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Nguyen HH, Vu TT, Bui AM, Dao GV, Tran HTT, Do LN. MOXAIC: A classification of major maxillofacial wounds, concerning 310 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e569-e575. [PMID: 34958966 DOI: 10.1016/j.jormas.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/16/2021] [Accepted: 10/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Although classification for facial fractures have been extensively described in the literature, corresponding systems for major maxillofacial wounds (MMW) are few. We would like to present MOXAIC: a new classification system for MMW. MATERIAL AND METHODS A retrospective study of 310 patients with MMW who underwent emergency operation between January 2005 and December 2016. MMW was defined as a facial wound longer than 10 cm, which includes damage to the craniofacial bone or other important facial structures such as the carotid arteries, facial nerves, parotid gland, Stensen's duct, or the eye. All the patients were followed at least 36 months. RESULT Based on the shape of the wound, the severity, and the mechanism of injury we were able to classify the MMW into five types: O, X, A, I, C. For each wound type we then looked at the treatment required and the outcome, objectively classified as good, satisfactory, or poor, concerning anatomical correction, aesthetics, and function. + Type OCircumferential wound: 81.6% result good. + Type X-Oblique wound: only 48.1% good, despite initial multidisciplinary approach. + Type A-Transverse facial wound: 78.1% good. + Type I-Direct wound: Immediate airway management and hemorrhage control are important. 48.8% good. + Type CCut wound: 88.1% good. The above classification was named MOXAIC which is a mnemonic of 'Maxillofacial' and the five wound types: O, X, A, I, C. CONCLUSION This classification is highly reproducible, easy to use, and allows quick treatment work up and prognosis. However, this classification requires further specialist review and study.
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Affiliation(s)
- Ha H Nguyen
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam.
| | - Truc T Vu
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Anh M Bui
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Giang V Dao
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Huyen T T Tran
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Linh N Do
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
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Stallwood-Hall C, Anderson J, Ebeid A. Systematic review and meta-analysis of arterial embolization compared with traditional management on outcomes of traumatic massive facial haemorrhage. ANZ J Surg 2022; 92:988-993. [PMID: 34984779 DOI: 10.1111/ans.17448] [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: 09/26/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maxillofacial trauma accounts for ~10% of trauma presentations to most centres, with massive haemorrhage occurring in 1.2-4.5% of cases. Despite its infrequent presentation, there is significant associated morbidity and mortality. Transcatheter arterial embolization (TAE) is playing an increasingly prominent role in trauma presentations. The aim of this article was to compare outcomes of TAE with more traditional management methods for the treatment of massive facial haemorrhage following maxillofacial trauma. METHODS A database and Google Scholar search was performed, with articles discussing massive facial haemorrhage secondary to maxillofacial trauma and its management included. RESULTS Twenty-seven articles were found that met inclusion criteria, encompassing 384 patients. Statistical testing comparing mortality between TAE and non-TAE groups did not find a significant difference, with a mortality rate of 30.2% in the TAE group and 38.9% in the non-TAE group. Assessment of morbidity directly related to interventions was difficult, as many of the included participants had significant associated injuries which contributed an indeterminate degree to morbidity. There was a 10% rate of adverse events associated with TAE, most commonly puncture site haematomas and soft tissue swelling, with more significant adverse events including cerebrovascular accidents and blindness. CONCLUSION Embolization was correlated with increased rates of haemorrhage control when compared with other interventions. Overall, despite no significant impact on mortality, embolization is recommended in the management of massive haemorrhage following maxillofacial trauma due to improved success rates at haemorrhage control and a low rate of significant adverse events.
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Affiliation(s)
- Catrin Stallwood-Hall
- Queen Mary University of London, Blizard Institute School of Medicine and Dentistry, London, UK
| | - Jordan Anderson
- Queen Mary University of London, Blizard Institute School of Medicine and Dentistry, London, UK
| | - Annelize Ebeid
- Queen Mary University of London, Blizard Institute School of Medicine and Dentistry, London, UK
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Cho DY, Willborg BE, Lu GN. Management of Traumatic Soft Tissue Injuries of the Face. Semin Plast Surg 2021; 35:229-237. [PMID: 34819804 DOI: 10.1055/s-0041-1735814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Facial soft tissue injuries encompass a broad spectrum of presentations and often present significant challenges to the craniofacial surgeon. A thorough and systematic approach to these patients is critical to ensure that the patient is stabilized, other injuries identified, and the full extent of the injuries are assessed. Initial management focuses on wound cleaning with irrigation, hemostasis, and debridement of nonviable tissue. Definitive management is dependent on the region of the face involved with special considerations for critical structures such as the globe, lacrimal apparatus, facial nerve, and parotid duct. Following sound surgical principles, these injuries can be managed to maximize both functional and aesthetic outcomes while minimizing complications.
