Bicycle-related maxillofacial injuries: a double-center study

A Comparison of Maxillofacial and Head Injuries Following Electric Scooter and Bicycle Accidents

BACKGROUND

The prevalence of maxillofacial and head injuries associated with electric scooters (e-scooter, ES) has risen in concordance with its popularity.

PURPOSE

The purpose of this study was to compare maxillofacial and head injury location, type, and severity related to ES and bicycle accidents and to identify factors contributing to injury severity.

STUDY DESIGN, SETTING, SAMPLE

The authors implemented a multicenter retrospective cohort study in Seattle, Washington, and enrolled a sample of ES riders and bicyclists who sustained maxillofacial injuries between September 2020 and September 2022. The exclusion criteria included nonmotorized scooters, motorized bicycles, injuries with other operators, or vehicles, and pre-evaluation deaths.

PREDICTOR VARIABLE

The predictor variable was vehicle type, bicycle or ES.

OUTCOME VARIABLES

The outcome variables included maxillofacial injury location, distinguished by horizontal facial thirds and injury type, defined as hard or soft tissue. Associated head injury types were also reported as hard (calvaria) or soft (scalp) tissue injuries. The severity of these injuries was quantified using both the injury severity score and the face and head abbreviated injury scale.

COVARIATES

Demographic, injury, and treatment-related variables were collected.

ANALYSES

Bivariate, multivariate, and regression statistics were computed. Statistical significance was P < .05.

RESULTS

The final sample was composed of 205 total subjects, of which 52 (25.4%) were in the ES group and 153 (74.6%) in the bicycle group. Isolated midface injuries were the most common hard tissue location in the ES (15.4%) and bicycle (29.4%) groups. The most common soft tissue injury location included the upper face and midface in the ES group (19.2%) and the midface in the bicycle group (22.9%). Both hard and soft tissue head injuries were more prevalent in the ES group (P < .0002 and P < .0001). Moreover, intracranial injuries were seen in 36.5% of ES subjects compared to 9.8% bicycle subjects (P < .0001). Between the two groups there was no difference in maxillofacial injury severity, but head injuries were more severe in the ES group (P < .0002). Using regression analysis, drug use was found to have a significant impact on the mean injury severity score (P < .002) and helmet use did not have significant impact on face or head injury severity.

CONCLUSION

Maxillofacial injury location, type, and severity are comparable among ES and bicycles. However, ES riders are at greater risk of severe head injuries compared to bicycles, and riding while intoxicated has the greatest effect on injury severity.

Do Bicycle Helmets Protect Against Facial Fractures? An Observational Study From a Level 1 Trauma Centre

This study investigates the impact of helmet use on the incidence of facial fractures in bicycle accidents. Analyzing data from hospitalized bicyclists between 2005 and 2016, the research focused on the correlation between helmet usage and various facial fractures. The study included 1256 bicyclists with known helmet use, among whom 277 individuals (22%) were identified with a total of 521 facial fractures. The findings revealed a significant reduction in the likelihood of facial fractures among helmeted cyclists compared with those without helmets (odds ratio, 0.65; confidence interval, 0.50-0.85; P=0.002). Specifically, the odds of sustaining fractures in the zygoma, orbit, nose, and maxilla were decreased by 47%, 46%, 43%, and 33%, respectively, among helmeted cyclists. However, helmet use did not significantly alter the odds of mandible fractures. Overall, the use of helmets in bicycling significantly lowered the risk of midface fractures but showed no notable effect on mandible fractures in severe cycling incidents.

Trends in Head and Neck Injuries Related to Electric Versus Pedal Bicycle Use in the United States

OBJECTIVES

To describe the incidence of head and neck trauma related to electric bicycles and to characterize head and neck injury patterns seen in electric bicycle (eBike) users versus pedal bicyclists in the United States.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried from 2009 to 2020 for patients with head and neck injuries related to electric and pedal bicycles. Extracted data included patient demographics, injury patterns, hospital admission, and helmet use. Univariate chi-squared analyses were performed to compare demographics and injury patterns between bicycle groups. Effect sizes were reported with Cramer V values (V).

RESULTS

The incidence of eBike-related head and neck injuries increased from 2993 in 2009 to 9916 in 2020. Compared to pedal bicycle users, eBike users were more likely to have head injuries (60.4% vs. 52.0%) and fractures (10.9% vs. 6.0%), and were more likely to require hospitalization (20.6% vs. 10.4%). The effect size of helmet use was significantly greater in eBike users compared to pedal bicyclists when examining distributions of age group (V = 0.203 vs. V = 0.079), injury location (V = 0.220 vs. V = 0.082), and injury type (V = 0.162 vs. V = 0.059). Helmeted injuries in eBike users more commonly involved neck injuries and sprains, rather than head injuries and fractures.

