sustained mild head injuries and were managed conservatively. Open reduction and internal fixation with miniplates was used for displaced facial bone fractures.
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Affiliation(s)
- Prasad B Rajendra
- Department of Neurosurgery, K.S.Hegde Medical Academy, Deralakatte-575018, Mangalore, Karnataka, India
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Li R, Wang H, Guo L, Tang W, Long J, Liu L, Tian W. Analysis of maxillofacial fracture victims in the Wenchuan earthquake and Yushu earthquake. Dent Traumatol 2010; 26:454-8. [PMID: 21078070 DOI: 10.1111/j.1600-9657.2010.00942.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To analyze retrospectively 419 patients after the Wenchuan earthquake and 46 after Yushu earthquake with maxillofacial fractures so as to provide reference on patients' treatment after an earthquake. METHOD We investigated 419 patients after Wenchuan earthquake and 46 after Yushu earthquake with maxillofacial fractures who were admitted to the West China Hospital of Stomatology and other 46 hospitals in 10 provinces. RESULT A total of 58 patients had maxillofacial fractures (13.8%) including 33 (56.9%) men and 25 (43.1%) women after the Wenchuan earthquake and 6 (13%) had maxillofacial fractures after Yushu earthquake. Most patients were injured by pressing or burying. The nasal-orbital-ethmoidal region was the most frequent site of the maxillofacial fracture (58.6% in the Wenchuan earthquake and 66.7% in the Yushu earthquake). The most prevalent pattern of maxillofacial fracture was multiple and/or comminuted fractures (87.9% in the Wenchuan earthquake and 100% in the Yushu earthquake). There were 48 (82.8%) patients with associated injuries, and the most common site was extremity injuries (58.6%) after Wenchuan earthquake. Few patients received adequate prehospital treatment, with bandages predominantly. Most patients (65.5% in the Wenchuan earthquake and 100% in the Yushu earthquake) underwent open reduction and rigid internal fixation. We failed to find any patients with generalized infection. However, all patients in our study presented the symptoms of post-traumatic stress disorder. CONCLUSION We analyze the characteristics of maxillofacial fractures after the two earthquakes, so as to improve our medical emergency system when such disasters happen again.
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Affiliation(s)
- Rui Li
- Faculty, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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The significance of pontomedullar laceration in car occupants following frontal collisions: A retrospective autopsy study. Forensic Sci Int 2010; 202:13-6. [PMID: 20439142 DOI: 10.1016/j.forsciint.2010.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 04/07/2010] [Accepted: 04/11/2010] [Indexed: 11/23/2022]
Abstract
The aim of this study was to determine the frequency of brainstem pontomedullar lacerations among fatally injured car occupants in head-on collisions, as well as the concomitant cranial injuries, and to establish a possible underlying mechanism for brainstem laceration. Brainstem pontomedullar lacerations (PML) are often associated with fractures of the skull base (hinge, ring or pyramidal fractures) or with cervical spine fractures. Out of 705 cases of deceased car occupants involved in head-on car collisions, some form of head injury was present in 447 cases (63.4%). These cases included 353 men and 94 women with an average age of 38.2±15.8 years (range 16-89 years). The collected cases included 229 drivers, 164 front-seat and 54 rear-seat passengers. PML were present in 67 of these cases (15%), 50 men and 17 women with an average age of 42.9±15.6 years (range 15-77 years), including 32 drivers, 26 front-seat and 9 rear-seat passengers. In all of these cases the brainstem laceration was partial and the depth varied approximately from 4mm to 8mm. To understand the mechanisms by which PML occurs, we classified the head impact areas into frontal, lateral, posterior and chin area, depending on the injuries to the soft tissue of the head and scalp, as well as facial and cranial fractures. Injury impact area of the head was a good predictor of PML occurrence (χ(2)=131.112, df=3, p=0.000). Chin impact was most often associated with PML-38 cases (Wald. coeff.=5.805, df=1, p=0.016). Presence or absence of mandibular fracture was significant for PML occurrence (χ(2)=11.413, df=1, p=0.001): persons without mandibular fracture have 2.3 times greater risk for PML than those with fracture (odd ratio=7.196). Among the observed skull base fractures, the best predictor of PML was ring fracture (Wald. coeff.=30.729, df=2, p=0.000). Our study showed that PML was present in a significant number of car occupants sustaining head injuries in head-on collisions (15%). Impact to the chin with or without a ring fracture to the skull base most often led to this fatal injury, probably after collision with the dashboard.