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Affiliation(s)
- Daniel Y Cho
- Division of Plastic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Brooke E Willborg
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - G Nina Lu
- Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
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Abstract
PURPOSE OF REVIEW Management of midface trauma is complex and challenging and requires a clear understanding of the facial buttress system, subunit anatomy and inter-relationships. Too often clinicians attempt surgical repair without adequate knowledge of the common complications associated with poor reduction and improper sequencing of fracture repair. This review outlines a working approach to the identification and management of such injuries, and the definitive management of common injury patterns. RECENT FINDINGS Midface trauma, with or without life-threatening and sight-threatening complications, may arise following isolated injury, or be associated with significant injuries elsewhere. Assessment needs to be both systematic and repeated, with the establishment of clearly stated priorities in overall care. SUMMARY Accurate and precise relocation of bony subunits and resuspension of soft tissues is vital in achieving acceptable functional and aesthetic outcomes.
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Abstract
Facial trauma varies widely in its severity and is also frequently associated with other injuries which can make prioritisation of injuries difficult. An effective method of triage is important to ensure this. This article describes one such approach and discusses the application of damage control principles to facial injuries. Both these issues commonly impact on the management of multiply injured patients with coexisting facial injuries during the initial stages of resuscitation or soon afterwards. Understanding facial trauma is based in part, on parallels with orthopaedic trauma.
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Affiliation(s)
- Mike Perry
- Consultant oral and maxillofacial surgeon, Northwick Park Hospital, UK
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Factors affecting survival following self-inflicted head and neck gunshot wounds: a single-centre retrospective review. Int J Oral Maxillofac Surg 2015; 45:513-6. [PMID: 26673835 DOI: 10.1016/j.ijom.2015.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/23/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022]
Abstract
Self-inflicted head and neck gunshot wounds are a common modality of suicide in the USA. This study reviewed all self-inflicted head and neck gunshot wound patients with complete records (n=157) treated at a tertiary centre between 2002 and 2012 inclusive. The associations between mortality and patient/clinical variables were evaluated with the χ(2) test or Fisher's exact test for statistical difference testing. Outcomes recorded were death (n=92, 59%), discharge to long-term care/rehabilitation (n=58, 37%), and discharge home (n=7, 4%). The majority of patients were male (86.6%) and single/separated/divorced (55.5%). The mortality rate by site, in descending order, was temporal 82%, frontal scalp 69%, submental/intraoral 30%, and neck 25%. Involvement of the central nervous system (n=127) resulted in a 70% mortality, but a lower mortality was observed among patients with an avulsion injury (P=0.025). A tracheostomy within 24h of admission was statistically associated with improved survival (P<0.001), but confounding factors were found. Multivariate analysis revealed increasing age, temporal entry site, and the severity of central nervous system involvement to be positively associated with an increased mortality.
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Krausz AA, Krausz MM, Picetti E. Maxillofacial and neck trauma: a damage control approach. World J Emerg Surg 2015; 10:31. [PMID: 26157475 PMCID: PMC4495937 DOI: 10.1186/s13017-015-0022-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/22/2015] [Indexed: 12/03/2022] Open
Abstract
Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock. These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists. Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries. Damage control surgery (DCS) can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the intensive care unit (ICU) and subsequent reexploration and definitive repair following restoration of normal physiology. Damage control resuscitation (DCR) consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation. Both strategies should be administered simultaneously in all of these patients.
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Affiliation(s)
- Amir A Krausz
- Department of Oral & Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael M Krausz
- Department of Surgery, Hillel Yaffe Medical Center, Hadera, Technion-Israel Institute of Technology, Haifa, Israel
| | - Edoardo Picetti
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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DeAngelis AF, Barrowman RA, Harrod R, Nastri AL. Review article: Maxillofacial emergencies: Maxillofacial trauma. Emerg Med Australas 2014; 26:530-7. [PMID: 25292416 DOI: 10.1111/1742-6723.12308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 11/27/2022]
Abstract
Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.