CONCLUSION

Head and neck trauma related to eBike use is increasing in the United States. Injury patterns and admission rates reflect greater injury severity in eBike users compared to pedal bicyclists. Helmet use may be particularly beneficial in mitigating head and neck injury in eBike users.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2734-2740, 2024.

Can the Mechanism of Injury Impact the Location of a Mandibular Fracture? A Systematic Review

Purpose

Mandible fractures are the second most common fractures of the facial skeleton because of the prominent position of the lower jaw. The purpose of this study was to calculate the prevalence of mandibular fractures based on their causes and locations.

Materials and Method

A systematic search of 3 electronic databases from January 2010 and January 2020 was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 359 articles identified for screening against selection criteria. The search identified 39 articles to be included in our analysis.

Results

A total of 20,135 patients with 31,468 mandible fractures in this review. There was a 76% male predominance. The third decade was the most common age group (21-30). Motor vehicle accidents (39.89%) were the leading cause of mandible fractures, followed by falls (27.72%) and violence (25.35%). Condylar fractures are the most common cause of MVA and fall (33.11%, 50% respectively). Mandible body fractures are the second most common type of MVA injury (17.06%). When it came to violence, the angle of the mandible was the most common site (31.73%).

Conclusions

The prevalence of mandible fractures was higher in male patients in the current study, particularly in the second and third decades of life. Road traffic accidents were the most common cause, and the condylar process of the mandible was the most frequently affected region. Demographic data such as age, gender, and mechanism of injury can help surgeons predict and identify specific areas of mandibular fracture.

Changing trends in maxillofacial injuries among paediatric, adult and elderly populations: A 22-year statistical analysis of 3424 patients in a tertiary care centre in Northwest Italy

BACKGROUND

This retrospective study analysed the epidemiology of maxillofacial trauma over 22 years to assess whether there have been significant changes in the causes and characteristics of fractures in paediatric, adult and elderly populations.

MATERIALS AND METHODS

The following data were collected: age, sex, injury cause and mechanism, fracture site, Facial Injury Severity Scale, associated injuries, time of injury, type of treatment and length of hospital stay. The patients were analysed by age group (children [≤16 years], adults [17-60 years] and elderly [>60 years]) and divided into two time groups (group 1: 2001-2011; group 2: 2012-2022) that were compared to each other. Statistical analyses were performed using SPSS software.

RESULTS

Between 01 January 2001 and 31 December 2022, 3535 patients (2690 males and 845 females, mean age 39.3 years) were admitted for facial fractures. The comparison of the two temporal periods showed a decrease in the prevalence of males (p = .02), in road traffic injuries (p < .001), and in fractures of the lower third of the face (p = .005); there were significant increases in the mean age (p < .001), prevalence of the elderly (p = .006) and in fall- and assault-related injuries (p < .001 and p = .03, respectively). Assault injuries increased only in the 17-60 age group (p = .02) while RTA-related fractures decreased in all age groups (p < .05 for all comparisons). Bicycle accidents increased significantly, with a parallel decrease in motor vehicle accidents (both p < .001). Fall-related fractures increased only in 17-60 and >60 age groups (p < .001 and p = .02, respectively).

CONCLUSIONS

This study shows significant changing trends in the epidemiology of maxillofacial trauma. While road traffic policies have been effective in the last years, preventive measures for falls in the elderly population and new legislative measures to prevent interpersonal violence should be advocated.

Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.

Facial Fractures and Their Relation to Head and Cervical Spine Injuries in Hospitalized Bicyclists

Bicyclists are vulnerable road users. The authors aimed to characterise facial fractures and their association with head and neck injuries in bicyclists admitted to a Scandinavian Level 1 trauma center with a catchment area of ~3 million inhabitants. Data from bicycle-related injuries in the period 2005 to 2016 were extracted from the Oslo University Hospital trauma registry. Variables included were age; sex; date of injury; abbreviated injury scale (AIS) codes for facial skeletal, head and neck injuries; and surgical procedure codes for treatment of facial fractures. Anatomical injury was classified according to AIS98. A total of 1543 patients with bicycle-related injuries were included. The median age was 40 years (quartiles 53, 25), and 1126 (73%) were men. Overall, 652 fractures were registered in 339 patients. Facial fractures were observed in all age groups; however, the proportion rose with increasing age. Bicyclists who suffered from facial fractures more often had a concomitant head injury (AIS head >1) than bicyclists without facial fractures (74% vs. 47%), and the odds ratio for facial fracture(s) in the orbit, maxilla and zygoma were significantly increased in patients with AIS head >1 compared to patients with AIS head=1. In addition, 17% of patients with facial fractures had a concomitant cervical spine injury versus 12% of patients without facial fractures. This results showed that facial fractures were common among injured bicyclists and associated with both head and cervical spine injury. Thus, a neurological evaluation of these patients are mandatory, and a multidisciplinary team including maxillofacial and neurosurgical competence is required to care for these patients.

