Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries

Trends in Management and Cost Burden of Facial Fractures: A 14-Year Analysis

OBJECTIVE

To discuss patient demographics and management and better understand the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center.

STUDY DESIGN

Retrospective chart review.

METHODS

We identified 5088 facial fractures in 2479 patients who presented from 2008 to 2022. Patient demographics, mechanism of injury, associated injuries, treatment information, and hospital charges were collected and analyzed to determine factors associated with surgical management and increased cost burden.

RESULTS

Our 14-year experience identified 1628 males and 851 females with a mean age of 45.7 years. Orbital fractures were most common (41.2%), followed by maxilla fractures (20.8%). The most common mechanism was fall (43.0%). Surgical management was recommended for 41% of patients. The odds of surgical management was significantly lower in female patients, patients age 65 and older, and patients who presented after the onset of the COVID-19 pandemic. The odds of surgical management was significantly higher for patients who had a mandible fracture or greater than 1 fracture. The average cost of management was highest for naso-orbito-ethmoidal fractures ($37,997.74 ± 52,850.88), followed by LeFort and frontal fractures ($29.814.41 ± 42,155.73 and $27,613.44 ± 39.178.53, respectively). The highest contributor to the total average cost of management was intensive care unit-related costs for every fracture type, except for mandible fractures for which the highest contributor was operating room (OR)-related costs.

CONCLUSIONS

This study represents one of the largest comprehensive databases of facial fractures and one of the first to provide a descriptive cost analysis of facial trauma management.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:3120-3126, 2024.

Impact of COVID-19 pandemic on the dynamic of patients with oral and maxillofacial trauma: interrupted time-series analysis

Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.

Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study

PURPOSE

The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF).

MATERIAL AND METHODS

This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded.

RESULTS

Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type.

CONCLUSION

Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.

Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients

PURPOSE

The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic.

METHODS

This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed.

RESULTS

The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

Evaluation of graphene oxide-doped poly-lactic-co-glycolic acid (GO-PLGA) nanofiber absorbable plates and titanium plates for bone stability and healing in mandibular corpus fractures: An experimental study

BACKGROUND

Open reduction with internal fixation is the preferred treatment option for displaced facial bone fractures. The superior mechanical properties of metallic plates have made them the most widely used material in existing bone fixation systems. However, after the healing period, these permanent plates can cause various problems. Alternative bioresorbable materials are being investigated to reduce these potential problems. This study compares bone stability and viability by using graphene oxide (GO)-doped poly-lactic-co-glycolic acid (PLGA) nanofiber plates and titanium plates for rats with fractured mandibles.

MATERIALS AND METHODS

The study included 20 male Sprague-Dawley rats, divided into four groups: a control group (Group I), a mandibular fracture group with no additional application (Group II), a mandibular fracture group repaired with titanium plates (Group III), and a mandibular fracture group repaired with GO-PLGA plates (Group IV). After 2 months, all of the rats were euthanized. A bone compression test was performed to assess bone stability, and a histological examination was performed to evaluate bone healing.

RESULTS

The osteocyte lacunae, Haversian ducts, canaliculi, and vascular structures of Group IV were found to be higher. In the compression test, vertical compression was applied to the bone axis, and Group IV had a higher maximum load and maximum stretch. GO-PLGA plates were found to be statistically superior to titanium plates in terms of both bone stability and bone healing (p < 0.05).

CONCLUSIONS

The present study found that GO-PLGA plates are more effective than titanium plates for the treatment of mandibular corpus fractures.

Acrylated Hyaluronic-Acid Based Hydrogel for the Treatment of Craniofacial Volumetric Muscle Loss

Current treatment options for craniofacial volumetric muscle loss (VML) have disadvantages and cannot fully restore normal function. Bio-inspired semisynthetic acrylated hyaluronic acid (AcHyA) hydrogel, which fills irregularly shaped defects, resembles an extracellular matrix, and induces a minimal inflammatory response, has shown promise in experimental studies of extremity VML. We therefore sought to study AcHyA hydrogel in the treatment of craniofacial VML. For this, we used a novel model of masseter VML in the rat. Following the creation of a 5 mm × 5 mm injury to the superficial masseter and administration of AcHyA to the wound, masseters were explanted between 2 and 16 weeks postoperatively and were analyzed for evidence of muscle regeneration including fibrosis, defect size, and fiber cross-sectional area (FCSA). At 8 and 16 weeks, masseters treated with AcHyA showed significantly less fibrosis than nonrepaired controls and a smaller decrease in defect size. The mean FCSA among fibers near the defect was significantly greater among hydrogel-repaired than control masseters at 8 weeks, 12 weeks, and 16 weeks. These results show that the hydrogel mitigates the fibrotic healing response and wound contracture. Our findings also suggest that hydrogel-based treatments have potential use as a treatment for the regeneration of craniofacial VML and demonstrate a system for evaluating subsequent iterations of materials in VML injuries.

Outcome Study of Mandibular Fractures Treated by Surgical Stabilization With Plates and Screws

This study aims to assess the outcomes of mandibular fractures treated through surgical stabilization using plates and screws, focusing on factors such as postoperative complications, patient satisfaction, and functional recovery. A total of 42 patients were included in the study. Surgical interventions involved the application of plates and screws at the fracture sites. Postoperative complications, including infection, hardware failure, and malocclusion, were recorded. Surgical stabilization of mandibular fractures using plates and screws demonstrates favorable outcomes in terms of stability, occlusal alignment, and patient satisfaction. The findings of this study contribute valuable insights into the efficacy of this surgical approach, highlighting its role in achieving successful outcomes for mandibular fracture management. Further prospective studies and randomized controlled trials are recommended to strengthen the evidence base and refine treatment protocols.

What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries?

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.

Correlation between Malocclusion and Mandibular Fractures: An Experimental Study Comparing Dynamic Finite Element Models and Clinical Case Studies

