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Yamada M, Hino S, Iijima Y, Horie N, Kaneko T. What are the Characteristics of Oral Injuries Caused by Playground Equipment? J Craniofac Surg 2024; 35:1456-1460. [PMID: 38861333 DOI: 10.1097/scs.0000000000010376] [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: 03/04/2024] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
PURPOSE Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury. METHODS Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level. RESULTS This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries. CONCLUSION Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.
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Affiliation(s)
- Miki Yamada
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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2
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Färkkilä EM, Oksanen E, Kormi E, Suojanen J. What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries? J Oral Maxillofac Surg 2024; 82:800-805. [PMID: 38621665 DOI: 10.1016/j.joms.2024.03.025] [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: 08/12/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Patients sustaining maxillofacial fractures are at risk for associated injuries (AIs) to other body regions. The incidence of AIs is reported to be from 20 to 35%. AIs may be life-threatening and play a key role in considering first-line management at the emergency department, as well as planning the definitive treatment of maxillofacial fractures. PURPOSE The study aimed to determine the frequency and risk factors for AIs in patients with maxillofacial fractures. STUDY DESIGN, SETTING, SAMPLE The investigators designed and implemented a retrospective cohort study of patients with facial fractures treated at Central Hospital (Lahti, Finland) from January 1, 2009 through December 31, 2019. All adult patients with verified maxillofacial fractures were included. Patients under 18 years of age were excluded from the study. PREDICTOR VARIABLE The predictor variable was the location of the maxillofacial fractures grouped into three categories: mandible alone, midface alone, and both midface and mandible. MAIN OUTCOME VARIABLE(S) The primary outcome variable was associated body region injuries coded as present or absent. The secondary outcome variable was the location of the AI categorized as skull, neck, thorax, pelvis, or extremity injuries. COVARIATES Other study variables included demographic data (age, sex, alcohol use), Glasgow Coma Scale, and etiology (fall, traffic- and bicycle accident, assault, pedestrian hit by motor vehicle, work-related, or sports/free-time injuries). ANALYSES Continuous variables were analyzed for normal distribution using the Shapiro-Wilks test and compared with categorical variables using the Mann-Whitney test. The univariate analyses of categorical variables were analyzed by the χ2 test (P ≤ .05 was considered statistically significant). RESULTS During the study period, 443 adult (≥18) patients had maxillofacial fractures. AIs were present in 88 subjects (20%). The mean age was 47.6 years (range 18-91); 52 years with AIs (range 19-91), and 47 years (range 18-92) without AIs (P = .03). Subjects with midface and mandible + midface fractures had greater risk to AIs compared to mandibular fractures (relative risk 2.0, P = .002, relative risk 2.8, P = .009). CONCLUSION AND RELEVANCE Every fifth maxillofacial trauma patient had an associated injury. Trauma patients should be evaluated in institutions with trauma protocols and imaging modalities before determining and executing the treatment plan for maxillofacial fractures.
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Affiliation(s)
- Esa M Färkkilä
- Instructor, Department of Oral and Maxillofacial Surgery, Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Lahti, Finland and University of Helsinki, Faculty of Medicine, Clinicum, Helsinki, Finland.
| | - Erkka Oksanen
- Resident, Department of Oral and Maxillofacial Surgery, Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Lahti, Finland and University of Helsinki, Faculty of Medicine, Clinicum, Helsinki, Finland
| | - Eeva Kormi
- Head of Department, Department of Oral and Maxillofacial Surgery, Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Lahti, Finland and University of Helsinki, Faculty of Medicine, Clinicum, Helsinki, Finland
| | - Juho Suojanen
- Associate Professor, Department of Oral and Maxillofacial Surgery, Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Lahti, Finland and Helsinki University Hospital, Department of Plastic Surgery, Cleft Palate and Craniofacial Centre, University of Helsinki, Faculty of Medicine, Clinicum, Helsinki, Finland
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Datta N, Tatum SA. Reducing Risks for Midface and Mandible Fracture Repair. Facial Plast Surg Clin North Am 2023; 31:307-314. [PMID: 37001933 DOI: 10.1016/j.fsc.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The midface skeleton provides structural scaffolding to the middle third of the face. Complications associated with fracture repair in these regions can result from incomplete, inaccurate, or delayed assessment, poor initial and subsequent reduction and fixation, infection, uncontrolled hemorrhage, hardware failure and associated soft tissue injuries. A systematic approach to managing the patient with facial trauma that includes Acute Trauma Life Support principles, early reconstruction, and precise reduction and fixation is essential to reducing the short-term and long-term risks of complications.