Anatomical distribution of mandibular fractures from severe bicycling accidents: A 12-year experience from a Norwegian level 1 trauma center

BACKGROUND/AIM

The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible because conventional helmets provide little protection to the lower part of the face. In addition, some studies indicate that helmets may lead to an increased risk of mandibular fractures. Thus, the aim of this study was to examine the anatomic distribution of mandibular fractures in injured cyclists and to assess if helmet use influenced the fracture locations.

MATERIAL AND METHODS

Data from a Norwegian Level 1 trauma center were collected in the Oslo University Hospital Trauma Registry over a 12-year period. Of 1543 injured cyclists, the electronic patient charts of 62 cyclists with fractures of the mandible were retrospectively evaluated in detail. Demographic data, helmet use, and fracture type were assessed.

RESULTS

Sixty-two patients (4%) had fractures of the mandible, and women had an increased risk (OR 2.49, 95% CI 1.49-4.16, p < .001). The most common fracture site was the mandibular body, followed by the condyle. Isolated mandibular fractures occurred in 45% of the patients and 55% had other concomitant facial fractures. There were 42% of the patients with fractures in multiple sites of the mandible, and 42% had a concomitant dentoalveolar injury. Half of the cyclists were wearing a helmet at the time of the accident and 39% were not. There was no significant difference in fracture distribution between the helmeted and non-helmeted groups.

CONCLUSIONS

Fracture of the mandibular body was the most prevalent mandibular fracture type following bicycle accidents. Women had an increased risk of mandibular fractures compared with men, whereas helmet wearing did not affect the anatomical fracture site.

Cycling-Related Injuries During COVID-19 Lockdown: A North London Experience

Objectives

There has been a notable surge in cycling injuries during the COVID-19(SARS-CoV-2 virus) pandemic. Cycling in general increased during lockdown as a leisure & fitness activity along with reduction in the use of public transport for commuting. We investigated the bicycle-related maxillofacial injuries & associations presenting through our emergency department(ED) which covers more than 1.6 million of London population.

Study Design/Methods

A retrospective observational study was undertaken in the Barnet General Hospital ("hub") which receives all maxillofacial referrals from 6 "spoke" hospitals & other urgent primary/community care practices in North London area between 16 March 2020 & 16 July 2020. All data corresponding to cycling injuries during the lockdown period was analyzed with the aid of trauma database/trust-wide electronic patient records.

Results

Twenty-two patients (6.7%) with cycling-related injuries out of a total of 322 patients who attended during the 4 months study period with maxillofacial emergencies were identified. Average age of patient cohort was 35.4 years, mainly consisting of adult males (77%). Seven patients had minor head injury and 1 patient suffered traumatic brain injury. About 59% patients did not wear a protective helmet & 3 patients had heavy alcohol/recreational drug intoxication during the accidents. Four patients needed inpatient admission and treatment under general anesthesia.

Conclusions

Based on our humble study, we advocate the need for robust road & personal safety measures with mandatory government legislations, policing of drug intoxication & encouragement of physical & mental health improvement measures during these unprecedented times & beyond.

The Association of Helmet Use with the Occurrence of Maxillofacial Injuries Following Bicycle or Scooter Accidents: A Retrospective Cohort Study

Study Design

Retrospective Cohort Study.

Objective

Yearly, bicycle and scooter accidents in the Netherlands amount to 90 thousand emergency department visits. Maxillofacial injuries are common after cycling or scooter accidents. To prevent these injuries, helmet use might be beneficial. However, the effect of helmet use on maxillofacial injuries remains unclear. The aim of this retrospective study is to assess the effect of helmet use on maxillofacial injuries in patients who had a bicycle or scooter accident.

Methods

We collected data from the emergency department of the Erasmus Medical Center in the period from October 2017 to October 2019. Patients that were involved in a bicycle or scooter accident and subsequently received a CT scan of the head were included. We compared the incidence of maxillofacial injuries in helmeted cyclists and scooter users to non-helmeted users. Descriptive and analytic statistics were computed. Level of statistical significance was set at p < 0.05.