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Abstract
International guidelines for frontal sinus fractures, dealing with the indication of surgical treatment, obliteration of the frontal sinus, drainage, and cranialization, may differ.In this work, we describe our experience with frontal traumas, analyzing indications, type of treatment, and outcomes by reviewing all data of 112 patients treated for frontal fractures at the Department of Maxillo-Facial Surgery, Università degli studi di Roma Sapienza.We reviewed all clinical and surgical records of patients with traumatic frontal injury treated from 1997 to September 2008. Patients presenting displaced fractures of the anterior wall of the frontal sinus were treated through skin laceration, if existing, or through a coronal approach and fixed with rigid internal devices. Patients with fracture of the posterior wall of the frontal sinus underwent frontal sinus cranialization with galea pericranium pedicled flap to prevent eventful septic complications.Follow-up controls documented that 98 of 112 patients showed no neurologic impairment, no symptoms of cerebrospinal fluid leak, and no other complications after 6 months and 1 and 5 years when follow-up was possible.In the international literature, there is wide agreement about indications dealing with displaced fractures of the anterior wall, although there is a lively debate about posterior wall treatment. In our 10-year experience, the protocol we carried out showed satisfying outcomes, in particular, on the morphofunctional recovery and aesthetic results.
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A Nationwide Review of the Associations Among Cervical Spine Injuries, Head Injuries, and Facial Fractures. ACTA ACUST UNITED AC 2010; 68:587-92. [DOI: 10.1097/ta.0b013e3181b16bc5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McMullin BT, Rhee JS, Pintar FA, Szabo A, Yoganandan N. Facial Fractures in Motor Vehicle Collisions. ACTA ACUST UNITED AC 2009. [DOI: 10.1001/archfaci.2009.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brian T. McMullin
- Departments of Otolaryngology and Communication Sciences (Drs McMullin and Rhee), Neurosurgery (Drs Pintar and Yoganandan), and Population Health (Dr Szabo), Medical College of Wisconsin, and the Zablocki Veteran Affairs Medical Center (Drs Rhee, Pintar, and Yoganandan), Milwaukee
| | - John S. Rhee
- Departments of Otolaryngology and Communication Sciences (Drs McMullin and Rhee), Neurosurgery (Drs Pintar and Yoganandan), and Population Health (Dr Szabo), Medical College of Wisconsin, and the Zablocki Veteran Affairs Medical Center (Drs Rhee, Pintar, and Yoganandan), Milwaukee
| | - Frank A. Pintar
- Departments of Otolaryngology and Communication Sciences (Drs McMullin and Rhee), Neurosurgery (Drs Pintar and Yoganandan), and Population Health (Dr Szabo), Medical College of Wisconsin, and the Zablocki Veteran Affairs Medical Center (Drs Rhee, Pintar, and Yoganandan), Milwaukee
| | - Aniko Szabo
- Departments of Otolaryngology and Communication Sciences (Drs McMullin and Rhee), Neurosurgery (Drs Pintar and Yoganandan), and Population Health (Dr Szabo), Medical College of Wisconsin, and the Zablocki Veteran Affairs Medical Center (Drs Rhee, Pintar, and Yoganandan), Milwaukee
| | - Narayan Yoganandan
- Departments of Otolaryngology and Communication Sciences (Drs McMullin and Rhee), Neurosurgery (Drs Pintar and Yoganandan), and Population Health (Dr Szabo), Medical College of Wisconsin, and the Zablocki Veteran Affairs Medical Center (Drs Rhee, Pintar, and Yoganandan), Milwaukee
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Tekeli K, Agrawal T, Worrall S. Unusual case of post-traumatic lingual paraesthesia. Br J Oral Maxillofac Surg 2008; 46:157-8. [DOI: 10.1016/j.bjoms.2007.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2007] [Indexed: 11/26/2022]