Mandibular fractures are very common in maxillofacial trauma surgery. While previous studies have focused on possible risk factors related to post-operative complications, none have tried to identify pre-existing conditions that may increase the risk of mandibular fractures. We hypothesized, through clinical observation, that anatomical conditions involving poor dental contacts, such as malocclusions, may increase the risk of mandibular fractures. This work was subdivided into two parts. In the first part, Digital Imaging and Communications in Medicine (DICOM) data of four healthy patients characterized by different dentoskeletal occlusions (class I, class II, class III, and anterior open bite) have been used to develop four finite element models (FEMs) that accurately reproduce human bone structure. A vertical and lateral impact have been simulated at increasing speed on each model, analyzing the force distribution within the mandibular bone. Both vertical and lateral impact showed higher level of stress at the impact point and in the condylar area in models characterized by malocclusion. Specifically, the class III and the open bite models, at the same speed of impact, had higher values for a longer period, reaching critical stress levels that are correlated with mandibular fracture, while normal occlusion seems to be a protective condition. In the second part of this study, the engineering results were validated through the comparison with a sample of patients previously treated for mandibular fracture. Data from 223 mandibular fractures, due to low-energy injuries, were retrospectively collected to evaluate a possible correlation between pre-existing malocclusion and fracture patterns, considering grade of displacement, numbers of foci, and associated CFI score. Patients were classified, according to their occlusion, into Class I, Class II, Class III, and anterior open bite or poor occlusal contact (POC). Class I patients showed lower frequencies of fracture than class II, III, and open bite or POC patients. Class I was associated with displaced fractures in 16.1% of cases, class II in 47.1%, class III in 48.8% and open bite/POC in 65.2% of cases (p-value < 0.0001). In class I patients we observed a single non-displaced fracture in 51.6% of cases, compared to 12.9% of Class II, 19.5% of Class III and 22.7% of the open bite/POC group. Our analysis shows that class I appears to better dissipate forces applied on the mandible in low-energy injuries. A higher number of dental contacts showed a lower rate of multifocal and displaced fractures, mitigating the effect of direct forces onto the bone. The correlation between clinical data and virtual simulation on FEM models seems to point out that virtual simulation successfully predicts fracture patterns and risk of association with different type of occlusion. Better knowledge of biomechanics and force dissipation on the human body may lead to the development of more effective safety devices, and help select patients to plan medical, orthodontic/dental, and/or surgical intervention to prevent injuries.

Prevalence of Craniofacial Injuries in the Elderly Population

INTRODUCTION

Recognizing and understanding risk factors for craniofacial injury in the elderly is of paramount importance in prevention. This research aims to investigate the prevalence of craniofacial injuries in connection with extrinsic preventable factors, particularly identifying common household products that pose the greatest risk for such injuries.

MATERIALS AND METHODS

This study was done with the utilization of the 2013 to 2022 National Electronic Injury Surveillance System (NEISS). Data gathered included patient age, injury type, cause of injury, and year of incidence. "Elderly" was defined as an individual of 65 years of age or older.

RESULTS

There was a total of 9,703,688 estimated national cases of elderly craniofacial injury from 2013 to 2022. In all, 5,888,112 (60.68%) of these occurred in females. In descending order, the 5 most common items responsible for craniofacial injury in the elderly are floors/flooring Materials (3,741,706, 30.92%), beds/bed frames (1,250,396, 10.33%), stairs/steps (907,92, 7.50%), chairs (546,697, 4.52%), and tables (453,989, 3.75%). These top 5 account for roughly 57% of all cases. The 5 most common presenting diagnoses were internal injury (2,957,095, 40.21%), lacerations (1,435,926, 19.53%), ABR (1,191,008, 16.20%), fracture (568,842, 7.74%), and hematoma (355,871, 4.84%).

CONCLUSIONS

Out of the roughly 10 million cases of craniofacial injury in the last decade, ~three-fifths have happened to women. The majority of injuries occur in a home setting. The overwhelming majority of cases were related to the product code 1807-floors or flooring materials, and the largest diagnosis was internal injury by a wide margin. Evidently, there is a large population of elderly patients who suffer from craniofacial injuries related to objects and items that permeate within their living residences. The elimination of excess elderly craniofacial injury can be achieved by reducing fall risk factors in the immediate vicinity of the elderly.

The profile of patients with maxillofacial trauma due to interpersonal violence treated in a hospital emergency room

AIM

This study evaluated records of patients with maxillofacial trauma due to interpersonal violence (IPV) being treated in the emergency room of a level I trauma center hospital in São Paulo, Brazil.

MATERIAL AND METHODS

Data of patients with maxillofacial trauma due to IPV recorded between January 2019 and December 2019 were retrospectively examined. Personal data, days on which they experienced IPV, and the type of maxillofacial trauma sustained were extracted and statistically analyzed (p < .050).

RESULTS

During the analysis, 1034 patients with maxillofacial trauma were identified; of these patients, 292 (28.2%) who experienced trauma due to IPV were included in this study. There was a mean age of 32.6 years and the most common type of trauma was soft tissue injuries (38.7%). Mandible and nose fractures were more prevalent in males and females, respectively. Our data, when compared with other studies on maxillofacial trauma due to IPV, showed a lower prevalence and male-to-female ratio, and a higher presence of dentoalveolar trauma. Additionally, our data when compared with studies on maxillofacial trauma due to other causes showed lower mean age and male-to-female ratios, and a higher occurrence of nose fractures differing from the predominance of mandibular fractures.

CONCLUSION

Oral and maxillofacial surgeons must be able to suspect and identify cases due to IPV among their patients with trauma. With our results, although each case has its individuality, we can suggest that cases of maxillofacial trauma in young, female, and nasal fracture patients may be suspicious for IPV.

Disasters in pediatric dentistry: a systematic review

BACKGROUND

Disasters can harm many people, especially children, in unpredictable and public ways. One of the neglected aspects of children's health in disasters is oral and dental hygiene, which can affect their physical and mental well-being. This systematic review explores how dentistry can help children in disasters, focusing on two aspects: providing oral health care and identifying disaster victims.

METHODS

A thorough search of databases, such as PubMed, Cochrane Library, Scopus, Embase, ProQuest, and Web of Science, was done to find English-language publications from 1930 to August 31, 2023. The screening, data collection, and quality assessment followed the PRISMA guidelines.

RESULTS

Out of 37,795 articles found in the databases, seven research articles were chosen. Five articles were retrospective, and two articles were prospective. The results showed that dentistry for children is very important in disasters by giving information about the oral and dental problems and identifying the victims. The results also showed some of the challenges and difficulties in giving dental care for children in disaster situations, such as changing control, referral systems, and parental fear of infection.

CONCLUSION

Dentistry for children can improve the health and well-being of children affected by disasters.

Oral health professional intervention and child physical abuse-European legal approach

Physical violence against children and adolescents is an issue of Global Public Health. This study aims to identify traumatic injuries and the medicolegal temporary framework of the victim's profile in the European legal approach. Participants and setting include the following: the clinical reports of a Portuguese European Clinical Academic Center database were analysed. An observational and prospective cohort study was performed. A descriptive analysis of the variables was conducted, considering gender, bimodal age groups, place of residence, offender data, place of occurrence, aetiology, localization, type of injuries, personal injury assessment by Quantum doloris, and injury time. The statistical analysis was performed by Spearman's rho and Kendall's tau-b correlation tests, Pearson's chi-square test of independence (χ2), and Mann-Whitney and Kruskal-Wallis nonparametric tests (P < 0.05). The relationship between age groups and the place of occurrence was statistically significant (P = 0.001). Orofacial and nonorofacial injuries were related (P = 0.035). The General Data Protection Regulation is not a barrier to the treatment and sharing of justified data but a framework for safeguarding individuals' fundamental rights, including the Right to Health. Meticulous reporting of the clinical situation involves the victim, the occurrence, and the potential offender.

