Maxillofacial Trauma Following Road Accidents and Falls

Maxillofacial Traumatic Fractures in a Saudi Pediatric Subpopulation: A 10-Year Retrospective Study

AIM

The primary objective of this study was to analyze the patterns and etiology of maxillofacial fractures among hospitalized pediatric patients.

METHODS

A retrospective analysis was conducted on pediatric trauma cases admitted to King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 1, 2010 to December 31, 2020. Data extracted from medical records was utilized to identify and establish correlations with various variables, including age, gender, trauma etiology, and the type of sustained fracture.

RESULTS

The study involved a total of 167 patients. The mean age of the patients was 11.79 years, with the youngest and oldest patients being 2 and 17 years old, respectively. The majority of participants (70.7%, n = 118) were male. A total of 257 fractures were identified, with the highest number (n = 173, 67.3%) occurring in the lower third of the face.

CONCLUSION

Road traffic accidents (RTAs) emerged as the primary cause of trauma in our study, accounting for 73% (n = 122) of cases, followed by falls at 16.8% (n = 28). All instances of polytrauma were linked to RTAs. Fractures in the lower third of the face constituted over two-thirds (67.3%, n = 173) of the total fractures observed. Among the fractures, condyle fractures were the most frequently observed (19.8%, n = 51) in our study.

Oral and maxillofacial emergencies: A retrospective study of 5220 cases in West China

BACKGROUND/AIM

There are no epidemiological reports focused on the oral and maxillofacial surgery emergency department in the West China Hospital of Stomatology. The aim of this study was to analyse the epidemiological characteristics of emergency patients admitted for Trauma and Plastic Surgery Department of the West China Hospital of Stomatology from 2016-2019.

MATERIALS AND METHODS

In this retrospective study, 5220 patients with complete medical records were evaluated. The following data were collected: gender, age, etiology, disease type distribution, anatomic injury site and treatment modality.

RESULTS

There were 3046 males and 2174 females (ratio 1.40:1), with an average age of 16.2 years. The largest group was children aged between 3 and 6 years old (28.3%). Maxillofacial injuries were the most common condition (87.3%), which mostly occurred on the forehead (29.7%), followed by the lips (27.8%). A fall was the leading cause of injury (59.9%), especially in patients younger than 6 years old. There were 327 cases of maxillofacial space infections (MSI), and the mandibular third molars were the most common tooth associated with odontogenic infections (36.2%). Univariable analysis identified that multiple-space infection, visit time and systemic conditions were the risk factors for being admitted to the hospital for treatment. There were 116 patients (2.2%) with bleeding as the main complaint, and most of the maxillofacial bleeding patients could be stopped by compression (52.6%).

CONCLUSION

Males and children aged younger than 6 years were the highest risk populations. Trauma accounted for the majority of emergency patients in maxillofacial surgery. Most maxillofacial injuries involved the forehead and were mainly caused by accidental falls. The proportion of MSI was not high, but serious cases may be life-threatening. The causes of bleeding were diverse, and the bleeding was easy to control.

Traumatic maxillofacial injuries: Patterns, outcomes, and long-term follow-up of a military cohort

BACKGROUND/AIMS

Maxillofacial trauma poses a distinct challenge on the modern battlefield, and data on its long-term implications are scarce. The aim of this study was to investigate maxillofacial injury characteristics, outcomes, and complications along the continuum of care among hospitalized military personnel from the pre-hospital setting through long-term rehabilitation.

MATERIALS AND METHODS

A registry-based study was undertaken of three national trauma and rehabilitation registries: The Israel Defense Forces Trauma Registry (IDF-TR), which records pre-hospital data. The Israeli National Trauma Registry for in-hospital data and the Israel Ministry of Defense Rehabilitation Department (MOD-RD) registry contain long-term disability data. The cohort comprised IDF soldiers who suffered maxillofacial injuries between 1997 and 2020.

