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Breeze J, Gensheimer W, Berg C, Sarber KM. Head Face and Neck Surgical Workload From a Contemporary Military Role 3 Medical Treatment Facility. Mil Med 2021; 187:93-98. [PMID: 34056658 DOI: 10.1093/milmed/usab221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Previous analyses of head, face, and neck (HFN) surgery in the deployed military setting have focused on the treatment of injuries using trauma databases. Little has been written on the burden of disease and the requirement for follow-up care. The aim of this analysis was to provide the most comprehensive overview of surgical workload in a contemporary role 3 MTF to facilitate future planning. METHOD The operating room database and specialty surgical logbooks from a U.S.-led role 3 MTF in Afghanistan were analyzed over a 5-year period (2016-2020). These were then matched to the deployed surgical TC2 database to identify reasons for treatment and a return to theatre rate. Operative records were finally matched to the deployed Armed Forces Health Longitudinal Technology Application-Theater outpatient database to determine follow up frequency. RESULTS During this period, surgical treatment to the HFN represented 389/1989 (19.6%) of all operations performed. Surgery to the HFN was most commonly performed for battle injury (299/385, 77.6%) followed by disease (63/385, 16%). The incidence of battle injury-related HFN cases varied markedly across each year, with 117/299 (39.1%) being treated in the three summer months (June to August). The burden of disease, particularly to the facial region, remained constant throughout the period analyzed (mean of 1 case per month). CONCLUSIONS Medical planning of the surgical requirements to treat HFN pathology is primarily focused on battle injury of coalition service personnel. This analysis has demonstrated that the treatment of disease represented 16% of all HFN surgical activities. The presence of multiple HFN sub-specialty surgeons prevented the requirement for multiple aeromedical evacuations of coalition service personnel which may have affected mission effectiveness as well as incurring a large financial burden. The very low volume of surgical activity demonstrated during certain periods of this analysis may have implications for the maintenance of surgical competencies for subspecialty surgeons.
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Affiliation(s)
- John Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham B15 2TH, UK
| | - William Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Craig Berg
- Department of Neurosurgery, 88th SGC/SGCO, Wright-Patterson Air Force Base, Dayton, OH 45433, USA
| | - Kathleen M Sarber
- Department of Otolaryngology, 96th Medical Group, Eglin AFB, FL 32542, USA
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Variation in UK Deanery publication rates in the British Journal of Oral and Maxillofacial Surgery: where are the current 'hot spots'? Br J Oral Maxillofac Surg 2021; 59:e48-e64. [DOI: 10.1016/j.bjoms.2020.08.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
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Outcomes following penetrating neck injury during the Iraq and Afghanistan conflicts: A comparison of treatment at US and United Kingdom medical treatment facilities. J Trauma Acute Care Surg 2020; 88:696-703. [PMID: 32068717 PMCID: PMC7182242 DOI: 10.1097/ta.0000000000002625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. The United States and United Kingdom (UK) had differing approaches to the surgical skill mix within deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan.
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Breeze J, Gensheimer W, DuBose JJ. Combat Facial Fractures Sustained During Operation Resolute Support and Operation Freedom’s Sentinel in Afghanistan. Mil Med 2020; 185:414-416. [DOI: 10.1093/milmed/usaa159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Facial fractures sustained in combat are generally unrepresentative of those commonly experienced in civilian practice. In the US military, acute trauma patient care is guided by the Joint Trauma System Clinical Practice Guidelines but currently none exists for facial trauma.
Materials and methods
All casualties that underwent surgery to facial fractures between January 01, 2016 and September 15, 2019 at a US deployed Military Treatment Facility in Afghanistan were identified using the operating room database. Surgical operative records and outpatient records for local Afghan nationals returning for follow-up were reviewed to determine outcomes.
Results
55 casualties underwent treatment of facial fractures; these were predominantly from explosive devices (27/55, 49%). About 46/55 (84%) were local nationals, of which 32 (70%) were followed up. Length of follow-up ranged between 1 and 25 months. About 36/93 (39%) of all planned procedures developed complications, with the highest being from ORIF mandible (18/23, 78%). About 8/23 (35%) casualties undergoing ORIF mandible developed osteomyelitis, of which 5 developed nonunion. Complications were equally likely to occur in those procedures for “battlefield type” events such as explosive devices and gunshot wounds (31/68, 46%) as those from “civilian type” events such as falls or motor vehicle collisions (5/11, 45%).
Conclusions
Complications Rates from facial fractures were higher than that reported in civilian trauma. This likely reflects factors such as energy deposition, bacterial load, and time to treatment. Load sharing osteosynthesis should be the default modality for fracture fixation. External fixation should be considered in particular for complex high-energy or infected mandible fractures where follow-up is possible.