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Affiliation(s)
- Néha Datta
- Department of Otolaryngology-Head and Neck Surgery, Upstate Medical University, State University of New York, 750 East Adams Street, Syracuse, NY 13210, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sherard A Tatum
- Department of Otolaryngology-Head and Neck Surgery, Upstate Medical University, State University of New York, 750 East Adams Street, Syracuse, NY 13210, USA.
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Färkkilä EM, Kaban LB, Boos-Lima FBDJ, Peacock ZS. Association of craniomaxillofacial fractures and blunt cerebrovascular injuries. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00485-4. [PMID: 36564270 DOI: 10.1016/j.ijom.2022.12.003] [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: 09/06/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
High energy trauma has been considered a risk factor for blunt cerebrovascular injuries (BCVI). The purpose of this study was to determine the incidence and risk factors for BCVI specifically in patients with maxillofacial fractures in an urban level I trauma center. A retrospective cohort study of patients aged ≥ 18 years, admitted to Massachusetts General Hospital (MGH) between 2007 and 2017, was implemented. There were 23,394 patients treated and entered into the MGH Trauma Registry: 22,287 sustained blunt trauma. Of the total blunt trauma patients, 68 (0.3%) had BCVI. There were 2421 patients with CMF fractures from blunt trauma (mean ± standard deviation age, 53 ± 22 years; 29.9% female included as study subjects, of whom 24 (1.0%) had BCVI). In a multivariate model, all mandible fracture (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.6-11.6, P = 0.004), crush injury, defined as blunt compression injury (OR 11.1, 95% CI 2.1-58.1, P = 0.004), and cervical spine injury (OR 10.1, 95 CI 3.7-27.5, P < 0.001) were independent risk factors for BCVI. Mortality was 4.3 times higher in craniomaxillofacial fracture patients with BCVI versus those without BCVI; complications of BCVI (stroke) contributed to the majority of deaths. Appropriate screening and treatment of BCVI in patients with maxillofacial fractures is important.
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Affiliation(s)
- E M Färkkilä
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA; Department of Oral and Maxillofacial Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L B Kaban
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - F B D J Boos-Lima
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Z S Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
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Stanbouly D, Baron M, Abdul-Wasay SS, Isaac R, Kocaelli H, Selvi F, Tannyhill RJ, Turner MD. What are the Risk Factors for Mortality Among Patients Who Suffer Le Fort III Fractures? J Oral Maxillofac Surg 2022; 80:1943-1951. [PMID: 36174662 DOI: 10.1016/j.joms.2022.08.017] [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: 03/17/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Le Fort III fractures are the most severe subtype of the Le Fort fractures and are associated with adverse clinical outcomes. The purpose of this study was to identify risk factors for mortality among patients who suffer Le Fort III fractures. MATERIALS AND METHODS A retrospective cohort study was completed using the 2016-2018 National Inpatient Sample. Patients with isolated Le Fort III fractures were selected. Patients who incurred bone fractures or organ injuries outside the head and neck were excluded. There were multiple, heterogenous predictor variables. The primary outcome variable was mortality. Relative risk was used to determine independent risk factors of mortality. Statistical significance was deemed for P values less than .05. RESULTS The final sample consisted of 559 patients (mean age, 45.9 years) who suffered a Le Fort III fracture, of whom 15 patients (2.68%) died. Most patients were male (82.7%) middle-aged adults (42.9%) of White race (66.5%) within the lowest income quartile (31.7%) that lived in large metro areas (54.9%). Relative to males, females were nearly 62 times more likely to die (P < .01). Relative to privately insured subjects, uninsured subjects were 23 times (P < .05) more likely to die. Relative to weekday admissions, weekend admissions increased the risk of mortality by 8 times (P < .05). Cranial vault fractures (odds ratio, 7.24; P < .05) and upper cervical fractures (odds ratio, 63.27; P < .05) were risk factors for mortality. Relative to males, females were at an increased risk for mortality (relative risk [RR] 7.14, 95% confidence interval [CI] 2.60, 19.61). Skull base fracture (RR 2.99, 95 CI 1.04, 8.63), cranial vault fracture (RR 3.04, 95 CI 1.07, 8.65), subdural hemorrhage (RR 2.98, 95 CI 1.10, 8.05), subarachnoid hemorrhage (RR 6.73, 95 CI 2.34, 19.35), and injury of blood vessels at neck level (RR 13.24, 95 CI 2.46, 71.16) were each risk factors for mortality. CONCLUSIONS Intracranial injury was not a risk factor for mortality. Instead, cranial vault fractures and skull base fractures increased the risk for mortality. In addition, uninsured patients and female patients were each at an increased risk for mortality.