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Affiliation(s)
- Adrian F DeAngelis
- Maxillofacial Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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DeAngelis AF, Barrowman RA, Harrod R, Nastri AL. Review article: Maxillofacial emergencies: Dentoalveolar and temporomandibular joint trauma. Emerg Med Australas 2014; 26:439-45. [DOI: 10.1111/1742-6723.12267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Adrian F DeAngelis
- Maxillofacial Surgery Unit; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Roland A Barrowman
- Maxillofacial Surgery Unit; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Richard Harrod
- Emergency Medicine Department; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Alf L Nastri
- Maxillofacial Surgery Unit; Royal Melbourne Hospital; Melbourne Victoria Australia
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Maxillofacial trauma in the emergency department: A review. Surgeon 2014; 12:106-14. [DOI: 10.1016/j.surge.2013.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/06/2013] [Accepted: 07/08/2013] [Indexed: 12/16/2022]
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Laversanne S, Pierrou C, Haen P, Brignol L, Thiéry G. [Damage control applied to severe maxillofacial trauma]. ACTA ACUST UNITED AC 2013; 115:37-41. [PMID: 24507725 DOI: 10.1016/j.revsto.2013.03.003] [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: 05/02/2012] [Revised: 12/28/2012] [Accepted: 03/11/2013] [Indexed: 10/26/2022]
Abstract
Damage control is defined by the extreme emergency implementation of a first resuscitation and surgical step, during which there is no attempt at repairing lesions but only at restoring adequate physiological function. In recent years, "damage control" has considerably improved the management of polytrauma patients, especially in war surgery. Respiratory distress or hemorrhagic shock requirements are critical maxillofacial emergencies. We present the specificities of "damage control" management for patients with severe maxillofacial trauma. Some clinical and biological criteria have been defined to choose "damage control" strategy, in patients presenting with life-threatening facial hemorrhage after facial trauma. A rapid initial stage restores vital functions. Airways are maintained and secured: oro-tracheal intubation, cricothyroidotomy, surgical tracheotomy. Facial bleeding is controlled with various means: oronasal packing, angiographic embolization, selective ligation then external carotid artery if necessary. The resuscitation step stabilizes the lethal triad: hypothermia, coagulopathy, metabolic acidosis. The second step that comes in later is a surgical repair of facial injuries. "Damage control" can be adequately applied to the management of patients with severe maxillofacial trauma.
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Affiliation(s)
- S Laversanne
- Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France.
| | - C Pierrou
- Service d'anesthésie-réanimation, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France
| | - P Haen
- Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France
| | - L Brignol
- Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France
| | - G Thiéry
- Service de chirurgie maxillofaciale, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille-Armées, France
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Gataa I, Muassa Q. Patterns of maxillofacial injuries caused by terrorist attacks in Iraq: retrospective study. Int J Oral Maxillofac Surg 2011; 40:65-70. [DOI: 10.1016/j.ijom.2010.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 04/09/2010] [Accepted: 07/19/2010] [Indexed: 11/17/2022]
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Emergency Department Assessment and Management of Facial Trauma From War-Related Injuries. J Craniofac Surg 2010; 21:1002-8. [DOI: 10.1097/scs.0b013e3181e1e7e0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Perry M. Maxillofacial trauma--developments, innovations and controversies. Injury 2009; 40:1252-9. [PMID: 19486969 DOI: 10.1016/j.injury.2008.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 12/07/2008] [Accepted: 12/17/2008] [Indexed: 02/02/2023]
Abstract
Despite seat belt and alcohol legislation, craniofacial trauma still remains a common health problem and significant workload in many maxillofacial units. Although management has evolved considerably from "wiring teeth together", complex fractures can still result in cosmetic and functional deformity. Today's challenge is to consistently restore patients back to their pre-injury form and function-but this is not always possible. Greater understanding and developments have significantly improved outcomes, although controversy still exists in some areas. This review outlines some of these topics.
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Affiliation(s)
- Michael Perry
- Consultant Oral and Maxillofacial Surgeon, Ulster Hospital, Dundonald, Belfast, Northern Ireland, UK.
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