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Eggensperger N, Smolka K, Scheidegger B, Zimmermann H, Iizuka T. A 3-year survey of assault-related maxillofacial fractures in central Switzerland. J Craniomaxillofac Surg 2007; 35:161-7. [PMID: 17583524 DOI: 10.1016/j.jcms.2007.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Accepted: 01/31/2007] [Indexed: 10/23/2022] Open
Abstract
AIM The aim of this study was to analyse the character of assault-related facial fractures in central Switzerland and to compare their prevalence with the data presented in similar reports from other countries. MATERIAL The present study comprised 65 patients with assault-related maxillofacial fractures treated in the Department of Cranio-Maxillofacial Surgery, University Hospital of Bern between 2000 and 2002. METHODS The mechanism, the causes of the injuries and the location of the fractures were analysed by reviewing emergency and hospital records. Concomitant injuries were also studied. RESULTS The mean age of the patients was 33 years with the largest group being below 25 years. The male-to-female ratio was 56:9. The most common causes of assault-related injuries were fights, most frequently facial blows, accounting for 92.5% of all patients. Seventy-six per cent of the fractures occurred in the middle and upper facial skeleton with a predominance of 2:1 for the left side. In 39 patients (60%) surgery was necessary, with a mean hospital stay of 3.3 days. Thirty-five patients (54%) had concomitant injuries. Alcohol and drug abuse was found in 15 patients (23%). CONCLUSION It seems that mostly young men suffer assault-related maxillofacial injuries. A contributing factor to the increased disposition for violence could be alcohol and drug abuse. Therefore, national prevention programmes for alcohol or drug abuse and addiction might have a positive effect on reducing the incidence of assault-related maxillofacial injuries.
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Affiliation(s)
- Nicole Eggensperger
- Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland.
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Abstract
PURPOSE This study retrospectively evaluated individuals with traumatic injuries from different mechanisms and tried to determine if there is any relationship between various isolated or combined fractures of facial skeleton and cranial injuries. MATERIALS AND METHODS We retrospectively studied hospital charts of all patients who reported to the trauma center at Kasturba Hospital in Manipal with facial fractures and suspected cranial injuries during a 5-year period (January 1, 1995 to December 31, 1999). These patients were admitted to the Department of Neurosurgery or the Maxillofacial Unit of Kasturba Hospital, Manipal. The complete medical record of each patient was reviewed, recording the following in a standard format: age, gender, cause of injury, type of facial fractures, type of cranial bone fracture, concussion, intracranial injury, cerebrospinal fluid (CSF) rhinorrhea, CSF otorrhea, and the Glasgow coma scale. RESULTS The study data were collected as part of retrospective analysis. A total of 12,329 patients reported to the trauma center of the study hospital during a 5-year period with various injuries. A total of 772 patients had facial fractures (6%). A total of 108 patients with a combination of cranial injuries and facial fractures were identified within this group (14%). Gender predilection was seen to favor males (90%) more than females (10%). The ratio was seen to be nearly 9:1. The ages of the patients ranged from 7 to 70 years with mean age being 32 years (standard deviation [SD] = +/-12). Central midfacial bone involvement was found to be more commonly associated with head injury. CONCLUSIONS There is a correlation between midfacial injuries and CNS trauma. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of head injuries associated with facial fractures.
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Affiliation(s)
- Biju Pappachan
- Department of Maxillofacial Surgery, Sharad Pawar Dental College, Radhika Meghe Memorial Medical Trust, Sawangi (Meghe), Wardha, Maharashtra, India.
