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Jeong YJ, Shin YM, Jeong W. Risk of complications in panfacial bone fracture according to surgeons: A meta-analysis. J Plast Reconstr Aesthet Surg 2024; 88:257-265. [PMID: 38007998 DOI: 10.1016/j.bjps.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Panfacial bone fractures pose intricate challenges because of severe fragmentation and the loss of landmarks. Surgeons use a variety of reduction techniques, including bottom-up and top-down approaches. This single proportional meta-analysis explores sequencing differences and complications between oral and maxillofacial surgery surgeons (OMSs) and plastic and reconstructive surgeons (PRSs) in treating panfacial bone fractures. METHODS The PubMed and Scopus databases were searched systematically, and we compiled 14 studies published between 2007 and 2023 involving 1238 patients. A systematic review of the included studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data on the reduction techniques; total complication rates; and rates of malocclusion, enophthalmos, infection, asymmetry, and esthetic complications were collected. RESULTS The bottom-up technique was the most prevalent for both types of surgeons (57.1%, 8 out of 14). Malocclusion rates (I2 = 0% for OMSs and 41% for PRSs) were similar between the groups (p = 0.72), but PRSs tended to have a lower enophthalmos rate (I2 = 0% for OMSs and 32% for PRSs) than OMSs (p < 0.01). Infection rates remained consistent across all studies. However, high heterogeneity was observed for the total complication rate (I2 = 94% for OMSs and 85% for PRSs) and asymmetry and esthetic complications (I2 = 88% for OMSs and 92% for PRSs), making direct comparison between the two groups inconclusive. CONCLUSIONS In this study, the differences in surgical techniques and levels of interest have a greater impact on the outcomes of the panfacial bone fracture than the surgeon's specialty. However, more in-depth studies are needed to accurately pinpoint panfacial bone fracture reduction trends and differences in postoperative complications in the two expert groups.
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Affiliation(s)
- Yong Jun Jeong
- Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Young Min Shin
- Department of Dentistry (Oral and Maxillofacial Surgery), Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
| | - Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
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2
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Stanbouly D, Koh D, Halsey J, Selvi F, Goudarzi F, Arce K, Chuang SK. Motorcycle Accidents are the Strongest Risk Factor for Panfacial Fractures Among Pediatric Patients. Craniomaxillofac Trauma Reconstr 2023; 16:258-267. [PMID: 38047150 PMCID: PMC10693262 DOI: 10.1177/19433875221116961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Study Design A retrospective cohort study was conducted using the Kids' Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population. Methods The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures. Results Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (P < .01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (P < .01) to result in panfacial fractures while car accidents were over two times more likely (P < .01) to result in panfacial fractures. Falls were less likely (OR, .39; P < .01) to result in panfacial fractures. Conclusions Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle.
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Affiliation(s)
- Dani Stanbouly
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Dylan Koh
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Jordan Halsey
- Johns Hopkins All Children’s Hospita Division of Plastic Surgery, St. Petersburg, FL, USA and Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Firat Selvi
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey
| | - Fereshteh Goudarzi
- Department of Oral and Maxillofacial Radiology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Kevin Arce
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic and Reconstructive Surgery, Mayo Clinic, MN, USA
| | - Sung-Kiang Chuang
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA and Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA, USA and Visiting Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
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3
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Shakir S, Ettinger RE, Susarla SM, Birgfeld CB. Pediatric Panfacial Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:607-617. [PMID: 37280142 DOI: 10.1016/j.coms.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
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Affiliation(s)
- Sameer Shakir
- Division of Plastic Surgery, Children's Wisconsin, Milwaukee, WI, USA.
| | - Russell E Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Srinivas M Susarla
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Craig B Birgfeld
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
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4
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Blows or Falls? Distinction by Random Forest Classification. BIOLOGY 2023; 12:biology12020206. [PMID: 36829485 PMCID: PMC9952774 DOI: 10.3390/biology12020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/10/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023]
Abstract
In this study, we propose a classification method between falls and blows using random forests. In total, 400 anonymized patients presenting with fractures from falls or blows aged between 20 and 49 years old were used. There were 549 types of fractures for 57 bones and 12 anatomical regions observed. We first tested various models according to the sensibility of random forest parameters and their effects on model accuracies. The best model was based on the binary coding of 12 anatomical regions or 28 bones with or without baseline (age and sex). Our method achieved the highest accuracy rate of 83% in the distinction between falls and blows. Our findings pave the way for applications to help forensic experts and archaeologists.