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Affiliation(s)
- Dani Stanbouly
- Dental Student, Columbia University, College of Dental Medicine, New York, NY
| | - Michael Baron
- Resident, Division of Oral and Maxillofacial Surgery, Mount Sinai Health System, New York, NY.
| | | | - Rafi Isaac
- Dental Student, University of Toronto Faculty of Dentistry, Toronto, Ontario, Canada
| | - Humeyra Kocaelli
- Associate Professor, Istanbul University, School of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Firat Selvi
- Associate Professor, Istanbul University, School of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - R John Tannyhill
- Residency Program Director and Assistant Professor, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - Michael D Turner
- Chief, Division of Oral and Maxillofacial Surgery, Mount Sinai Hospital, New York, NY; Associate Professor, Icahn School of Medicine at Mount Sinai, New York, NY
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Jarab F, Bataineh A. Pattern of Facial Fractures and Its Association with a Cervical Spine Injury in a Tertiary Hospital in Jordan. Int J Clin Pract 2022; 2022:4107382. [PMID: 35989870 PMCID: PMC9356895 DOI: 10.1155/2022/4107382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/05/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Facial fractures can be accompanied by serious and life-threatening injuries such as cervical spine injury (CSI), which can lead to serious consequences if misdiagnosed. OBJECTIVE To assess the patterns of maxillofacial fractures and to explore the association between these fractures and cervical spine injuries (CSIs) in patients with a traumatic facial injury. METHODS A retrospective analysis was conducted on the data of the subjects who were admitted to the King Abdullah University Hospital (KAUH) and had a maxillofacial fracture in the period from January 2017 through December 2020. Stepwise binary logistic regression analysis was conducted to find the variables which are significantly and independently associated with CSIs. RESULTS A total of 394 maxillofacial fractures were reported for a total of 221 subjects. The mandible was the most common site of the reported fractures (41.88%). The majority of the subjects had associated injuries (70.6%), of which 82.7% were CSIs. The most common type of the CSIs was the vertebral fracture (52%). Increased age (OR = 1.543, P < 0.05), having a mandibular fracture (OR = 4.382, P < 0.01), and having a maxillary fracture (OR = 3.269, P < 0.05) were significantly associated with the presence of CSI. CONCLUSION The current study revealed that the most common type of facial fracture occurred in the mandible area, and CSI was the most common fracture-associated injury (82.7%). Increased age and having mandibular or maxillary fracture were associated with an increased risk of developing CSI. Therefore, it is necessary to rule out the presence of concomitant CSI during the emergency management of maxillofacial fractures, particularly for elderly patients and those with mandibular or maxillary fractures.
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Affiliation(s)
- Fadi Jarab
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Anwar Bataineh
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
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AlMofreh, DDS F, AlOtaibi S, Jaber M, Bishawi, DDS K, AlShanably, DDS A, AlMutairi F. Cervical Spine Injuries and Maxillofacial Trauma: A Systematic Review. Saudi Dent J 2021; 33:805-812. [PMID: 34938019 PMCID: PMC8665169 DOI: 10.1016/j.sdentj.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/24/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Identify specific maxillofacial trauma patterns associated with cervical spine injuries. METHODS The protocol was developed according to (PRISMA-P) and was admitted to PROSPERO under accreditation code #CRD42020177816. Furthermore, the reporting of the present SR was conducted based on the PRISMA checklist. RESULTS Of the 1,407,750 patients recorded, a total of 115,997 patients (12.13%) had MFF with an associated CSI with a gender proportion (M:F) of 3.63:1 respectively. Motor vehicle accident was the most common cause of the combined Maxillofacial Trauma (MFT) and CSI. The most common CSI location was at the C2, followed by the C5 cervical spines. The most common location of a maxillofacial fracture resulting in a CSI was the mandible. CONCLUSION The incidence of the association of CSIs with MFT has been low (12.13%). Nevertheless, in cases of an isolated mandibular trauma due to a severe blow presenting with a low Glasgow Coma Scale, maxillofacial surgeons should be at a high alert of an associated CSI.