Results

Helmet use among scooter users was associated with a significant reduction in maxillofacial fractures (p < 0.001) and soft tissue injuries (p < 0.001). Helmet use among cyclists was not associated with a reduction in maxillofacial fractures (p = 0.17) or soft tissue injuries (p = 0.30). Helmet use was not associated with a reduction in soft tissue injuries of the lower face in both cyclists (p = 0.47) and scooter users (p = 0.24).

Conclusions

Helmet use should be considered among cyclists and scooter users to prevent maxillofacial injuries. Especially unhelmeted scooter users might benefit from helmet use as this is associated with a lower incidence of maxillofacial injuries.

Injury patterns and outcomes in bicycle-related maxillofacial traumata: A retrospective analysis of 162 cases

The objective of the current study is to retrospectively evaluate cycling related dental and maxillofacial injuries and to gain insight into the epidemiology and results of these accidents. Data of patients who were admitted due to the maxillofacial injuries between April 2018 and September 2020 were retrospectively evaluated regarding the patients' characteristics, helmet wearing, type of radiological assessment required for diagnosis and therapy, injury patterns, duration of hospitalization and concomitant injuries. Data of 162 patients were included. 86 (53.08%) patients presented with at least one maxillofacial fracture. A total of 186 maxillofacial bones were fractured. Zygomatico-maxillary complex was the most commonly affected region (n:103, 55,36%). Analysis of the dental traumata revealed that crown fracture without pulp exposure was the most commonly observed entity (n:37, 32.46%) and upper central incisors (n:61, 53.50%) were the most commonly affected teeth. The overall ratio of the number of the fracture line/fracture case was 2.80. However, this ratio was statistically higher in e-bike cases (4.25) compared to non-e-bike riders (2.34) (p:0.014). Bicycle related maxillofacial injuries could correlate with specific morbidity rates and result in severe injuries of the maxillofacial region.

Characteristics of pediatric maxillofacial fractures in Kuwait: A single-center retrospective study

BACKGROUND

Pediatric maxillofacial fractures always present a challenge due to the unique nature of the facial skeleton anatomy and development. The aim of this study was to investigate the incidence, etiology, site of fracture, and management modalities of pediatric maxillofacial fractures in Kuwait.

METHODS

A retrospective cross-sectional study was conducted. The records of all pediatric patients who were diagnosed with maxillofacial fractures and admitted to one of the major hospitals in Kuwait between January 2007 and March 2020 were reviewed.

RESULTS

A total of 186 patients aged between 0 and 13 years old were included. An average of 13 patients was seen each year between 2007 and 2020. The leading cause of the pediatric maxillofacial trauma was road traffic accidents (RTA) that accounted for 38.2% of the patients followed by 22% falls from height (FFH). Male patients were more affected than females, with a ratio of 2.3:1. More than half of the children had mid-face fractures, of which 57% were in multiple sites. Conservative management was the main approach for 52.2% of the patients.

CONCLUSIONS

Pediatric maxillofacial fractures were mainly attributed to road traffic accidents in Kuwait. Mid-face bone fractures were reported more than mandibular fractures and were mostly managed conservatively.

Associated Injuries Are Common Among Patients With Bicycle-Related Craniofacial Fractures

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.

Epidemiology of maxillofacial soft tissue injuries in an oral emergency department in Beijing: A two-year retrospective study

BACKGROUND/AIMS

Maxillofacial soft tissue injuries (STIs) may differ in epidemiological characteristics from other maxillofacial injuries. The aim of this study was to investigate the epidemiology of maxillofacial STIs in a public oral emergency department in Beijing, China, from 2017 to 2018.

MATERIAL AND METHODS

In this retrospective study, 5949 patients with maxillofacial STIs and complete medical records were evaluated. Gender, age, etiology, visit date and time, interval between accident and treatment, anatomic injury site, treatment modality, and the number of associated maxillofacial bone fractures or tooth injuries were analyzed.

RESULT

There were 3831 males and 2118 females (ratio 1.81:1). Patients younger than 10 years were the most frequently seen group (44.2%). Among adults, 20- to 29-years-old (16.2%) was the most prominent age group. The month of May (11.8%) had the highest incidence of maxillofacial STIs, and February (4.5%) had the lowest incidence. The average number of daily visits was significantly higher on holidays than on workdays. Of the 5949 patients, 45.9% attended at night, 2021 patients had dental trauma, and 31 had jaw fractures. The lips were the most common site of STIs, followed by the chin and gingiva. Lip and gingival STIs were more common in the 0- to 10-years-old group. Chin STIs were more common in the 20- to 39-years-old group. A fall was the leading cause of injury, especially in patients younger than 10 years and older than 70 years. Approximately 56.7% of the falls resulted in injuries to the lower one-third of the face. Sports injuries were more common among 10- to 29-years-old individuals.