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5
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Pontell ME, O'Sick NR, Kalmar CL, Golinko MS. Pediatric Craniomaxillofacial Trauma. Pediatr Rev 2022; 43:665-675. [PMID: 36450635 DOI: 10.1542/pir.2021-005276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Matthew E Pontell
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Nicholas R O'Sick
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher L Kalmar
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S Golinko
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN.,Division of Pediatric Plastic Surgery, Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
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6
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Contemporary management of complex craniofacial trauma: virtual planning, navigation and the novel thermoformed cage splints in a strategic, sequential, computer-guided protocol. J Craniomaxillofac Surg 2022; 50:837-847. [PMID: 36272940 DOI: 10.1016/j.jcms.2022.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION It was the aim of the study to assess if computerized simulation and the use of thermoformed cage splints are useful to plan cases of complex craniofacial trauma. MATERIALS AND METHODS patients with fractures in any of the thirds of the craniofacial skeleton and occlusion impairment. Virtual surgical planning with digital reduction of fractures, navigated planning, thermoformed cage splints were used in all cases. Surgical outcomes were evaluated by computing the surface deviation and occlusograms between planned and postoperative models. RESULTS 13 patients were enrolled in this study. Accuracy of bone repositioning was evaluated compared with the surgical planning. For the mandible, mean Root Mean Square Error (RMSE) was of 1.67 with a standard deviation (SD) of ±0.75 mm (p < 0.001); for the maxilla, average RMSE was of 0.88 with SD of ±0.52 mm (p < 0.001); and for midfacial and upper third bone segments, average RMSE was of 0.59 with SD of ±0.47 mm (p < 0.001) CONCLUSIONS: Within the limitations of the study it seems that thermoformed cage splints might be a promising alternative to other well-established approaches for accurate occlusal restoration and can be fully integrated within the digital workflow.
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7
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Approaching patients with panfacial fractures by using an anatomical reference. A novel concept and preliminary study. J Plast Reconstr Aesthet Surg 2022; 75:4249-4253. [DOI: 10.1016/j.bjps.2022.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
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8
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Smith EB, Patel LD, Dreizin D. Postoperative Computed Tomography for Facial Fractures. Neuroimaging Clin N Am 2021; 32:231-254. [PMID: 34809841 DOI: 10.1016/j.nic.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In order for a radiologist to create reports that are meaningful to facial reconstructive surgeons, an understanding of the principles that guide surgical management and the hardware employed is imperative. This article is intended to promote efficient and salient reporting by illustrating surgical approaches and rationale. Hardware selection can be inferred and a defined set of potential complications anticipated when assessing the adequacy of surgical reconstruction on postoperative computed tomography for midface, internal orbital, and mandible fractures.
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Affiliation(s)
- Elana B Smith
- Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Lakir D Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - David Dreizin
- Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, USA.
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9
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Technical Note on Three- and Four-Wall Orbital Reconstructions with Patient-Specific Implants. J Craniofac Surg 2021; 33:991-996. [PMID: 34802019 DOI: 10.1097/scs.0000000000008303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orbital reconstruction is one of the most complex procedures in maxillofacial surgery. It becomes even more complex when all references to the original anatomy are lost. The purpose of this article is to provide an overview of techniques for complex three- and four-wall orbital reconstructions. Preoperative virtual surgical planning is essential when considering different reconstruction possibilities. The considerations that may lead to different approaches are described, and the advantages and drawbacks of each technique are evaluated. It is recommended to reconstruct solitary three-wall or four-wall orbital defects with multiple patient-specific implants. Optimizations of this treatment protocol are suggested, and their effects on predictability are demonstrated in a case presentation of a four-wall defect reconstruction with multiple patient-specific implants.