Key points

An oral health professional's notification of the event is a fundamental step of the judicial process.The timeline is the core of traumatic injury assessment in a child physical abuse scenario.Medicolegal evaluation impacts disability prevention, imputability, and notification of the crime.

Comparison of characteristics of kick- and electric-scooter-related dental and maxillofacial injuries: A retrospective study

BACKGROUND/AIM

Owing to the nearly three-year-long COVID-19 pandemic, small personal transportation devices that allow for greater freedom of movement within the cities have gained attention. Therefore, the number of people using kick or electric scooters has increased. This study aimed to compare the characteristics of kick and electric scooter-related dental and maxillofacial trauma and provide helpful information for preventing scooter accidents, appropriate treatment of patients with scooter-related trauma, and policy establishment.

MATERIALS AND METHODS

This retrospective observational study analysed the medical records of 310 patients who visited the emergency room of Ajou University Dental Hospital for kick and electric scooter-related oral and maxillofacial injuries between 1 January 2017 and 31 December 2022. Sex, age, scooter type, time, and mechanism of the accident, helmet use, alcohol consumption, dental and maxillofacial injury types, and treatment were analysed.

RESULTS

The average age in the kick-scooter group (5.71 ± 4.25) was lower than that in the electric-scooter group (28.24 ± 10.02) (p < .0001). There were more males in both groups. The helmet usage rates of the two groups were 2.80% and 7.88%, respectively. In the kick-scooter group, periodontal damage was more common than pulp injury, while in the electric-scooter group, pulp injury was more common than periodontal injury. There was no significant difference in soft-tissue damage between the two groups; however, bone fractures occurred significantly more frequently in the electric-scooter group (p < .0001).

CONCLUSIONS

Electric scooters cause more crown and bone fractures than kick scooters and require more active treatment of dental and maxillofacial injuries. Riders should use protective equipment to prevent dental and maxillofacial injury. Although there are regulations related to scooters, the effectiveness of both kick- and electric-scooter related laws needs to be evaluated.

The risk of osteomyelitis after mandibular fracture is doubled in men versus women: analysis of 300,000 patients

Postoperative complications following mandibular fracture treatment vary from local wound infections to severe conditions including osteomyelitis and impaired fracture healing. Several risk factors have been associated with the development healing disorders, including fracture localisation, treatment modality and substance abuse. However, limited research on the sex-specific influence of these complications exists. A total of about 300,000 female and male patients with mandibular fractures were examined in two cohorts. After matching for confounders (age, nicotine and alcohol dependence, malnutrition, overweight, anaemia, diabetes, osteoporosis and vitamin D deficiency), two cohorts were compared with propensity-score-matched patients according to outcomes (osteomyelitis, pseudoarthrosis and disruption of the wound) within 1 year after fracture. There were significant differences between female and male patients regarding the occurrence of osteomyelitis (odds ratio [OR] [95% confidence interval]: 0.621 [0.563; 0.686]) and disruption of the wound (OR [95% confidence interval]: 0.703 [0.632; 0.782]). Surprisingly, matching for the expected confounders did not change the results substantially. Sex plays a dominant role in determining the risk stratification for postoperative osteomyelitis and disruption of the wound, after accounting for other potential confounding factors. Additional research is needed to understand the underlying mechanisms and to develop sex-specific strategies to prevent these complications.

A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement

INTRODUCTION

Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement.

MATERIALS AND METHODS

Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded.

RESULTS

OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT.

CONCLUSIONS

The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.

Long-Term Aesthetic Cicatrization Analysis of Lower Eyelid Incision for Orbital Floor Fracture Approach

Orbital fractures are among the most frequent facial injuries. Of the 3 most widely described approaches in the literature, the lower eyelid approach is the authors' preference. This study retrospectively analyzed the patients treated at the Trauma Center of the Umberto I Hospital, Sapienza University of Rome from January 2010 to December 2020. Inclusion criteria were as follows: diagnosis of pure/impure orbital bone fracture, complete clinical and radiological documentation, and a minimum of 12 months follow-up. Sex, age, etiology, treatment, and associated complications were analyzed using IBM SPSS Statistics. Two internationally validated scales were used for the functional and esthetic long-term evaluation: the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver one. The scales were compiled by the patient himself and by 3 independent expert observers. Of the 543 patients who underwent surgery in the specified period, 208 fully met the inclusion criteria. One hundred forty-two (68.2%) were males and 66 (31.8%) were females, with a mean age of 40.68 years. The main cause was represented by assaults (33.1%). One hundred seventy-nine patients had a pure orbital fracture (83.8%) and 29 an impure one (16.2%). The most frequent symptoms at the time of diagnosis were diplopia (31.2%), followed by anesthesia of the second trigeminal branch (24.3%). Open reduction with internal fixation was the preferred treatment and proved to be effective in reducing the main signs and symptoms of the fracture in a statistically significant way ( P < 0.05). Long-term esthetic results of the lower eyelid, using the Vancouver and POSASs, were respectively as follows: Vancouver Scar Scale mean total score was 2.41 (range: 0-8), observer POSAS mean total score was 1.83 (range: 1.2-3.9), observer general opinion mean score was 1.66, patient POSAS mean total score was 2.23 (range: 1.33-3.7), and patient general opinion mean score was 2.87. The lower eyelid approach has proven to be reproducible, with a fast-learning curve and a low complication rate. The analysis conducted highlighted an excellent long-term esthetic-functional result. Further studies will be needed to statistically compare the results obtained with other orbital floor surgical approaches.

Trauma (Excluding Falls) in the Older Adult

Trauma in the older adult will increasingly become important to emergency physicians hoping to optimize their patient care. The geriatric patient population possesses higher rates of comorbidities that increase their risk for trauma and make their care more challenging. By considering the nuances that accompany the critical stabilization and injury-specific management of geriatric trauma patients, emergency physicians can decrease the prevalence of adverse outcomes.

The Pattern of Midface Fractures in Jordan: A Retrospective Review of Medical Records

Introduction

Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018-2021.

Methods

This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021.

Results

During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures.

Conclusions

Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.

A Retrospective Study of Maxillofacial Fractures at a Tertiary Care Centre in North India: A Review of 1674 Cases

Objective

To examine the pattern of maxillofacial fractures in patients treated at the SMS Hospital in Jaipur, India, over a two-year period.

Methods

A retrospective study was conducted from October 2019 to September 2021, which recorded various data of patients with maxillofacial fractures, including age, sex, site distribution, cause of injury, type of facial bone fractures, soft tissue injuries, dentoalveolar trauma, and type of treatment. The days spent in the hospital before and after surgery were also recorded.