CONCLUSION

STIs of the maxillofacial region were most likely to occur at night, in May and during holidays. Males, children younger than 10 years and 20- to 29-years-old adults were high-risk populations. Most maxillofacial STIs involved the lips, and one-third of the patients had dental trauma.

Dentoalveolar injuries, bicycling accidents and helmet use in patients referred to a Norwegian Trauma Centre: A 12-year prospective study

BACKGROUND/AIM

Despite its many benefits, bicycling carries the risk of accidents. Although numerous studies have reported the effect of helmet use on traumatic brain injury, it remains unclear if, and to what extent, helmet use reduces the risk of facial injuries. This is particularly true in regard to injuries of the lower face. In addition, there is limited evidence of the effect of helmet use on dentoalveolar injuries. Thus, the aim of this study was to determine the frequency and distribution of dentoalveolar injuries in bicycling accidents and to explore the influence of helmet use.

MATERIAL AND METHODS

A total of 1543 bicyclists were included from the trauma registry of a Norwegian tertiary trauma center over a 12-year period. Data were collected prospectively, including patient characteristics, type of injury, and helmet use. The prevalence of dentoalveolar injuries was assessed in conjunction with helmet use and facial fractures.

RESULTS

Twenty-five percent of the patients had maxillofacial injuries, and 18% of those with facial fractures exhibited concomitant dentoalveolar injuries. The most common type of dentoalveolar injury was tooth fracture (39%). The most frequent location of facial fractures with combined dentoalveolar injuries was the maxilla, which had fractured in 32 patients. Women had a higher risk of sustaining dentoalveolar injuries compared to men (odds ratio 1.50, 95% confidence interval 1.02-2.22). There were 1257 patients (81%) who had reliable registration of helmet use; 54% of these wore a helmet, while 46% did not. Helmet users had an increased risk of dentoalveolar injuries compared to non-helmeted bicyclists (adjusted odds ratio 1.54, 95% confidence interval 1.02-2.31).

CONCLUSIONS

Dentoalveolar injuries are fairly common in trauma patients admitted to a trauma center following bicycling accidents. Bicycling helmets are associated with an increased risk of dentoalveolar injuries.

Maxillofacial trauma following road accidents-An 11-year multi-center study in Israel

BACKGROUND/AIM

Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk.

METHODS

This historical prospective multi-center study was based on Israel's Trauma Registry between 2008-2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e-bike/scooter), maxillofacial injury location, and maxillofacial treatment.

RESULTS

MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e-bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0-14 years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento-alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians.

CONCLUSION

Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type.

Maxillofacial Injuries in Cyclists: A Biomechanical Approach for the Analysis of Mechanisms of Mandible Fractures

PURPOSE

The investigators characterized the occurrence of maxillofacial injuries in cyclists and biomechanically analyzed the mechanisms of mandible fractures.

METHODS

We retrospectively analyzed injury data and performed biomechanical analyses with finite element models. Hospital records from 2011 through 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries while riding a bicycle. Patients with maxillofacial fractures were compared to those without. Logistic regression analysis was performed to identify which variables were independently associated with the occurrence of maxillofacial fractures. To reconstruct the injury scenario (one in which a person falls from a bicycle and contacts the road surface with their face), computer simulations using The Total Human Model for Safety model were performed.

RESULTS

The hospital records of 94 patients (62 men, 32 women; 26.1 ± 17.3 years of age) who sustained oral and maxillofacial injuries while riding a bicycle were reviewed. Twenty patients (21.3%) sustained maxillofacial fractures; mandible fractures were most common (16 patients). Patients with maxillofacial fractures were significantly older and had higher severity injuries; however, logistic regression analysis showed that only age was an independent predictor of the occurrence of maxillofacial fracture (odds ratio, 1.03; P = .025). In simulations, higher von Mises stresses were found in the mandible when the cyclist fell with the neck extended and the body horizontal, and consequently, the center of mandibular body strikes the road surface. Contact forces were approximately 8 kN. High tensile stresses occurred laterally and high compressive stresses occurred medially in the mandibular ramus, which indicated that the mandibular ramus deformed in the transverse plane.