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10
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Lin C, Wu J, Yang C, Zhang C, Xu B, Zhang Y, Zhang S. Classifying and standardizing panfacial trauma according to anatomic categories and Facial Injury Severity Scale: a 10-year retrospective study. BMC Oral Health 2021; 21:557. [PMID: 34724954 PMCID: PMC8559398 DOI: 10.1186/s12903-021-01900-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to identify the epidemiologic factors of panfacial fractures (PFs), and to evaluate the significance of anatomic PF categories and the Facial Injury Severity Scale (FISS) in classifying and standardizing panfacial injuries. Methods A retrospective review of all patients treated with PFs at our institution between June 2010 and April 2021 was performed. PF was defined as a concurrent fracture in at least 3 of 4 facial subunits (frontal, upper midface, lower midface, and mandible). Data regarding patient demographics, causes of injury, location of fractures, major concomitant injuries, and postinjury complications were collected, and the FISS score was collected from each patient. Statistical analysis was performed using IBM SPSS Statistics version 22.0. Results A total of 227 patients were enrolled. The most commonly fractured bones were the maxillary sinus wall (92.1%), mandible (82.8%), and zygomatic arch (75.3%), and the most common fracture sites in PFs were graphically presented. Four PF patterns were defined: FULM (n = 60), FUL (n = 39), ULM (n = 127), and FUM (n = 1). There was a significant association between PF patterns and sex (p = 0.018), the number of concomitant injuries (p = 0.014), and early surgical airway management (p = 0.003). Different PF patterns were significantly correlated with different types of concomitant injuries and complications. The FISS score showed a significant difference with PF patterns (p = 0.000) and sex (p = 0.007), and a FISS value of 11 or more is the appropriate cutoff for the prediction of multiple concomitant injuries and complications. Conclusions Both the anatomic PF categories and FISS were significantly correlated with various concomitant injuries and complications. The combination of PF categories and FISS provided a better positive and negative prediction of concomitant injuries and complications for PF patients. Patients with FULM and FISS > 11 had an obviously higher proportion of the need for multiprofessional treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01900-w.
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Affiliation(s)
- Chengzhong Lin
- The 2nd Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jinyang Wu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Chengshuai Yang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Chuxi Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Bing Xu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yong Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Shilei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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11
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Versatility of Hard Occlusal Splints in Optimizing Outcomes in Patients with Old Pan-facial Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3855. [PMID: 34646723 PMCID: PMC8500587 DOI: 10.1097/gox.0000000000003855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022]
Abstract
Pan-facial fracture repair is considered one of the most challenging complex reconstructive procedures to perform. It is always better to treat facial fractures as soon as possible. A delay of several days or weeks makes an ideal anatomic reduction difficult, if not impossible.
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12
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Nseir S, Abu Shqara F, Krasovsky A, Rachmiel A. Surgical Dilemmas in Multiple Facial Fractures - Coronal Flap Versus Minimally Invasive: Case Report and Literature Review. Ann Maxillofac Surg 2021; 11:191-194. [PMID: 34522683 PMCID: PMC8407624 DOI: 10.4103/ams.ams_452_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
The Rationale: Pan-facial fracture is a complex trauma that involves the upper, middle, and lower third of the facial bones. The surgical management of such complex cases is either by the posterior approach (coronal flap) or anterior approach through local incisions. Patient Concerns: This report describes the case of severe pan-facial trauma in a 52-year-old male who sustained a severe pan-facial trauma. Diagnosis: He suffered from multiple facial fractures that included: Frontal bone, skull base, Naso-orbitoethmoid (NOE), zygomatic and sub-condylar fractures. Treatment: He was managed by minimally local periorbital and lynch incisions. Outcomes: Fractures were properly reduced with resultant symmetrical facial dimensions. No postoperative complications were demonstrated including facial nerve function. Take-away Lessons: We should consider minimally invasive local incisions in pan-facial fractures when there is no need to restore the frontal sinus and the anterior-posterior dimensions of the zygomatic arch.