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Madhusudan G, Sharma RK, Khandelwal N, Tewari MK. Nomenclature of Frontobasal Trauma: A New Clinicoradiographic Classification. Plast Reconstr Surg 2006; 117:2382-8. [PMID: 16772946 DOI: 10.1097/01.prs.0000218794.28670.07] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-velocity accidents cause significant injury to the cranial and facial skeleton. Frontobasal fractures include fractures of the upper third of the face and anterior skull base. The pattern and classifications of these fractures are poorly understood at present. The authors have attempted a new comprehensive classification based on detailed clinicoradiographic evaluation. METHODS A prospective study was undertaken in a tertiary care hospital in 1 calendar year (July of 2000 to June of 2001). All 63 patients with frontobasal fractures had detailed clinical and radiographic evaluation with plain radiographs and high-resolution computed tomographic scan. The fractures were classified as frontal, basal, and combined. Areas were separated as central (designated type 1) and lateral (designated type 2) to differentiate the pattern in the sagittal plane according to the site of impact. Combined fractures involving both central and lateral areas were designated type 3. These could be further classified into unilateral or bilateral or pure or impure, depending on the absence or presence of midfacial fractures. RESULTS The fractures were subdivided into nine types considering the whole lateral and anteroposterior extents of the frontobasal region. The most common was the combined frontobasal type (30.16 percent). We found the pure type in 38.1 percent (24 of 63) and the impure type in 61.9 percent (39 of 63) of patients. Cerebrospinal fluid leaks occurred more commonly in impure types of frontobasal fracture. Blunt trauma leading to closed frontobasal fracture was seen in 35 patients. Penetrating trauma with open fractures was found in 28 patients and cerebrospinal fluid leak through the wound was seen in six of them. CONCLUSIONS The new comprehensive classification clearly defines the anatomical areas within the frontobasal region, the nature of injury, and its association with midfacial injuries, and is helpful in planning the approach to their exposure in surgery.
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Affiliation(s)
- G Madhusudan
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Bagheri SC, Holmgren E, Kademani D, Hommer L, Bell RB, Potter BE, Dierks EJ. Comparison of the severity of bilateral Le Fort injuries in isolated midface trauma. J Oral Maxillofac Surg 2005; 63:1123-9. [PMID: 16094579 DOI: 10.1016/j.joms.2005.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The Le Fort classification pattern established in 1901 by the French surgeon Rene Le Fort is commonly used in describing midface fractures. This frequently used classification system is based on predictable patterns of midface fractures initially described for blunt trauma. The purpose of this study was to compare the profile and outcome of patients with isolated bilateral Le Fort I, II, and III fractures. PATIENTS AND METHODS All patients presenting to the emergency department (ED) at Legacy Emanuel Hospital (Level I trauma center) in Portland, OR, between December 1990 and December 2003 with isolated bilateral Le Fort I, II, or III fractures with or without concomitant nonfacial injuries were identified retrospectively using the Hospital Trauma Registry. Patients were classified into study groups I (n = 22), II (n = 22), or III (n = 23) corresponding to the Le Fort classification, respectively. RESULTS Sixty-seven patients had a diagnosis of isolated bilateral Le Fort I, II, or III fracture. The average Injury Severity Score (ISS) and hospital length of stay were 18.8 +/- 8.9 and 9.5 +/- 11.9 days, respectively. Blood alcohol was detected in 19 patients. Sixty-four injuries (95.5%) were secondary to blunt trauma, and the remaining 3 (4.5%), penetrating injuries. More than half of the patients (n = 35, 52.2%) were admitted to the intensive care unit (ICU), 18 patients (26.8%) were transferred to the hospital trauma ward from the ED, and 14 patients (20.9%) were taken directly to the operating room. Fifteen (22.4%) patients required a tracheostomy secondary to their maxillofacial injuries. A statistically significant difference in the ISS was detected between patients with Le Fort I versus those with II or III injuries ( P < .0001). Patients with Le Fort II or III fractures had a significantly higher probability of ICU admission or immediate operative intervention. Ten patients (43.5%) with Le Fort III injuries required tracheostomy versus 3 patients (13.6%) with Le Fort I, and 2 patients (9.1%) with Le Fort II injuries. This was statistically significant. None of the patients with Le Fort I injuries had a negative outcome (death); however, 1 patient with Le Fort II injuries (4.5%) and 2 with Le Fort III injuries (8.7%) had a negative outcome. No statistically significant differences or emerging trends were observed among the 3 groups for age, gender, length of stay, number of operations, and number of associated injuries. CONCLUSIONS Patients with higher Le Fort injuries are characterized by an overall greater severity of injuries as measured by the ISS and the more frequent need for a surgical airway. Patients with Le Fort III injuries have a higher chance of requiring neurosurgical intervention or of experiencing vision-threatening ocular trauma. Immediate operative intervention and/or ICU care is more frequently indicated in these patients.
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Affiliation(s)
- Shahrokh C Bagheri
- Department of Oral and Maxillofacial Surgery, Legacy Emanuel Hospital, Portland, OR, USA.
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