CONCLUSION

Biomechanical analyses show that mandible fractures can occur when a cyclist falls from a bicycle and their lower face strikes the road's surface.

Factors influencing the long-term hospitalization of bicyclists and motorcyclists with oral and maxillofacial injuries

BACKGROUND/AIM

Because bicyclists and motorcyclists with oral and maxillofacial injuries often suffer from disabilities requiring long-term treatment, reducing the severity of such injuries is a valuable objective for improving these people's quality of life (QOL). The aims of this study were, first, to present the prevalence and patterns of oral and maxillofacial injuries of bicyclists and motorcyclists and to compare the features of these injuries and, second, to determine the factors contributing to long-term hospitalization for these patients and to propose effective preventive measures.

MATERIAL AND METHODS

This was a single-center retrospective analysis. Hospital records from 2011 through 2018 were reviewed for all patients who had sustained oral and maxillofacial injuries in bicycle or motorcycle collisions and had presented at a university hospital which was the only hospital in the region attended 24 hours per day by oral and maxillofacial surgeons. Characteristics of the oral and maxillofacial injuries, injury severity, and factors influencing the length of hospitalization were examined.

RESULTS

Records of 130 patients (82 bicyclists and 48 motorcyclists) with a mean age of 28.0 years were analyzed. Thirty-three patients (25.4%) had maxillofacial fractures, with 41 fracture lines while 103 patients (79.2%) had dental injuries and 57 patients (43.8%) had soft-tissue injuries. The distribution and prevalence of oral and maxillofacial injuries were similar for bicyclists and motorcyclists. However, motorcyclists had significantly higher Abbreviated Injury Scale (AIS) scores for facial injuries and the maximum AIS score than did bicyclists. According to a multiple regression analysis, the number of fracture lines and the requirement for intermaxillary fixation were independent factors influencing long-term hospitalization (standard regression coefficients: 6.795 and 6.715, respectively; P < .001).

CONCLUSIONS

The number of fracture lines and the use of intermaxillary fixation were independent factors influencing long-term hospitalization of both bicyclists and motorcyclists with oral and maxillofacial injuries.

Differences in severity of injuries between motorcyclist and bicyclist fatalities in single vehicle collisions

To understand the injury severity of bicyclists and motorcyclists in single vehicle collisions, we performed a retrospective analysis of forensic autopsy cases of 25 motorcyclists and 14 bicyclists performed from 1999 to 2018. Collision details, injury characteristics, and involvement of alcohol were examined. The injury severity between bicyclists and motorcyclists was compared. The average age of victims was 62.3 years. All motorcyclists and no bicyclists wore a helmet. Motorcyclists had more severe injuries than bicyclists (mean Injury Severity Score of 42 and 27, respectively). The motorcyclists had more severe chest injuries but fewer severe facial injuries than bicyclists, owing to the difference in collision velocity or rate of helmet use (p < 0.05). Alcohol was present in the blood of 52.0% of bicyclists but no motorcyclists. The mean blood alcohol concentration of these bicyclists was 1.59 mg/mL. The bicyclists under the influence of alcohol had more severe injuries to neck and upper extremities than non-drunken bicyclists (p < 0.05). Our results may be useful for determining the cause of death and reconstructing the mechanisms of fatal injuries in bicyclists and motorcyclists.

Bicycle helmets are protective against facial injuries, including facial fractures: a meta-analysis

Cycling is a popular activity. However there are risks associated with cycling, including facial injury. Helmets are often worn to prevent head injury. Evidence for their protection against facial injury is limited. This meta-analysis investigated the effect of bicycle helmets on the incidence of facial injury. The PubMed/MEDLINE, Google Scholar, and Cochrane Library databases were searched. Studies included were observational and involved adult participants. Paediatric studies, studies on helmet legislation, and those combining facial injuries with other injury types were excluded. The studies were evaluated by two reviewers. Risk of bias was assessed using the RevMan bias assessment tool. Odds ratios (OR) were extracted for facial injuries and facial fractures. Two meta-analyses were performed using these categories. Nine of the 102 studies identified were included. Helmets were protective against facial injury (OR 0.69, 95% confidence interval 0.63-0.75, P<0.0001). Five studies reported facial fracture rates; helmets were protective against these also (OR 0.79 95% confidence interval 0.70-0.90, P=0.0003). There are no randomized controlled trials on this topic and the number of studies available is small. Bicycle helmets offer protection against facial injuries and this should be considered by cyclists when deciding whether or not to use one.