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Affiliation(s)
- Saleh Nseir
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Fadi Abu Shqara
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Andrei Krasovsky
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Institution of Technion, Haifa, Israel
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13
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Sikkerimath BC, Anshu A, Jose A, Jain S. Evaluation of Postoperative Sensory and Motor Deficit Following Craniomaxillofacial Reconstruction Using Bicoronal Flap: An Evaluative Study. Ann Maxillofac Surg 2021; 11:21-26. [PMID: 34522649 PMCID: PMC8407612 DOI: 10.4103/ams.ams_426_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/08/2021] [Accepted: 04/17/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The ideal surgical approach to treat craniomaxillofacial skeleton should provide maximum exposure of the facial skeleton, ensure less potential for injury to facial structures and allow for good cosmetic result. Several designs have been described such as hemicoronal, preauricular, lateral eyebrow, and bicoronal approach. Although the bicoronal flap gives superior long-term cosmetic results, it has a few disadvantages. We conducted this study to assess neurosensory disturbances and motor deficit following craniomaxillofacial reconstruction using bicoronal flap. Materials and Methods: A prospective study was carried out in the Department of Oral and Maxillofacial Surgery, North Karnataka, India. Forty patients with craniomaxillofacial trauma requiring fixation of fracture or reconstruction were included in the study. Postoperative neurosensory evaluation is carried out at intervals of 1 week, 1 month, 3 months, and 6 months clinically using mechanoreceptive and nociceptive testing. Results: Among 40 cases, 11 (27.5%) had postoperative paraesthesia affecting the supraorbital region; 9 (22.5%) of them had return of normal sensation within 6 months and 2 (5%) patients became normal after one year. Four patients had unilateral frontalis weakness on the right side for a period of 6 months. Discussion: The bicoronal flap is a preferred approach for access to the craniofacial skeleton and orbit with minimal sensory and motor complications. However, before choosing the same, the advantage of raising such a wide flap should be weighted comparing the benefits and complications.
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Affiliation(s)
- B C Sikkerimath
- Department of Oral and Maxillofacial Surgery, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Aditya Anshu
- Department of Oral and Maxillofacial Surgery, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Anu Jose
- Department of Oral and Maxillofacial Surgery, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Saurabh Jain
- Department of Oral and Maxillofacial Surgery, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
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14
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Bicsák Á, Dietmar A, Wruck Y, Hassfeld S, Bonitz L. Evaluation of Panfacial Fractures in a German Supraregional Trauma Center between 2015 and 2017 - A Retrospective Study. Ann Maxillofac Surg 2021; 11:97-102. [PMID: 34522662 PMCID: PMC8407637 DOI: 10.4103/ams.ams_418_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Panfacial fractures represent the most severe injuries to the face. The combination of these fractures determines the treatment strategy. This study aims to retrospectively review the data of adult patients treated for complex facial skull fractures in a hospital in Dortmund, Germany from 2015-2017. Materials and Methods: We extracted related patient data from the hospital electronic repository and reviewed the patient files and radiological images. The fractures were classified based on the AO-Classification. The statistical analysis was performed by descriptive statistical methods. The main goal was to determine the most common fracture combinations. Results: A total of 188 patients with panfacial fractures were identified (181 adults, 7 children and adolescents). The gender and age distribution corresponded to the international literature (male-to-female ratio: 3.1:1, most common injuries among young men). 2–9 fracture sites were identified per patient, resulting in a fracture frequency of 3.13 per patient. 69 different fracture combinations have been identified. The most common ones were combinations of lateral and central mid-face fractures, and combinations of nasal bone fractures with lateral midface fractures or nasal bone fractures combined with mandibular fractures. Between 1 and 13 osteosynthesis implants per patient were used for osteosynthesis; the most commonly used plates were 2.0 mm and 1.5 mm straight plates. The average inpatient stay was 3 days (standard deviation [SD] = 3.0 days), and the average operation time (incision to suture) was 39.5 min (SD = 53.5 min). Discussion: Panfacial fractures are the most complex maxillofacial injuries. The complication rate in this study (4.5%) is below the international data. The treatment of panfacial fractures requires designated centers with experienced teams and good interdisciplinary cooperation.