Results

The study included 1674 patients, with a male-to-female ratio of 4.07:1 and males being the most affected at 80.3%. The most common cause of injury was road traffic accidents (53.5%), followed by falls (18.6%) and assaults (16.1%). Mandibular fractures accounted for 38% of all fractures, with the parasymphysis being the most common site for fractures. Open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) were the most common treatment options for mandibular fractures.

Conclusion

The study highlights the need for strict enforcement of traffic rules and road safety laws, along with education and preventive measures to reduce the incidence of maxillofacial trauma. The pattern of maxillofacial injuries can provide useful information for designing programs towards the prevention and management of maxillofacial trauma.

The effects of Kinesio tapes on facial swelling following bimaxillary orthognathic surgery in the supraclavicular region

BACKGROUND

Several osteotomies are required for orthognathic surgery to reposition the jaws correctly. This study aimed to evaluate whether Kinesiotaping can reduce swelling, pain, and trismus following orthognathic surgery of the facial skull.

MATERIALS AND METHODS

The present study consists of two phases. In the split-mouth phase, 16 skeletal class III patients underwent Bimax Orthognathic surgery, and Kinesiological tape (KT) was applied on one half of the face. In the prospective case-control phase, 30 patients were divided into two groups. Kinesio tape was applied on both sides of the face of the Kinesio group, and pressure dressing and ice therapy were used for the second group. The tape was parallel to the lower border of the mandible along its entire length, tangent to the labial commissure area on the studied side. The tape was placed in place for 5 days. Edema was evaluated by measuring the distance from the menton to the lower edge of the tragus. The maximum mouth-opening trismus was evaluated, and the VAS index was used to evaluate pain.

RESULTS

There was evidence of swelling reduction after KT; within the same study, differences between the left and right sides as well as for the same side were statistically significant (p < 0.001). As a result of tapping lymphatic Kinesio tape on the affected area, tension was reduced, and lymphatic circulation was restored. Blood and lymph microcirculation was improved, enabling the body to heal itself.

CONCLUSION

Kinesio tape reduced swelling after orthognathic surgery in a positive way. As a simple, non-traumatic, economical method, Kinesio taping seems promising.

Patterns and Trends of Facial Fractures at a Tertiary Care Trauma Center in India - A 13 years Retrospective Study

Study Design

Retrospective study.

Objective

The purpose of this study was to retrospectively analyze the prevalence, pattern, diagnosis, and treatment of the facial fractures falling under ambit of facial plastic surgery in a multi-specialty hospital at India from the year 2006-2019.

Methods

This retrospective study analyzed 1508 patients, having orbital fractures (from 2006 to 2019) for demographic data, cause of trauma, type of fracture, and the treatment given. The data were compiled in excel and analyzed by using SPSS version 21.0.

Results

Out of these 1508 patient (1127 (74.73%)-males and 381 (25.27%)-females), the etiology of injuries was Road traffic accident (RTA) (49.20%), assault (26.52%), and sports injuries (11.47%). The most common fracture pattern was Isolated Orbit and/or Orbital Floor fracture in 451 patients (32.08%), followed by Mid-facial fractures (21.93%). Also, 105 patients (6.96%) experienced ocular/retinal trauma along with other fractures.

Conclusions

Orbit, peri-ocular, and mid-face trauma comprised a large position of this study. It requires a great deal of expertise to treat such complex trauma, which is not covered in one specialty alone. Hence, a holistic approach of craniofacial fracture management, rather than limiting these skills to water-tight craniofacial compartments becomes necessary. The study highlights the critical need of multidisciplinary approach for predictable and successful management of such complex cases.

Treatment of Persistent Post-traumatic Diplopia - An Algorithmic Approach to Patient Stratification and Operative Management

Study Design

Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma.

Objective

Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes.

Methods

A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005-2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified.

Results

Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair.

Conclusions

Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery.

Success rates of lateral canthotomy and cantholysis for treatment of orbital compartment syndrome

PURPOSE

Vision loss after facial trauma can occur from orbital compartment syndrome (OCS). Orbital compartment syndrome is commonly treated surgically with a lateral canthotomy and cantholysis (C&C). Our study investigates success rates of lateral C&C for the treatment of OCS amongst emergency medicine (EM) and ophthalmology providers.

METHODS

A retrospective cohort study was performed. Cases were identified and the electronic medical record of patients was interrogated for clinical and procedural information. Success of a lateral C&C was defined as a decrease in intraocular pressure (IOP) to <30 mmHg after the first attempt at the procedure. Inclusion criteria included documentation of a procedural attempt, a pre-procedure IOP >30 mmHg and a post-procedure IOP measurement; or alternatively if no pre-procedure IOP was documented but the IOP was >30 on arrival to the level 1 trauma center. Exclusion criteria included periprocedural use of ocular hypotensive medications and comorbid hyphema.

RESULTS

The final analysis included 74 eyes from 64 patients. Emergency medicine providers performed the initial lateral C&C in 68% of cases compared to 32% by ophthalmologists, and success rates were comparable - 68% vs 79.2%, respectively (p = 0.413). Poorer visual outcomes were associated with the initial failure of a lateral C&C and head trauma without an orbital fracture. All patients treated with a vertical lid split procedure met the criteria for 'success' as defined by this study.

CONCLUSIONS

The success rate of a lateral C&C is comparable amongst EM and ophthalmology providers. Improved training of physicians on the lateral C&C or other simpler procedures, such as the vertical lid split, could improve outcomes in OCS.

Imaging of Maxillofacial Trauma

Maxillofacial trauma is common. Computed tomography is the primary imaging tool for diagnosis. Study interpretation is aided by understanding regional anatomy and clinically relevant features of each subunit. Common injury patterns and the most important factors related to surgical management are discussed.

Patterns and Characteristics of Midface Fractures in North-Eastern Romania

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence.

Quantitative analysis of diplopia following orbital fracture repair

Orbital fractures can result in devastating functional complications to sight and well-being, yet our understanding of functional sequelae post reconstruction is not well understood in the literature. This research retrospectively analysed the activity of a specialist orbital surgeon over five years to evaluate the incidence of, and risk factors for, debilitating complications such as diplopia and restriction of extraocular movement. Orbital fracture cases repaired between 1 January 2015 and 31 December 2019 were retrospectively analysed. Demographics, orthoptic assessment, injury classification, timing, operative details, outcomes, and complications were recorded. Preoperative and postoperative binocular single vision scores (BSV) were recorded to calculate the effect of orbital repair on residual diplopia. Of 582 patients undergoing orbital access, 472 cases of orbital wall reconstruction satisfied the inclusion criteria, of which 162 (34%) were Jaquiéry 4 or 5. Overall, 10.6% had complications, 4.9% had diplopia, and 5.7% were returned to theatre. All those with residual diplopia had had it preoperatively, and had evidence of an improvement in BSV score. Time to surgery, material, and pure orbital fractures had a significant impact on the incidence of diplopia. Defect size did not. Whilst complication rates were low we conclude that strict adherence to a defined surgical protocol, postoperative imaging, and objective assessment of postoperative function are central to maintaining these standards. Objective orthoptic analysis of patients before and after orbital repair is critical to our understanding of this pathology. Whilst preoperative prediction of the persistence of long-term diplopia currently eludes us, further research should target it.