Urban Bicyclist Trauma: Characterizing the Injuries, Consequent Surgeries, and Essential Sub-Specialties Providing Care

In the United States in 2013, nearly 500,000 bicyclists were injured and required emergency department care. The objectives of this study were to describe the types of injuries which urban bicyclists sustain, to analyze the number and type of surgeries required, and to better delineate the services providing care. This is an observational study of injured bicyclists presenting to a Level I trauma center between February 2012 and August 2014. Most data were collected within 24 hours of injury and included demographics, narrative description of the incident, results of initial imaging studies, Injury Severity Score, admission status, length of stay, surgical procedure, and admitting and discharging service. A total of 706 injured bicyclists were included in the study, and 187 bicyclists (26.4%) required hospital admission. Of those admitted, 69 (36.8%) required surgery. There was no difference in gender between those who required surgery and those who did not (P = 0.781). Those who required surgery were older (mean age 39.1 vs 34.1, P = 0.003). Patients requiring surgery had higher Abbreviated Injury Scores for head (P ≤ 0.001), face (P ≤ 0.001), abdomen (P = 0.012), and extremity (P ≤ 0.001) and higher mean Injury Severity Scores (12.6 vs 3.7, P < 0.001). Sixty-nine patients required surgery and were brought to the operating room 82 times for 89 distinct procedures. Lower extremity injuries were the reason for 43 (48.3%) procedures, upper extremity injuries for 14 (15.7%), and facial injuries for 15 (16.9%). Orthopedic surgery performed 50 (56.2%) procedures, followed by plastic surgery (15 procedures; 16.8%). Trauma surgeons performed five (5.6%) procedures in four patients. The majority of admitted patients were admitted and discharged by the trauma service (70.1%, 56.7%, respectively) followed by the orthopedics service (13.9%, 19.8%, respectively). Injured bicyclists represent a unique subset of trauma patients. Orthopedic surgeons are most commonly involved in their operative management and rarely are the operative skills of a general traumatologist required. From a resource perspective, it is more efficient to direct the inpatient care of bicyclists with single-system trauma to the appropriate surgical subspecialty service soon after appropriate initial evaluation and treatment by the trauma service.

Patterns of Maxillofacial Fractures in Uttar Pradesh, India

This study aimed to obtain dependable epidemiologic data of the variation in cause and characteristics of maxillofacial fractures by identifying, describing, and quantifying trauma. This retrospective study was conducted in the state of Uttar Pradesh, India, over 1 year, based on a systematic computer-assisted database search from March 2015 to March 2016 for maxillofacial fractures. The demographics, etiology, geographic distribution, date of injury, site and number of fractures, and type of intervention were recorded for each. The study population consisted of 1,000 patients with 1,543 fractures. The male:female ratio was 8:1. A peak incidence of fractures was seen in the third decade (mean age: 30.3) with maximum patients younger than 40 years (80.8%). The incidence of fractures was highest in spring (42.9%). Road traffic accidents were the most common cause of trauma (64.4%) and mainly involved two wheelers (60.2%). Single-site fractures were most common. Mostly zygomatic (45.1%) and mandibular fractures (44.4%) were encountered, accounting for approximately 90% of all fractures. The main site of mandibular fractures was the body (34.4%); 46.2% of fractures underwent open reduction and internal fixation (ORIF) while 53.8% were treated by closed methods. The study provides important data to contrive future plans for injury prevention. The trend of most traffic-related injuries continues with the increasing traffic on roads. Zygomatic complex and mandibular fractures remain the most frequent. The major populations at risk are young men and those driving two wheelers. The use of helmets could achieve a large reduction in maxillofacial fractures. Awareness for preventive measures and safety guidelines should be propagated and legislation on traffic rules strictly reinforced.

Mandibular trauma: a two-centre study

The aims of this study were to assess and compare epidemiological data on mandibular fractures from two European centres and to perform a review of the literature. Between 2001 and 2010, a total of 752 patients with a total of 1167 mandibular fractures were admitted to a hospital in Turin, and 245 patients with a total of 434 mandibular fractures were admitted to a hospital in Amsterdam. The mean age in Turin was 34.8 years and in Amsterdam was 32 years. The age group 20-29 years showed the highest incidence of mandibular fractures in both centres. The fractures were mainly the result of assaults, in agreement with several articles in the recent literature, followed by falls. The continuous long-term and multicentre collection of data on the epidemiology of maxillofacial trauma is important because it provides the information necessary for the development of preventative measures aimed at reducing the incidence of facial injuries.