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Affiliation(s)
- Ákos Bicsák
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Abel Dietmar
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Yannic Wruck
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Stefan Hassfeld
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Lars Bonitz
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
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15
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Bonitz L, Wruck V, Peretti E, Abel D, Hassfeld S, Bicsák Á. Long-term evaluation of treatment protocols for isolated midfacial fractures in a German nation-wide craniomaxillofacial trauma center 2007-2017. Sci Rep 2021; 11:18291. [PMID: 34521960 PMCID: PMC8440643 DOI: 10.1038/s41598-021-97858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
An update on the trends in maxillofacial traumatology provides additional information on the actual and changing needs. This retrospective study aimed to review all patient records of patients treated for isolated midface fractures in the Department of Cranial- and Maxillofacial Surgery at the Dortmund General Hospital between 2007 and 2017. The patient radiographs and patient files were reviewed. The safety and efficacy of the applied methods were controlled by assessing complications based on the Clavien-Dindo classification system. The statistical analysis included descriptive methods including regression analysis and χ2-test. In eleven years, 3474 isolated midface fracture sites have been identified in 2868 patients. The yearly trend is slightly increasing, in elderly clearly worsening, in children and youth decreasing. The male-to-female ratio was 2.16:1 for the whole study population, in the age group 18-25 y.o. 6.95:1 while in elderly above 80 y.o. 1:2.51, the age group specific incidence reflects this result, too. The most common fractures were nasal bone fractures (1405), zygomatic fractures (832) and orbital floor fractures (700). The average hospital stay was 2.7 days, the most fractures were operated within 24 h. The complication rate was 2.02% (Clavien-Dindo class II-V). The incidence of midfacial fractures is increasing in the total population and especially in elderly, but decreasing in children. Development of injury prevention measures is needed in this population. The diagnostic and therapeutic procedures are appropriate, as there is a low complication rate and short inpatient stay observed.
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Affiliation(s)
- Lars Bonitz
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Vivienne Wruck
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Elena Peretti
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Dietmar Abel
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Stefan Hassfeld
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Ákos Bicsák
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany.
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany.
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Daniels JS, Albakry I, Braimah RO, Samara MI, Albalasi RA, Begum F, Al-Kalib MAM. Experience with Airway Management and Sequencing of Repair of Panfacial Fractures: A Single Tertiary Healthcare Appraisal in Najran, Kingdom of Saudi Arabia - A Retrospective Study. Ann Maxillofac Surg 2020; 10:402-408. [PMID: 33708586 PMCID: PMC7943977 DOI: 10.4103/ams.ams_202_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Special cooperation is required among surgeons and anesthetists in airway management during repair of panfacial fractures, due to problems of shared airway and occlusion. Several methods have been proposed for airway management and sequencing of repair of panfacial fractures. The main objective of the current study was to share our experience in the airway management and sequencing of repair of panfacial fractures. Methods: This was a retrospective study of panfacial fractures in the Kingdom of Saudi Arabia from January 2008 to December 2018. Data collected included demographics, type of airway management, sequence of repair (as primary variables), and outcome of surgery (secondary variable), while surgeon and anesthetic expertise are confounders. Data were analyzed using IBM SPSS Statistics for Windows Version 25 (Armonk, NY, USA: IBM Corp). Results were presented as simple frequencies and descriptive statistics. Pearson Chi-square was used to compare categorical variables such as airway management and sequencing of repair with the panfacial fractures. Statistical significance was set at P ≤ 0.05. Results: Overall, 1057 patients sustained different categories of maxillofacial bone fractures with 23 females and 1034 males (M:F of 46:1). A total of 43 male patients out of 1057 patients had panfacial fractures during the study period, giving a prevalence rate of 4.1%. Only the 43 male patients with panfacial fractures were analyzed. All cases were as a result of motor vehicular accident. Six (13.9%) patients had tracheostomy while 37 (86.1%) patients had submental intubation. “Bottom-up” and “outside-in” approach was used in 33 (76.7%) patients, while “top-bottom” and “inside-out” approach was used in 10 (23.3%) patients. Discussion: Submental intubation was the major airway management of panfacial fracture, and “bottom-up” and “outside-in” approach was the main sequence of repair in our series. These approaches have been mentioned in the literature. Conclusion: From our study, victims of pan-facial fractures were found to be exclusively male with MVA as the sole etiological factor. Barring severe head injuries, which may necessitate the use of tracheostomy to sustain breathing over a longer period, submental intubation is extremely reliable as a mode of airway management during surgical treatment of panfacial fractures. The sequencing of repair of panfacial fractures can only be determined according to the case presentation rather than a predetermined one.