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Affiliation(s)
| | - Sami AlOtaibi
- Department of Oral and Maxillofacial Surgery, King Saud University, Saudi Arabia
| | - Mohamed Jaber
- Department Head, Surgical Sciences, Ajman University, United Arab Emirates
| | | | | | - Faris AlMutairi
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Saudi Arabia
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8
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Mooney S, Gulati RD, Yusupov S, Butts SC. Mandibular Condylar Fractures. Facial Plast Surg Clin North Am 2021; 30:85-98. [PMID: 34809889 DOI: 10.1016/j.fsc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mandibular condyle fractures can result in short-term and long-term morbidity. As a weak area of the mandible, the condyle is vulnerable to injury by a direct impact or an indirect force. Current treatment recommendations aim to better match the severity of the fracture with the choice of closed or open approach. Long-term follow-up of patients provides the best opportunity to monitor the degree of functional restoration after treatment. There is a growing consensus regarding the use of standardized fracture classification methods and outcomes measures that will allow better assessment of treatment results and strengthen the quality of outcomes research.
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Affiliation(s)
- Sean Mooney
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Rahul D Gulati
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Steve Yusupov
- Staten Island University Hospital/Northwell Health, 256-C Mason Avenue, Staten Island, NY 10305, USA
| | - Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, SUNY Downstate Health Sciences University, Kings County Hospital Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA.
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Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries. Sci Rep 2021; 11:11989. [PMID: 34099849 PMCID: PMC8184887 DOI: 10.1038/s41598-021-91543-2] [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: 12/08/2020] [Accepted: 05/18/2021] [Indexed: 11/09/2022] Open
Abstract
Concomitant maxillofacial and cervical spine injuries occur in 0.8-12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture. A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization. 7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1 and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.
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Bicsák Á, Sarge R, Müller O, Hassfeld S, Bonitz L. Concomitant injuries of the cervical spine and maxillofacial region. J Neurosurg Sci 2021; 66:164-165. [PMID: 33870672 DOI: 10.23736/s0390-5616.21.05334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ákos Bicsák
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Dortmund, Germany - .,Department of Health, University Witten-Herdecke, Witten, Germany -
| | - Robert Sarge
- Department of Neurosurgery, Dortmund General Hospital, Dortmund, Germany
| | - Oliver Müller
- Department of Neurosurgery, Dortmund General Hospital, Dortmund, Germany
| | - Stefan Hassfeld
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Health, University Witten-Herdecke, Witten, Germany
| | - Lars Bonitz
- Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Health, University Witten-Herdecke, Witten, Germany
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Puolakkainen T, Thorén H, Vähäsilta L, Narjus-Sterba M, Wilson ML, Brinck T, Snäll J. Cervical spine injuries in facial fracture patients - injury mechanism and fracture type matter. J Craniomaxillofac Surg 2021; 49:387-393. [PMID: 33589331 DOI: 10.1016/j.jcms.2021.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/21/2020] [Accepted: 01/31/2021] [Indexed: 12/29/2022] Open
Abstract
Evidence supports the notion that craniofacial fractures are significant predictors of cervical spine injuries (CSIs), but some debate remains on the injury mechanism of co-existing CSIs in craniofacial fractures and the relationship between CSI and specific facial fractures. In this retrospective study, we aim to assess the incidence rates of specific facial fracture types as well as other important variables and their relationship with CSIs. The primary outcome variable, CSI, and several predictor variables, including facial fracture type, were evaluated with logistic regression analyses. Of 2919 patients, the total CSI incidence rate was 3.0%. Rates of CSI in patients with isolated mandibular fractures (OR 0.26 CI 0.10, 0.63; p = 0.006) were lower than those previously reported, whereas isolated nasal fractures were strongly associated with CSI (OR 2.67 CI 1.36, 5.22; p = 0.004). Patients with concomitant cranial injuries were twice as likely to have CSI (OR 2.00, CI 1.22, 3.27; p = 0.006). Even though there is a strong occurrence rate of CSIs in patients with cranial injuries, clinicians should be aware that patients presenting with isolated facial fractures are at significant risk for sustaining CSIs also.