Which sports have a higher risk of maxillofacial injuries?

OBJECTIVES

Sports etiology is one of the most common causes of maxillofacial injuries. This work aimed to provide an up-to-date review of sports-related maxillofacial injuries.

METHODS

An updated review was conducted on Pubmed and Google Scholar. No publication year and language restrictions were applied. Two different search strategies were performed, the first addressed which sports, generally associated with maxillofacial injuries, and the second search was conducted to determine the frequency of maxillofacial injuries associated with each sport individually.

RESULTS

The first search returned 26 articles distributed across different sports, from different countries, and with varied age distribution. The second search displayed 85 articles on individual sports group. Papers were rated and categorized according by the sport associated to the reported injury. A useful sports risk scale for maxillofacial injuries has been developed. Peculiar themes from all participating sports were evaluated. The use of protective equipment and other preventive measures were highlighted.

CONCLUSIONS

Some sports with ball and cycling can be considered riskier sports for maxillofacial injuries. Athlete education and the mandatory use of mouthguards, helmets, and eye protection, among other things, are crucial to prevent these injuries. Tailor-made mouthguards and protective masks, which are becoming cheaper, are in vogue. The Sports-related Maxillofacial Injuries Risk scale can be useful for athletes, athletic coaches, and maxillofacial surgeons.

Patterns of Midface and Mandible Fractures in a Government Hospital

Study Design: Cross-sectional study.

Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City.

Materials and Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test.

Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin ( P = .06). Conservative treatment was more frequent at 71.67% in intrapersonal violence ( P = .019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% ( P = .028).

Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence.

The changing face of maxillofacial trauma during the 2020 COVID-19 lockdowns in Melbourne, Australia

PURPOSE

To compare the incidence, aetiology, and patterns of maxillofacial fracture presentations during the various stages of the 2020 Melbourne COVID-19 lockdown restrictions to periods outside lockdown in 2019 and 2020.

METHODS

This is a retrospective study of 344 subjects. The patterns of facial trauma presentations to a tertiary hospital in metropolitan Melbourne during the 2020 COVID-19 restrictions were compared to periods with no restrictions over 22 months from March 2019 to December 2020.

RESULTS

The incidence of maxillofacial fractures decreased by 28% during lockdown (0.41 vs. 0.57 injuries/day, P = 0.0003). Falls overtook interpersonal violence as the leading cause of fractures (44% of lockdown presentations vs. 25.7% of presentations outside lockdown, P = 0.002), while sporting injuries dropped drastically (4% vs. 17.1%, P = 0.005). Lockdowns saw an increase in the proportion of female patients (40% vs. 26.8%, P = 0.03) and a fivefold increase in proportion of domestic violence-related fractures (6.7% vs. 1.1%, P = 0.006). Alcohol-related injuries decreased significantly (11% vs. 21%, P = 0.03).

CONCLUSIONS

While restrictions reduced rates of interpersonal violence and alcohol-related maxillofacial trauma, there was a higher proportion of injuries to females, increased falls, and domestic violence-related injuries.

Decline in Maxillofacial Injuries during the Pandemic: The Hidden Face of COVID-19

Maxillofacial injuries result from a variety of daily activities. Traffic accidents, interpersonal violence, and falls represent some of the most common etiological factors behind maxillofacial fractures. During the COVID-19 outbreak, the social distancing measures imposed by healthcare authorities aimed at abolishing the spread of the viral infection. This study aimed to evaluate the effect of social distancing measures on the incidence of maxillofacial injuries.

METHODS

Data were retrieved from the medical file registry at the Galilee Medical Center, Nahariya, Israel. Incidence, gender, age, etiology, and cost of hospitalization during the COVID-19 lockdown and the previous periods were retrieved.

RESULTS

A decrease in maxillofacial fractures was registered during the 2020 lockdown; younger patients had the largest share of maxillofacial traumas during this period. The midface was the most involved facial region in both periods, and a reduction of 62.3% in the cost of OMF fracture treatment was observed during the COVID-19 era.

CONCLUSIONS

The occurrence, etiology, and cost of treatment of maxillofacial injuries during the COVID-19 period were different from those in the corresponding period in the pre-COVID-19 era. These results can provide a guide to help design programs for the prevention of OMF trauma.

Maxillofacial injuries among ice hockey players: a retrospective study from a Finnish trauma Centre

OBJECTIVE

Ice hockey players are at risk of a variety of injuries. In our investigation, we aimed to evaluate the types of facial fractures, injury mechanisms and need for surgical intervention in professional and recreational ice hockey players.

MATERIAL AND METHODS

This retrospective study included all patients presenting to a tertiary trauma centre with any ice hockey-related facial fracture during the period from January 2013 to July 2020. The primary outcome variable was the need for surgical treatment, and the primary predictor variable was the injury mechanism. Demographic and clinically relevant variables were statistically evaluated and presented.

RESULTS

Of 66 total patients, the most frequent fracture type was isolated mandible fracture (56.1%). Males were overrepresented (98.5%) in the patient population. Puck strikes were the most common mechanism of injury (74.2%). Surgical intervention was performed in nearly half of the patients (48.5%), and was significantly more common in younger patients (p = 0.006). Associated dental injuries were present in 27.3% of the cases and they were significantly associated with puck strikes (p = 0.027).

CONCLUSIONS

Mandible fractures and puck strikes, the most common injury site and fracture mechanism respectively, sustained by ice-hockey players required surgical intervention in the majority of cases.

A retrospective epidemiological review of maxillofacial trauma in a tertiary care centre in Goa, India

PURPOSE

Trauma accounts for the leading cause of morbidity and mortality worldwide in the present day and may rightly be called the new pandemic. The prominent nature of the face exposes it to various traumatic injuries. A timely, prompt diagnosis along with employment of correct and quick treatment greatly improves the outcome for these patients. The aim of this retrospective study was to analyse the characteristics of maxillofacial injuries over a decade.