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Affiliation(s)
- John Spencer Daniels
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ibrahim Albakry
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ramat Oyebunmi Braimah
- Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Kingdom of Saudi Arabia
| | - Mohammed Ismail Samara
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Rabea Arafa Albalasi
- Department Oral and Maxillofacial Surgery, Sharourah General Hospital, Sharourah, Kingdom of Saudi Arabia
| | - Farzana Begum
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
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Ramakrishnan K, Palanivel I, Narayanan V, Chandran S, Narayanan J. Sequencing of Fixation in Panfacial Fracture: A Systematic Review. J Maxillofac Oral Surg 2020; 20:180-188. [PMID: 33927485 DOI: 10.1007/s12663-020-01387-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022] Open
Abstract
Objective In panfacial fracture management, the controversy still exists in the sequencing of fixation. The purpose of this systematic review is to establish the best sequence pattern which assists in achieving definite facial width, vertical height and anteroposterior projection. Methods The review was conducted according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Two independent authors performed a comprehensive search of the PUBMED, EBSCO, J-Gate, SCOPUS and NDH for articles published up until December 2018. Sequence of fixation, timing of intervention, outcome, follow-up period and complications were evaluated for patients with panfacial fracture. Results In total, 202 articles were identified from the databases. After screening and full text analysis, 25 studies were included in this systematic review. Nineteen studies reported bottom-to-top sequence and two studies reported top-to-bottom approach. However, four studies reported both the approaches. The follow-up period ranges from 3 weeks to 4 years. Conclusion Based on the literature support and evidence, good and satisfactory outcome achieved in "Bottom-top and outside-in" sequence when compared with other sequence pattern. Early repair of panfacial fracture is advised for proper reduction and fixation, but can be delayed in accompanying life-threatening injuries. Complications are perceptible in all the sequences; it can be avoided by definitive treatment planning and stepwise management.
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Affiliation(s)
- Karthik Ramakrishnan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, TamilNadu 603203 India
| | - Indu Palanivel
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, TamilNadu 603203 India
| | - Vivek Narayanan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, TamilNadu 603203 India
| | - Saravanan Chandran
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, TamilNadu 603203 India
| | - Janani Narayanan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, Chennai, TamilNadu 603203 India
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Dalena MM, Liu FC, Halsey JN, Lee ES, Granick MS. Assessment of Panfacial Fractures in the Pediatric Population. J Oral Maxillofac Surg 2020; 78:1156-1161. [PMID: 32247625 DOI: 10.1016/j.joms.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Management of panfacial fractures is critical and often difficult in adults; however, there is little to no literature regarding these fractures in the pediatric population. In this study, we present our experience to provide insight and further investigation regarding prevention and management strategies within the pediatric population. PATIENTS AND METHODS We performed a retrospective chart review of all panfacial fractures in the pediatric population between 2002 and 2014 treated at an urban, level 1 trauma center (University Hospital, Newark, NJ). Data including patient demographic characteristics, mechanisms of injury, locations of fractures, concomitant injuries, and surgical management strategies were collected. RESULTS We identified 82 patients aged 18 years or younger who had sustained a panfacial fracture. The mean age at the time of injury was 12.9 years, with a male predominance of 64.9%. A total of 335 fractures were identified on radiologic imaging. The most common etiologies were motor vehicle accidents and pedestrians being struck. Orbital, frontal sinus, nasal, and zygoma fractures were the most common fractures. The mean score on the Glasgow Coma Scale on arrival was 12.0. A total of 29 patients were intubated on arrival-or before arrival-at the trauma bay. A surgical airway was required in 9 patients. The most common concomitant injuries were traumatic brain injury, intracranial hemorrhage, and skull fracture. Surgical repair was required in 38 patients. The cephalic-to-caudal approach was used most, followed by caudal to cephalic, medial to lateral, and lateral to medial. Within a year of the initial surgical procedure, 4 patients underwent reoperations for complications. Four patients died. CONCLUSIONS Pediatric panfacial fractures are rare occurrences; however, the impact of these injuries can be devastating, with concomitant life-threatening injuries and complications. Given the lack of literature, as well as the preventable nature of these injuries, we hope this study can address primary prevention strategies and provide insight toward the management and characteristics of these fractures.