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Affiliation(s)
- Tero Puolakkainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, PO BOX 100, FI-00029, HUS, Finland.
| | - Hanna Thorén
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, FI-20014, Finland; Department of Oral and Maxillofacial Diseases, Turku University Hospital, FI-20521, Turku, Finland
| | - Linda Vähäsilta
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, FI-20014, Finland; Department of Oral and Maxillofacial Diseases, Turku University Hospital, FI-20521, Turku, Finland
| | - Matilda Narjus-Sterba
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, PO BOX 100, FI-00029, HUS, Finland
| | - Michael Lowery Wilson
- Injury Epidemiology and Prevention (IEP), Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, PO BOX 52, FI-20014, Finland; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Tuomas Brinck
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, PO BOX 100, FI-00029, HU, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, PO BOX 100, FI-00029, HUS, Finland
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12
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Puolakkainen T, Murros OJ, Abio A, Thorén H, Virtanen K, Snäll J. Associated Injuries Are Common Among Patients With Bicycle-Related Craniofacial Fractures. J Oral Maxillofac Surg 2021; 79:1319-1326. [PMID: 33607009 DOI: 10.1016/j.joms.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ample evidence exists on the relationship between bicycle injuries and craniofacial fractures. However, as the mechanism behind these injuries is often multifactorial, the presence of associated injuries (AIs) in this study population requires further examination. We hypothesized that patients with craniofacial fracture injured in bicycle accidents are at high risk of sustaining severe AIs, especially those of the head and neck region. PATIENTS AND METHODS The investigators performed a retrospective study on all patients with bicycle-related craniofacial fracture admitted to a tertiary trauma centre during 2013 to 2018. The predictor variable was defined as any type of craniofacial fracture. The outcome variable was defined as any kind of AI. Other study variables included demographic and injury-related parameters. Variables were analyzed using bivariate and Firth's logistic regression analyses. RESULTS A total of 407 patients were included in the analysis. Our results revealed that AIs were present in 150 (36.9%) patients; there were multiple AIs in 47 cases. Traumatic brain injuries followed by upper limb injuries were the most frequent AIs. Severe head and neck injuries were present in 20.1% of all patients with craniofacial fracture. AIs were observed in 57.4% of patients with combined midfacial fractures (P < .001). Helmet use had a protective effect against traumatic brain injuries (P < .001). CONCLUSIONS Our results suggest that AIs are relatively common in this specific patient population. Close co-operation in multidisciplinary trauma centers allowing comprehensive evaluation and treatment can be recommended for patients with bicycle-related craniofacial fracture.
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Affiliation(s)
- Tero Puolakkainen
- Resident, Post-Doctoral Student, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland.
| | - Olli-Jussi Murros
- Resident, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Anne Abio
- Doctoral Student, Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland; and Doctoral Student, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Hanna Thorén
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland; Professor, and Department of Oral and Maxillofacial Diseases, Turku University Hospital, Finland, Turku, Finland
| | - Kaisa Virtanen
- Chief Physician, Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Johanna Snäll
- Department Head, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland
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Combined trauma in craniomaxillofacial and orthopedic-traumatological patients: the need for proper interdisciplinary care in trauma units. Eur J Trauma Emerg Surg 2020; 48:2521-2528. [PMID: 32869128 PMCID: PMC9360163 DOI: 10.1007/s00068-020-01479-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
Aim The primary aim of this study was to analyze frequency and characteristics of combined facial and peripheral trauma with consecutive hospitalization and treatment. Materials and methods The study included all patients with concomitant orthopedic-traumatolgical (OT) and craniomaxillofacial (CMF) injuries admitted to our level I trauma center in 2018. The data were collected by analysis of the institution’s database and radiological reviews and included age, sex, injury type, weekday and time of presentation. All patients were examined and treated by a team of surgeons specialized in OT and CMF directly after presentation. Results A total number of 1040 combined OT and CMF patients were identified. Mean age was 33.0 ± 26.2 years. 67.3% (n = 700) were male patients. Primary presentation happened most frequently on Sundays (n = 199) and between 7 and 8 pm (n = 74). 193 OT fractures were documented, where cervical spine injuries were most frequent (n = 30). 365 facial and skull fractures were recorded. 10.8% of the 204 patients with fractures of the viscerocranium presented with at least one fracture of the extremity, 7.8% (16/204) with cervical spine fractures, 33.3% (68/204) with signs of closed brain trauma and 9.8% (20/204) with intracranial hemorrhage. Discussion The study shows a high frequency of combined facial with OT-injuries and brain damage in a predominantly young and male cohort. Attendance by interdisciplinary teams of both CMF and OT surgeons specialized in cervical spine trauma surgery is highly advisable for adequate treatment. Conclusion Diagnostics and treatment should be performed by a highly specialized OT and CMF team, with a consulting neurosurgeon in a level-1 trauma center to avoid missed diagnoses and keep mortality low.