METHODS

The data were collected manually from the medical records of patients who reported to the tertiary centre from 1 January 2011 to 31 December 2019. All injured patients irrespective of age/gender with complete hospital records of clinical and radiographical diagnosis of maxillofacial injuries were included. The demographic data, etiology, site and type of injury, and seasonal variation were analyzed. Data were tabulated into six age groups (0-7 years, 8-18 years, 19-35 years, 36-40 years, 41-59 years, and >60 years). Five etiological factors, i.e. road traffic accidents, falls, assaults, sports-related, and occupational accidents, were further evaluated based on genders. Facial injuries were classified into six types: panfacial fractures, mandibular fractures (subcategorized), midface fractures (subcategorized), dentoalveolar fractures, dental injuries, and soft tissue injuries. The monthly and seasonal variation of the injuries was also charted. Data were expressed as frequency and percent.

RESULTS

A total of 10,703 injuries were included from the tertiary centre from the period of 2011-2019, including 8637 males and 2066 females, with the highest occurrence of the injuries between 19 and 35 years. Road traffic accident was the principal etiological factor of the maxillofacial injuries in both genders (80.5%). This was followed by falls (9.6%), assaults (8.0%), occupational accidents (1.2%), and sporting injuries (0.7%). Midface fractures amounted for 52.5% (5623 fractures), followed by mandibular fractures (38.1%).

CONCLUSION

The current study describes a change in the incidence of injuries along with variation in the demographic data. The implementation of safety gears and stricter traffic laws along with public awareness may aid in the reduction of maxillofacial injuries.

Orbital bone fractures: 10 years' experience at the Rome trauma centre: retrospective analysis of 543 patients

Orbital fractures are among the most frequent facial traumas. This study retrospectively analysed patients treated in Umberto I Hospital Trauma-Centre, Sapienza University of Rome from 1 January 2010 to 31 December 2020. The inclusion criteria were as follows: diagnosis of pure/impure orbital bone fracture, complete clinical and radiological records, and a minimum 12-month follow up. Gender, age, aetiology, fracture type, treatment, and associated complications were analysed using IBM SPSS Statistics, and p values of <0.05 were considered significant. In total, 1393 patients presented with orbital trauma, 543 of whom met the inclusion criteria and underwent surgery (394 males (72.6%) and 149 females (27.4%); mean (range) age 39.2 (7-90) years). Assault (n = 165, 30.4%) was the most common cause of trauma, followed by road traffic accidents and sports-related incidents. Diplopia was the major symptom at diagnosis (n = 183, 33.6%). Open reduction and internal fixation via a sub-eyelid approach was the preferred treatment, achieving a significant reduction in the functional changes induced by fracture (p < 0.05). Our data will aid future studies of maxillofacial traumatology and suggest that education and prevention measures could reduce the incidence of this type of trauma.

What are the Risk Factors for Mortality Among Patients Who Suffer Le Fort III Fractures?

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.

OCCS Classification and Treatment Algorithm for Comminuted Mandibular Fractures Based on 109 Patients and 11 Years Experiences: A Retrospective Study

Comminuted mandibular fractures (CMFs) pose significant challenges to surgeons for their serious complications and poor outcomes. We aimed at proposing a classification with treatment algorithm of each category for CMFs. Patients with CMFs were retrospectively reviewed and classified into five categories: Type I: relatively good occlusion, no or slightly displaced fragments, no continuity destruction or bone defect; Type II: relatively good occlusion, damaged morphology, low comminution degree but intact continuity without bone defect; Type III: damaged morphology and higher comminution degree with intact continuity and relatively good occlusion; Type IV: high comminution, impaired continuity and poor occlusion without segmental bone defect; Type V: segmental bone defect. Conservative treatment, open reduction and internal fixation or microvascular osteocutaneous free flap transplantation was performed, accordingly. Demographics, perioperative data, complications and reasons for reoperations were recorded. The chi-square test was used for statistical analysis. In total, 109 patients were included in the study. After surgery, in the following group, 5 manifested infections, 1 manifested bone non-union, and 2 experienced reoperations, while in the unfollowing group, 10 manifested infections, 5 manifested bone non-union and 8 experienced reoperations. The OCCS classification and algorithm for CMFs achieve better outcomes and with lower complication rate.

Retrospective Evaluation of Maxillofacial Fractures With Cone-Beam Computed Tomography

ÖZ Amaç: Bu çalışmanın amacı maksillofasiyal bölgede meydana gelen fraktürlerin yaş ve cinsiyete göre dağılımlarını, lokalizasyonlarını, sayısını, deplasman varlığını, radyolojik özelliklerini Konik Işınlı Bilgisayarlı Tomografi (KIBT) ile retrospektif olarak değerlendirmektir. Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi Diş Hekimliği Fakültesi, Ağız Diş ve Çene Radyolojisi Anabilim Dalı’na 2019 ve 2021 yılları arasında travma nedeniyle başvuran 84 hastadan alınan KIBT görüntüleri retrospektif olarak incelenmiştir. Yaş, cinsiyet, fraktür lokalizasyonu, fraktürlerde deplasman varlığı kayıt altına alındı. İstatistiksel analiz için tüm hasta grubuna tanımlayıcı ve frekans analizleri uygulanırken, hastaların yaş ve cinsiyetlerini; fraktür hattı ve fraktür bölgesi ile karşılaştırırken ki-kare testi uygulandı. Bulgular: 60 erkek 24 kadın hasta (E/K, 2,5/1) olmak üzere toplam 84 hastanın maksillofasiyal travma nedeniyle KIBT görüntüsü incelendi. Çalışmada incelenen hasta grubunun yaşları 6 ve 72 arasında değişmekte olup yaş ortalaması 33.17±1.48 olarak belirlendi. Farklı etiyolojik nedenlerden kaynaklı çeşitli lokalizasyonlarda meydana gelen 116 fraktür hattı sayısı radyolojik olarak tespit edildi. İncelenen tüm fraktürlerin 73’ünde deplasman izlenirken kalan 43 fraktür hattında deplasman görülmedi. Meydana gelen fraktürler en sık angulus mandibulada (%22,61:n=19) tespit edildi. En az fraktür mandibula ramus (%3,57; n=3) ve koronoid proseste (%3,57; n=3) görüldü. Sonuçlar: Fraktür hatlarının varlığının, lokalizasyonlarının ve kırık parçalarının yer değişiminin doğru radyografik teknikler aracılığıyla tespit edilmesi, gerekli tedavi prosedürlerinin uygulanması açısından önem taşımaktadır. İki boyutlu radyografilerin kullanımının yetersiz kaldığı durumlarda KIBT gibi üç boyutlu görüntüleme yöntemleri tercih edilmelidir. Anahtar Kelimeler: Konik Işınlı Bilgisayarlı Tomografi, Fraktür, Mandibula, Teşhis

Evaluation of Mandibular Fractures in a German Nationwide Trauma Center Between 2015 and 2017

Introduction

This study analyses the treatment of isolated mandibular fractures between 1.1.2015 and 21.31.2017 at Dortmund General Hospital.