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Affiliation(s)
- Margaret M Dalena
- Medical Student, Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Farrah C Liu
- Plastic Surgery Resident, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Jordan N Halsey
- Chief Resident, Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
| | - Edward S Lee
- Division Chief, Program Director, and Associate Professor of Plastic Surgery, Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Mark S Granick
- Professor of Plastic Surgery, Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
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A novel fixation method for panfacial fracture using an Ilizarov-type external fixator. Trauma Case Rep 2019; 22:100214. [PMID: 31294071 PMCID: PMC6595467 DOI: 10.1016/j.tcr.2019.100214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 01/19/2023] Open
Abstract
In general, internal plate fixation is mainly performed in order to reduce multiple facial bone fractures and rarely uses an external fixator. Although it would be ideal to successfully achieve or preserve the occlusal relationship of the upper and lower jaws, it is difficult to successfully manage multiple bone fragments in order to use them to achieve internal fixation, especially when treating a severely comminuted facial fracture. In addition, it is also important to prevent the onset of severe infection after sub-periosteal dissection, due to the presence of avascular bony fragments and an internal fixation implant which thus represents a foreign body. In order to treat extensive comminuted fracture without internal plate fixation, we performed external fixation using an Ilizarov-type external fixator. The Ilizarov-type external fixator is characterized by a few circular external structures and threaded rods. This device can be modified for use in the field of orthopedic surgery to correct three-dimensional deformities caused by fragile complicated fractures and bone defects. The advantages of the Ilizarov-type external fixator for treating panfacial fractures include a low invasiveness, utility in various fracture situations, easy adjustment of threaded rods, and a low potential cost. We herein report the first case of a severe panfacial fracture that was successfully treated using an Ilizarov-type external fixator.
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20
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Voß JO, Thieme N, Märdian S, Doll C, Hartwig S, Heiland M, Raguse JD, Adolphs N. [Frequency and management of complex facial fractures-an oral and maxillofacial surgical assessment]. Unfallchirurg 2019; 122:711-718. [PMID: 30783709 DOI: 10.1007/s00113-019-0618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The treatment of facial fractures is an integral part of the oral and maxillofacial surgical treatment spectrum. In the case of complex fractures that involve multiple levels of the facial skeleton associated with severe concomitant injuries, an individual and interdisciplinary treatment approach is needed, which requires the infrastructure of a national trauma center. OBJECTIVE The aim of this study was to analyze the incidence and management of patients with complex facial fractures and considering the concomitant injury pattern. MATERIAL AND METHODS A retrospective analysis of patients with complex facial fractures during the years 2009-2015 admitted to the emergency surgical department of a national trauma center was carried out. The identification of appropriate patient cases was based on the International Statistical Classification of Diseases and Related Health Problems (ICD) coding of electronic patient data. Only patients with at least a combination of mandibular and midfacial fractures (2-level fractures) were considered. Patients with mainly dentoalveolar fractures and simple nasal bone fractures were not included. The evaluation of the electronic medical records included the etiology, fracture pattern, associated severe injuries on the basis of the injury severity score (ISS), treatment regimen as well as the length of the hospital stay. RESULTS In the 7‑year study period, 3382 patients were identified with facial fractures. Of these, 128 patients (3.78%) presented with a complex fracture pattern with a combination of mandibular fractures and fractures of the midface. The majority of these patients (n = 92) had less severe concomitant injuries (ISS ≤ 16), while 36 patients showed severe concomitant injuries (ISS > 16). The incidence of a 3-level fracture involving the mandible, midface and anterior skull base was only 0.47% and could be detected in 16 patients, of which 10 were classified as polytrauma (ISS > 16). CONCLUSION The incidence of complex fractures of the facial skeleton was comparatively low with almost 4%. More than one in four patients with complex injury patterns of the facial skeleton exhibited severe concomitant life-threatening injuries, necessitating an interdisciplinary management with the specialized infrastructure of a nationwide trauma center.
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Affiliation(s)
- Jan Oliver Voß
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Nadine Thieme
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Sven Märdian
- Klinik für Orthopädie und Unfallchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Christian Doll
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Stefan Hartwig
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Johannes Wesling Klinikum Minden, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - Max Heiland
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Jan-Dirk Raguse
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Nicolai Adolphs
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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