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Affiliation(s)
- John Breeze
- Royal Centre for Defence Medicine, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - William Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland 20762
| | - Joseph J DuBose
- Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, Maryland 21201
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Jain RP, Meteke S, Gaffey MF, Kamali M, Munyuzangabo M, Als D, Shah S, Siddiqui FJ, Radhakrishnan A, Ataullahjan A, Bhutta ZA. Delivering trauma and rehabilitation interventions to women and children in conflict settings: a systematic review. BMJ Glob Health 2020; 5:e001980. [PMID: 32399262 PMCID: PMC7204922 DOI: 10.1136/bmjgh-2019-001980] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background In recent years, more than 120 million people each year have needed urgent humanitarian assistance and protection. Armed conflict has profoundly negative consequences in communities. Destruction of civilian infrastructure impacts access to basic health services and complicates widespread emergency responses. The number of conflicts occurring is increasing, lasting longer and affecting more people today than a decade ago. The number of children living in conflict zones has been steadily increasing since the year 2000, increasing the need for health services and resources. This review systematically synthesised the indexed and grey literature reporting on the delivery of trauma and rehabilitation interventions for conflict-affected populations. Methods A systematic search of literature published from 1 January 1990 to 31 March 2018 was conducted across several databases. Eligible publications reported on women and children in low and middle-income countries. Included publications provided information on the delivery of interventions for trauma, sustained injuries or rehabilitation in conflict-affected populations. Results A total of 81 publications met the inclusion criteria, and were included in our review. Nearly all of the included publications were observational in nature, employing retrospective chart reviews of surgical procedures delivered in a hospital setting to conflict-affected individuals. The majority of publications reported injuries due to explosive devices and remnants of war. Injuries requiring orthopaedic/reconstructive surgeries were the most commonly reported interventions. Barriers to health services centred on the distance and availability from the site of injury to health facilities. Conclusions Traumatic injuries require an array of medical and surgical interventions, and their effective treatment largely depends on prompt and timely management and referral, with appropriate rehabilitation services and post-treatment follow-up. Further work to evaluate intervention delivery in this domain is needed, particularly among children given their specialised needs, and in different population displacement contexts. PROSPERO registration number CRD42019125221.
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Affiliation(s)
- Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mariella Munyuzangabo
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Health System and Services Research, Duke-NUS Medical School, Singapore
| | - Amruta Radhakrishnan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Breeze J, Bowley DM, Harrisson SE, Dye J, Neal C, Bell RS, Armonda RA, Beggs AD, DuBose J, Rickard RF, Powers DB. Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts. J Neurol Neurosurg Psychiatry 2020; 91:359-365. [PMID: 32034113 PMCID: PMC7147183 DOI: 10.1136/jnnp-2019-321723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/14/2019] [Accepted: 01/12/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment facilities (MTFs), while the UK did not. Our aim was to compare the incidence, TBI and treatment in US and UK-led military MTF to ascertain if differences in deployed trauma systems affected outcomes. METHODS The US and UK Combat Trauma Registries were scrutinised for patients with HI at deployed MTFs between March 2003 and October 2011. Registry datasets were adapted to stratify TBI using the Mayo Classification System for Traumatic Brain Injury Severity. An adjusted multiple logistic regression model was performed using fatality as the binomial dependent variable and treatment in a US-MTF or UK-MTF, surgical decompression, US military casualty and surgery performed by a neurosurgeon as independent variables. RESULTS 15 031 patients arrived alive at military MTF after TBI. Presence of a neurosurgeon was associated with increased odds of survival in casualties with moderate or severe TBI (p<0.0001, OR 2.71, 95% CI 2.34 to 4.73). High injury severity (Injury Severity Scores 25-75) was significantly associated with a lower survival (OR 4×104, 95% CI 1.61×104 to 110.6×104, p<0.001); however, having a neurosurgeon present still remained significantly positively associated with survival (OR 3.25, 95% CI 2.71 to 3.91, p<0.001). CONCLUSIONS Presence of neurosurgeons increased the likelihood of survival after TBI. We therefore recommend that the UK should deploy neurosurgeons to forward military MTF whenever possible in line with their US counterparts.