Materials and Methods

Patient documentation and radiological images have been assessed, and a descriptive statistical analysis has been performed.

Results

Three hundred and twenty-eight patients were identified with isolated mandibular fractures (259 male, 69 female). The male-to-female ratio is 3.75: 1. A total of 541 fracture sites have been identified (1.65 fractures/patient). Forty of these were observed in the dentoalveolar region (fracture of the alveolar process, dental injuries), and the other 501 injuries were distributed in the remaining parts of the lower jaw.A detailed analysis of the osteosynthesis implants is provided. A total of 20 serious complications were observed (6% in all primary cases, 4.5% without osseointegrated implants).

Discussion

The demographic data and the anatomical distribution of the fracture sites are comparable with international literature. Dentoalveolar injuries mostly occur in younger patients. The complication rate in this study (4.5%) is below the international data; however, we found a considerably higher rate than in the midfacial region (central midface: 0%, lateral midface: 1.43%). Despite this complication rate, the procedure can be considered safe.

Supplementary information

The online version of this article (10.1007/s12663-021-01513-4).

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

Study Design

Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes.

Objective

This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures.

Methods

After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center.

Results

1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications.

Conclusions

Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.

Do Postinjury Prophylactic Antibiotics Reduce Infection for Isolated Midface Fractures: A Cohort Study

PURPOSE

Fractures of the midface are a core component to the practice of contemporary oral and maxillofacial trainees and surgeons. As such, in an era where antibiotic resistance is increasing it is important to investigate if antibiotics are required after midface fractures to prevent infections before follow-up in an outpatient setting. The purpose of this study is to determine whether postinjury prophylactic preoperative antibiotics reduce rates of infection after midface fracture.

METHODS

A retrospective multicenter cohort study was conducted in Queensland, Australia. Patients who presented to Royal Brisbane Hospital and Townsville Hospital with isolated midface fractures between January 2017 and January 2019 were included. Clinical and demographic data of patients who received postinjury prophylactic antibiotics were compared to those who did not using the χ² test. Logistic regression was used to determine factors associated with increased odds of postinjury prophylactic antibiotic prescription.

RESULTS

In total, 1,353 patients with midfacial fractures over the 2-year period were included. In addition, 724 (53.5%) patients received postinjury antibiotics and 629 (46.5%) patients did not. The overall rate of infection was very low: 1 patient who received postinjury prophylactic antibiotics (0.1%) developed infection compared to 2 patients (0.3%) who did not receive postinjury prophylactic antibiotics, and this difference was not significant (χ² = 0.49; P = .48). Male sex (odds ratio 1.4; 95% confidence interval, 1.1 to 1.7; P = .02) and tobacco use (odds ratio 1.4; 95% confidence interval, 1.1 to 1.7; P = .008) were associated with an increased odds of postinjury prophylactic antibiotic prescription in the univariate analyses, but were no longer significant once site, age, and fracture type were adjusted for in the multivariate model.

CONCLUSIONS

The rate of infection after midface fracture was low and there was no significant difference in infection rates for patients who received postinjury prophylactic antibiotics compared to those who did not. Use of postinjury prophylactic preoperative antibiotics for midfacial fractures should be reconsidered.

Maxillofacial Fractures in the Province of Terni (Umbria, Italy) in the Last 11 Years: Impact of COVID-19 Pandemic

The main purpose of this retrospective study is to analyze the main causes and the main anatomical structures involved in maxillofacial traumas in the province of Terni, Umbria. From January 2009 to July 2021, 603 patients were admitted with a maxillofacial trauma diagnosis and underwent surgery at “Santa Maria Hospital” in Terni, Italy. The collected data included sex, age, nationality, cause of trauma, type of fractures, comorbidities, clinical signs, symptoms, date of admission, and date of discharge from the hospital. Causes were divided into 5 categories: road traffic accidents, accidental falls, physical assault, sport accidents, and occupational injuries. Men were more involved than women, with a male:female ratio of 325:1. The mean age of the population was 41.7 years. The main cause of trauma were road traffic accidents (36%), followed by accidental falls (27%), an increasing phenomenon during the current SARS-CoV-2 global pandemic. The orbital floor was the most fractured anatomical site, followed by zygoma and nasal bones.

Evaluation of primary teeth affected by dental trauma in patients visiting a university clinic, Part 1: Epidemiology

OBJECTIVES

The retrospective study reported herein was the first of three that investigated dental trauma in primary teeth. This article discusses the study that aimed to reveal the epidemiology of trauma with data such as prevalence, risk factors, and types of injuries, and to highlight prevention.

MATERIALS AND METHODS

The records of 320 patients aged 0-9 years who visited the Erciyes University Faculty of Dentistry Pedodontics Department due to dental trauma were evaluated according to the age, gender, medical condition, season, oral habits, trauma environment/type/cause, personal characteristics, and number of siblings. The chi-square test was used to compare the categorical variables by group.

RESULTS

Of the patients, 25.9% were aged 24-35 months at the time of study, 62.8% were male, 38.1% had two siblings, 37.2% had a sucking habit, 93.4% had a healthy medical condition, 41.3% experienced the trauma in summer, and 26.3% were aged 30-34 months at the time they incurred the trauma. Of the traumas, 54.1% were caused by falling, 60% occurred at home, 23% pertained to lateral luxation, and 70% were incurred when the patients were with their mother.

CONCLUSION

Given the results of this study, mothers with low education levels should be informed about their children's risk of incurring injuries from falling at home, especially in summer. Parents should also be warned that their children's oral habits increase their risk of trauma.

CLINICAL RELEVANCE

This study can help increase the knowledge level of clinicians, can raise social awareness, and can guide plan formulation for preventing risks.

Clinical risk factors associated with cerebrospinal fluid leak in facial trauma: A retrospective analysis

OBJECTIVE

Cerebrospinal fluid (CSF) leak occurs most commonly following skull fracture, with a CSF leakage complicating up to 2% of all head traumas. This study aims to identify demographic and injury characteristics correlated with the highest risk of CSF leak in patients with known facial fractures.

METHODS

Retrospective data was collected from a previously described trauma registry from 2010 to 2019. Patients over 18 years old with any type of facial fracture, known CSF leak status, available neuroimaging, and hospital admission were included. Chi-Square analysis for demographic and injury characteristic data were utilized.