Mandibular trauma treatment: a comparison of two protocols

Objectives: The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study Design: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two centers in Turin, Italy and in Amsterdam, the Netherlands for ten years. Only patients who were admitted for mandibular fractures were considered for this study. Results: Between 2001 and 2010, a total of 752 patients were admitted at Turin hospital with a total of 1167 mandibular fractures not associated with further maxillofacial fractures, whereas 245 patients were admitted at Amsterdam hospital with a total of 434 mandibular fractures. At Amsterdam center, a total of 457 plates (1.5 - 2.7 mm) were used for the 434 mandibular fracture lines, whereas at Turin center 1232 plates (1.5 – 2.5 mm) were used for the management of the 1167 mandibular fracture lines. At Turin center, 190 patients were treated primarily with IMF, whereas 35 patients were treated with such treatment option at Amsterdam center. Conclusions: Current protocols for the management of mandibular fractures are quite efficient. It is difficult to obtain a uniform protocol, because of the difference of course of each occurring fracture and because of surgeons’ experiences and preferences. Several techniques can still be used for each peculiar fracture of the mandible.

Key words:Mandibular fracture, facial trauma, maxillofacial, treatment, multicentre, database.

Maxillofacial Fractures due to Falls: does Fall Modality Determine the Pattern of Injury?

Objectives

In several epidemiological studies of maxillofacial trauma, falls were one of the most frequent causes of facial injury. The aim of this study is to analyse the patterns of fall-related maxillofacial injuries based on the height of the fall.

Material and Methods

Using a systematic computer-assisted database of patients hospitalised with maxillofacial fractures, only those with fall-related injuries were considered. The falls were divided into four groups: falls from slipping, tripping or stumbling (STSF), loss of consciousness (LOCF), stairs (SAF), and height (HF). Data on the age, gender, fracture site, Facial Injury Severity Scale (FISS), facial lacerations, associated lesions, type of treatment, and length of hospital stay were also analysed.

Results

This study included 557 patients (338 males, 219 females; average age 51.5 years [range 4 - 99 years]). In the over 60 age group, females were more prevalent in STSF than males. According to aetiology, STSF was the most frequent cause of maxillofacial fractures (315 patients; 56.5%) followed by LOCF (157; 28.2%), HF (55; 9.9%), and SAF (30; 5.4%). The middle third of the face was affected most frequently. After LOCF, however, the inferior third was prevalently involved. The majority of associated fractures, as well as the most severe injuries and greatest rate of facial lacerations, occurred secondary to HF.

Conclusions

This study showed that fracture severity and site are influenced not only by patient age, but also by the nature of the fall.

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study

OBJECTIVE

The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year.

STUDY DESIGN

The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years.

RESULTS

The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures.

CONCLUSIONS

Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

Fractures of the mandibular coronoid process: a two centres study

The aim of this study was to assess the characteristics of patients with coronoid fractures treated in two European centres over 10 years and to briefly review the literature. This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures and surgically treated in two European centres between 2001 and 2010. During the 10 years, 1818 patients and 523 patients with maxillofacial fractures were admitted to the two centres respectively: 21 patients (16 males, 5 females) were admitted with 21 coronoid fractures and 28 associated maxillofacial fractures. A mean age of 42.1 years was observed. The fractures were mainly the result of motor vehicle accidents, followed by assaults and falls. The most frequently observed associated maxillofacial fracture was a zygomatic fracture (13 fractures). In both centres, mandibular coronoid fractures are treated unless a severe dislocation of the fractured coronoid is observed or a functional mandibular impairment is encountered. Conservative treatment can be used, together with the open reduction and internal fixation of associated fractures. The crucial point is to prevent ankylosis, which may be prevented by correct and early postoperative physiotherapy and mandibular function.

Diplopia and driving: a problematic issue

The aim of this article was to review the literature regarding diplopia and driving license and to review the West European legislations about this topic, in order to obtain appropriate indications for hospitals specialists and patients. A systematic review of articles published about diplopia and driving was performed. In addition a review of West European national legislations about driving license regulations for medical illnesses was performed, in addition to the European Union Directive on driving licenses. In the literature, the presence of diplopia has not been considered a reliable predictor of the safety of driving behavior, or it has not appeared to be a contraindication for driving according to some authors who were unable to demonstrate significant differences on driving simulator performance between subjects with chronic stable diplopia and control subjects. Nevertheless, in all western European legislations, acute diplopia constitutes an important limitation for driving, thus making the knowledge of current regulations fundamental for specialists involved in managing patients with diplopia. Ophthalmologists and maxillofacial/head and neck surgeons, may advise patients before hospital discharge about current legislations in their respective countries.