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Affiliation(s)
- John Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Douglas M Bowley
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Stuart E Harrisson
- Department of Neurosurgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Justin Dye
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, USA
| | - Christopher Neal
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Randy S Bell
- National Capital Neurosurgery Consortium, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rocco A Armonda
- Department of Neurosurgery, Georgetown University Medical Center, Washington, DC, USA
| | - Andrew D Beggs
- Surgical Research Laboratory, University of Birmingham, Birmingham, UK
| | - Jospeh DuBose
- Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - Rory F Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - David Bryan Powers
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Breeze J, Bowley DM, Combes JG, Baden J, Rickard RF, DuBose J, Powers DB. Facial injury management undertaken at US and UK medical treatment facilities during the Iraq and Afghanistan conflicts: a retrospective cohort study. BMJ Open 2019; 9:e033557. [PMID: 31772107 PMCID: PMC6887033 DOI: 10.1136/bmjopen-2019-033557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To perform the first direct comparison of the facial injuries sustained and treatment performed at USA and UK deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan. SETTING The US and UK Joint Theatre Trauma Registries were scrutinised for all patients with facial injuries presenting alive to a UK or US deployed MTF between 1 March 2003 and 31 October 2011. PARTICIPANTS US and UK military personnel, local police, local military and civilians. PRIMARY AND SECONDARY OUTCOME MEASURES An adjusted multiple logistic regression model was performed using tracheostomy as the primary dependent outcome variable and treatment in a US MTF, US or UK military, mandible fracture and treatment of mandible fracture as independent secondary variables. RESULTS Facial injuries were identified in 16 944 casualties, with the most common being those to skin/muscle (64%), bone fractures (36%), inner/middle ear (28%) and intraoral damage (11%). Facial injuries were equally likely to undergo surgery in US MTF as UK MTF (OR: 1.06, 95% CI 0.4603 to 1.142, p=0.6656); however, variations were seen in injury type treated. In US MTF, 692/1452 (48%) of mandible fractures were treated by either open or closed reduction compared with 0/167 (0%) in UK MTF (χ2: 113.6; p≤0.0001). US military casualties who had treatment of their mandible fracture (open reduction and internal fixation or mandibulo-maxillary fixation) were less likely to have had a tracheostomy than those who did not undergo stabilisation of the fractured mandible (OR: 0.61, 95% CI 0.44 to 0.86; p=0.0066). CONCLUSIONS The capability to surgically treat mandible fractures by open or closed reduction should be considered as an integral component of deployed coalition surgical care in the future.
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Affiliation(s)
- John Breeze
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Douglas M Bowley
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James G Combes
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - James Baden
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Joseph DuBose
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - David B Powers
- Duke University Medical Center, Durham, North Carolina, USA
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Breeze J, Combes JG, DuBose J, Powers DB. How are we currently training and maintaining clinical readiness of US and UK military surgeons responsible for managing head, face and neck wounds on deployment? J ROY ARMY MED CORPS 2018; 164:183-185. [DOI: 10.1136/jramc-2018-000971] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 11/03/2022]
Abstract
IntroductionThe conflicts in Iraq and Afghanistan provided military surgeons from the USA and the UK with extensive experience into the management of injuries to the head, face and neck (HFN) from high energy bullets and explosive weaponry. The challenge is now to maintain the expertise in managing such injuries for future military deployments.MethodsThe manner in which each country approaches four parameters required for a surgeon to competently treat HFN wounds in deployed military environments was compared. These comprised initial surgical training (residency/registrar training), surgical fellowships, hospital type and appointment as an attending (USA) or consultant (UK) and predeployment training.ResultsNeither country has residents/registrars undertaking surgical training that is military specific. The Major Trauma and Reconstructive Fellowship based in Birmingham UK and the Craniomaxillofacial Trauma fellowship at Duke University USA provide additional training directly applicable to managing HFN trauma on deployment. Placement in level 1 trauma/major trauma centres is encouraged by both countries but is not mandatory. US surgeons attend one of three single-service predeployment courses, of which HFN skills are taught on both cadavers and in a 1-week clinical placement in a level 1 trauma centre. UK surgeons attend the Military Operational Surgical Training programme, a 1-week course that includes 1 day dedicated to teaching HFN injury management on cadavers.ConclusionsMultiple specialties of surgeon seen in the civilian environment are unlikely to be present, necessitating development of extended competencies. Military-tailored fellowships are capable of generating most of these skills early in a career. Regular training courses including simulation are required to maintain such skills and should not be given only immediately prior to deployment. Strong evidence exists that military consultants and attendings should only work at level 1/major trauma centres.