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Philip MR, Soumithran CS. Prevalence of Neurologic Deficits in Combined Facial and Cervical Spine Injuries: A Retrospective Analysis. Craniomaxillofac Trauma Reconstr 2020; 14:49-55. [PMID: 33613836 DOI: 10.1177/1943387520940182] [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: 11/17/2022] Open
Abstract
Study design A retrospective data analysis of maxillofacial trauma patients with combined cervical spine injuries. Objective This study is based on investigating the importance of timely diagnosis of patients who suffer with cervical spine injuries along with maxillofacial trauma by estimating the prevalence of neurologic deficits and its relation with etiology. Methods A database of 4460 patients suffering from maxillofacial injuries and admitted in specialized environment surgery of Government Medical College, Trivandrum, Kerala was taken under consideration. The prevalence and types of neurologic deficits and its relation with etiology were assessed in patients with combined facial and cervical spine injuries. Results Of 4460 patients, 48 were having cervical spine injury along with facial damage with the prevalence of 0.01%. Neurologic deficits were seen highest with etiology of road traffic accidents followed by falls from height. Most of the accidents occurred in bike riders and helmets were absent. Conclusions It was concluded that most of the accidents engage bike riders and drivers, due to unethical and unsafe driving. There was no significant correlation found between facial and cervical spine injuries.
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Affiliation(s)
- Manju Roby Philip
- Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, KSA
| | - C S Soumithran
- Department of Maxillofacial Surgery, Government Dental College, Trivandrum, Kerala, India
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15
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Färkkilä EM, Peacock ZS, Tannyhill RJ, Petrovick L, Gervasini A, Velmahos GC, Kaban LB. Frequency of cervical spine injuries in patients with midface fractures. Int J Oral Maxillofac Surg 2019; 49:75-81. [PMID: 31301924 DOI: 10.1016/j.ijom.2019.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
The aim of this retrospective cohort study was to determine the frequency and risk factors for cervical spine injury (CSI) in patients with midface fractures. Patients ≥18 years of age entered in the Massachusetts General Hospital Trauma Registry from 2007 to 2017 were identified. Those with a midface fracture, computed tomography and/or magnetic resonance imaging of the cervical spine, and complete medical records were included. There were 23,394 patients in the registry; 3950 (16.9%) had craniomaxillofacial fractures and 1822 (7.8%) had a CSI. Craniomaxillofacial fractures included fractures of the midface (n=2803, 71.0%), mandible (n=873, 22.1%), and midface plus mandible (n=274, 6.9%). The overall frequency of CSI in patients with midface fractures was 11.4% (350/3077). Patients with midface fractures had a higher risk for CSI compared to patients without a midface fracture (odds ratio 2.4, 95% confidence interval 2.1-2.4, P<0.001). In a multivariate model, nasal and orbital fractures, chest injuries, age, injury severity score, and motor vehicle crash or fall as the etiology were independent risk factors for CSI. Mortality was two times higher in subjects with CSI. Early and accurate diagnosis of CSI is a critical factor when planning the treatment of patients with these fractures.
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Affiliation(s)
- E M Färkkilä
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Z S Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - R J Tannyhill
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - L Petrovick
- Trauma and Emergency Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Gervasini
- Trauma and Emergency Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G C Velmahos
- Trauma and Emergency Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - L B Kaban
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA.
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Brasileiro BF, Ferreira da Silva LC. Risk Factors for Cervical Spine Injury in Patients With Mandibular Fractures. J Oral Maxillofac Surg 2019; 77:1099. [DOI: 10.1016/j.joms.2019.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/17/2022]
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Färkkilä E, Peacock ZS, Tannyhill RJ, Kaban LB. Risk Factors for Cervical Spine Injury in Patients With Mandibular Fractures. J Oral Maxillofac Surg 2019; 77:1099-1100. [PMID: 30880134 DOI: 10.1016/j.joms.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
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