RESULTS

A total of 79 patients with CSF leak and 4907 patients without CSF leak were included in the database. Patients with CSF leak tended to be younger than those without CSF leak (38.45 +/- 0.28 vs 44.08 +/- 0.28, M +/- SE, p = 0.0197). CSF leak depended on the mechanism of injury (MOI; X² =27.02, df=2, p = 0.0000013), with CSF leak rates highest in penetrating injuries (4.87%) and motor vehicle accidents (1.78%) compared to blunt injuries (0.95%); age did not significantly differ between the MOI groups (p = 0.11). CSF leak was also more common in patients with a lower Glasgow coma scale (GCS; 7.95 +/- 0.58 vs 12.21 +/- 0.10, p = 10^-15), LeFort type 2&3 and pan-facial fractures compared to all other facial fracture types (8.9% vs 1.2%, p = 10^-15), and radiographic midline shift (29.4% vs 9.1%, p = 10^-15). There was a trend towards a higher proportion of males in those with CSF leak compared to those without (83.3% vs 73.7% males, p = 0.073), and in patients with prolonged loss of consciousness (LOC; 9.43% with LOC > 1 h vs 2.69% LOC < 1 h, p = 0.056).

CONCLUSION

Facial fractures often present with CSF leak, and certain demographic and injury risk factors including younger age, worse GCS score, evidence of midline shift, and certain mechanisms of injury (penetrating and motor vehicle) are correlated with increased risk and warrant close screening and follow-up for CSF leak detection. LeFort type 2&3 and pan-facial fractures are at high risk of CSF leak.

Meat tenderizer assault and associated facial trauma: A case report

Background

Blunt trauma to the face, head and neck is frequently encountered in violent assaults (Brink, 2009 [1]). There can be trauma to the cranium in high energy mechanisms, though interpersonal trauma is less likely to be associated with traumatic brain injury (TBI) (Salentijn et al., 2014 [2]).

Case report

We describe severe soft tissue facial trauma, ocular trauma, subdural and epidural hematomas as well as calvarial fractures, orbital floor and zygomaticomaxillary complex (ZMC) fracture following assault with a meat tenderizer. Due to the unique mechanism of trauma and the extent of injury including TBI coordination of care involved many teams. The patient was treated, then discharged to a skilled nursing facility with subsequent discharge to home. He has continued neurocognitive improvement but loss of vision in the left eye.

Conclusion

Violent trauma with a meat tenderizer can lead to significant soft tissue trauma, facial fractures, calvarial fractures and TBI.

How Did the COVID-19 Pandemic Affect Trends in Facial Trauma?

Study Design:

Retrospective cohort analysis.

Objective:

To examine the impact the COVID-19 pandemic and its accompanying societal measures had on the incidence, characteristics, and management of maxillofacial traumatic injuries.

Methods:

This cohort analysis compared facial trauma injuries presenting to the highest-volume Level I Trauma Center in New Jersey, USA from January 1 to July 31 in 2020 and 2019. Differences in demographics, mechanisms, and interventions were compared between the pandemic period (March 16–July 31, 2020) and the equivalent pre-pandemic date period in 2019 using X², Fishers Exact, and Mann–Whitney U testing.

Results:

In total, 616 subjects were included. The daily incidence of facial trauma consults during the 2020 pandemic (1.81 ± 1.1) decreased compared to 2019 (2.15 ± 1.3) (p = 0.042). During the outbreak, there was an increase in the proportion of subjects with positive urine drug screens (21.5% vs. 12.2%; p = 0.011) and injuries related to domestic violence (10.2% vs. 4.5%; p = 0.023). Patients were 30% less likely to be transferred from local hospitals (RR, 0.70 [0.53–0.93]; p = 0.014). Although subjects had a 25% increased risk of presenting with injuries deemed procedural (RR, 1.25 [95% CI, 1.05–1.56]; p = 0.048), a greater proportion were discharged with operative procedures scheduled as outpatients (16.0% vs. 4.9%; p = 0.005).

Conclusions:

The COVID-19 pandemic has impacted both the epidemiology and management of maxillofacial traumatic injuries, perhaps secondary to modifications in personal and community behaviors or the effects on healthcare systems in our region.

Diagnostic accuracy of physical examination findings for midfacial fractures: a systematic review and meta-analysis

Objectives

To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of physical examination findings and related clinical decision aids for midfacial fractures in comparison to computed tomography and cone beam computed tomography.

Material and methods

A systematic review was performed by searching the MEDLINE, Cochrane, EMBASE, and CINAHL databases. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity, and diagnostic odds ratios with the corresponding 95% confidence intervals were calculated for each physical examination finding and reported clinical decision aids.

Results

After screening 2367 records, 12 studies were included. High risk of patient selection bias was detected in three studies (25%). Additionally, high concerns regarding applicability were found for the patient selection in five studies (41.7%), and for the reference standard in eleven studies (91.7%). Of the total 42 individual physical examination findings, only 31 were suitable for a meta-analysis. High specificity and low sensitivity were found for most findings. The pooled diagnostic odds ratio ranged from 1.07 to 11.38. Clinical decision aids were reported by 8 studies, but none were constructed specifically for midfacial fractures.

Conclusion

Based on the current available evidence, the absence of physical examination findings can successfully identify patients who do not have a midfacial fracture, but the presence of individual findings does not necessarily mean that the patient has a midfacial fracture. Although various clinical decision aids were presented, none focused on exclusively midfacial fractures.

Clinical relevance

The diagnostic accuracy of physical examination findings can be used to diagnose a midfacial fracture so as to reduce unnecessary imaging, health care costs, and exposure to ionizing radiation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-022-04423-y.

Detection and classification of mandibular fracture on CT scan using deep convolutional neural network

OBJECTIVES

This study aimed to evaluate the accuracy and reliability of convolutional neural networks (CNNs) for the detection and classification of mandibular fracture on spiral computed tomography (CT).

MATERIALS AND METHODS

Between January 2013 and July 2020, 686 patients with mandibular fractures who underwent CT scan were classified and annotated by three experienced maxillofacial surgeons serving as the ground truth. An algorithm including two convolutional neural networks (U-Net and ResNet) was trained, validated, and tested using 222, 56, and 408 CT scans, respectively. The diagnostic performance of the algorithm was compared with the ground truth and evaluated by DICE, accuracy, sensitivity, specificity, and area under the ROC curve (AUC).

RESULTS

One thousand five hundred six mandibular fractures in nine subregions of 686 patients were diagnosed. The DICE of mandible segmentation using U-Net was 0.943. The accuracies of nine subregions were all above 90%, with a mean AUC of 0.956.

CONCLUSIONS

CNNs showed comparable reliability and accuracy in detecting and classifying mandibular fractures on CT.

CLINICAL RELEVANCE

The algorithm for automatic detection and classification of mandibular fractures will help improve diagnostic efficiency and provide expertise to areas with lower medical levels.

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study

Background/Aims

Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1‐year period.

Methods

The following data were collected: age (preschool [0–6 years], school age [7–12 years], and adolescent [13–18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software.

Results

Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001).

Conclusion

The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0–6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.