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Breeze J, Blanch R, Baden J, Monaghan AM, Evriviades D, Harrisson SE, Roberts S, Gibson A, MacKenzie N, Baxter D, Gibbons AJ, Heppell S, Combes JG, Rickard RF. Skill sets required for the management of military head, face and neck trauma: a multidisciplinary consensus statement. J ROY ARMY MED CORPS 2018; 164:133-138. [DOI: 10.1136/jramc-2017-000881] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
IntroductionThe evolution of medical practice is resulting in increasing subspecialisation, with head, face and neck (HFN) trauma in a civilian environment usually managed by a combination of surgical specialties working as a team. However, the full combination of HFN specialties commonly available in the NHS may not be available in future UK military-led operations, necessitating the identification of a group of skill sets that could be delivered by one or more deployed surgeons.MethodA systematic review was undertaken to identify those surgical procedures performed to treat acute military head, face, neck and eye trauma. A multidisciplinary consensus group was convened following this with military HFN trauma expertise to define those procedures commonly required to conduct deployed, in-theatre HFN surgical combat trauma management.ResultsHead, face, neck and eye damage control surgical procedures were identified as comprising surgical cricothyroidotomy, cervico-facial haemorrhage control and decompression of orbital haemorrhage through lateral canthotomy. Acute in-theatre surgical skills required within 24 hours consist of wound debridement, surgical tracheostomy, decompressive craniectomy, intracranial pressure monitor placement, temporary facial fracture stabilisation for airway management or haemorrhage control and primary globe repair. Delayed in-theatre procedures required within 5 days prior to predicted evacuation encompass facial fracture fixation, delayed lateral canthotomy, evisceration, enucleation and eyelid repair.ConclusionsThe identification of those skill sets required for deployment is in keeping with the General Medical Council’s current drive towards credentialing consultants, by which a consultant surgeon’s capabilities in particular practice areas would be defined. Limited opportunities currently exist for trainees and consultants to gain experience in the management of traumatic head, face, neck and eye injuries seen in a kinetic combat environment. Predeployment training requires that the surgical techniques described in this paper are covered and should form the curriculum of future military-specific surgical fellowships. Relevant continued professional development will be necessary to maintain required clinical competency.
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Lei T, Xie L, Tu W, Chen Y, Tang Z, Tan Y. Blast injuries to the human mandible: development of a finite element model and a preliminary finite element analysis. Injury 2012; 43:1850-5. [PMID: 22889532 DOI: 10.1016/j.injury.2012.07.187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 07/12/2012] [Accepted: 07/19/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In an attempt to explore new tools for constructing a model of blast injuries to the human mandible, a finite element method was used. This model allowed us to perform dynamic simulations and analyse the injury processes and severity of trauma to the human mandible from an explosion striking at the middle mandibular angle. METHODS A 3D finite element model of the human mandible was created using digitally visualised CT scanning data of the human mandible. It was used to dynamically simulate the complete injury process of a blast event to a human mandible (at the middle mandibular angle) under the injury conditions of a 600 mg TNT explosion. The model was also used to elucidate the subsequent mandibular damage and the dynamic distribution of several biomechanical indices (e.g., stress, and strain). The resulting data were subjected to a comparative analysis. RESULTS Simulation was successfully conducted for injury events in which 600 mg of TNT exploded at 3 cm, 5 cm and 10 cm from the middle mandibular angle of a human mandible; specifically, the simulation included the dynamic injury processes and the distribution of stress and strain in various parts of the damaged mandible. A comparison of the simulation data revealed that different blast distances resulted in considerable variation in the severity and biological indices of the mandibular injury. CONCLUSION The finite element model was able to dynamically simulate the blast-initiated trauma processes to a human mandible, which allowed for investigation of the severity of damage to the mandible under different injury conditions. This model and the simulation method are conducive for applications in basic studies and clinical investigations of blast-initiated injury mechanisms of bone tissues.
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Affiliation(s)
- Tao Lei
- Department of Oral and Maxillofacial Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, PR China
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A review of trauma and trauma-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2010-2011. Br J Oral Maxillofac Surg 2012; 50:769-73. [PMID: 23021563 DOI: 10.1016/j.bjoms.2012.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/06/2012] [Indexed: 11/23/2022]
Abstract
This review summarises all trauma and related papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) from January 2010 to December 2011. In total 45 articles were published, of which 42% (19) were full-length articles. These articles primarily focused on the management of mandibular condyle and orbital fractures, with several papers discussing maxillofacial surgery by the British military. There were no articles discussing midfacial fractures or massive facial trauma. The remaining papers included short communications, technical notes, and letters; and provided discussion of interesting cases, new surgical techniques and fracture classifications. The number of trauma papers published in BJOMS appears to be less than other sub-specialties such as head and neck oncology. The number of prospective and randomised studies remains low, highlighting a need to foster further research within maxillofacial trauma.
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