RESULTS

A total of 672 patients with maxillofacial injuries were included in the study, and 6.4% of all trauma admissions were related to maxillofacial injuries. Of these, 366 (54%) were injured in non-military (NMC) circumstances, and 306 (46%) were wounded in military circumstances (MC). The mechanisms of injury were mainly traffic-related among the NMC group compared with an explosion in the MC group. Maxillofacial fractures were frequently associated with traumatic brain injuries with higher rates in the NMC group than in the MC group (55% vs. 30%, p < .001). In a multivariate analysis, zygomatic and orbital fractures were associated with higher odds of concomitant head injury. The most common categories of long-term disability included central nervous system disorders, skull injuries, epilepsy, hearing impairment, ophthalmologic conditions, and post-traumatic stress disorder.

CONCLUSIONS

Maxillofacial injuries are often associated with concomitant traumatic brain injury. Long-term disabilities associated with these injuries included the central nervous system, hearing, ophthalmologic impairments, and post-traumatic stress disorder.

Maxillofacial trauma due to traffic accidents and falls: an exploratory study of associated factors

Background

This study aimed to determine the pattern of Maxillofacial trauma (MFT) due to traffic accidents and falls in a reference hospital in a rural region of northeastern Brazil between December 2011 and December 2018 and to identify associated factors.

Material and Methods

This was a cross-sectional study using 585 medical records of patients with MFT. The data were subjected to a Poisson-Tweedie multiple regression analysis to estimate the Prevalence ratio (PR), with a 95% confidence interval (95% CI) and a significance level of p<0.05.

Results

MFT due to traffic accidents was more prevalent among patients 21 to 40 years old (PR=2.30; 95% CI=1.20-4.41; p<0.001) diagnosed with zygomatic-orbital complex fractures (PR=1.80; 95% CI=1.08-2.98; p=0.023). Falls were more frequent among older groups of 41 to 60 years (PR=1.83; 95% CI=1.09-3.06; p=0.022) and over 61 years (PR=2.23; 95% CI=1.09-3.06; p=0.022). In traffic accidents, alcohol consumption increased the length of stay (PR=2.081; 95% CI=1.553-2.787; p<0.001), and patients who did not use personal protective equipment (PPE) had higher hospital costs (PR=179.964; 95% CI=1.485-1.994; p<0.001) for this etiology. Traffic accidents and falls are two of the main etiologies of MFT, especially for males in the young adult age group (traffic accidents) and those above 41 years (falls). Alcohol consumption and the nonuse of PPE influenced the length of the hospital stay and hospital costs.

Conclusions

Strategies to confront this problem, such as road and highway improvements, effective enforcement of laws and intersectoral coordination involving the entire community to implement policies and prevention programs targeted at these populations, can be implemented.

Key words:Maxillofacial Injuries, public policy, hospital cost.

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

BACKGROUND/AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Complex Dentoalveolar Fractures: Main Clinical Variables Description and Analysis

AIMS AND OBJECTIVES

To analyze and evaluate clinical features that define complex dentoalveolar trauma.

MATERIALS AND METHODS

Forty-five patients, with a mean age of 36.1 years, were included in the study; most patients were male (82.2%). The main clinical features defining dentoalveolar fractures were evaluated, including the status of the tooth, alveolar socket and adjacent soft tissues and their relationships with tooth loss. The relationship between splinting and tooth loss was also studied. The data were analyzed using descriptive and statistical methods.

RESULTS

A significant relationship was observed between the different clinical variables and tooth loss, in particular the status of the alveolar socket as the most relevant clinical factor; there was also a significant relationship between splinting and tooth loss, as this was the main protective factor.

CONCLUSIONS

Tooth loss prognosis following complex dentoalveolar trauma is related to the clinical features of the fracture, particularly the status of the alveolar socket and the possibility of using splinting as treatment.

Nonlinear dynamic analysis of the pure "buckling" mechanism during blow-out trauma of the human orbit

Considering the interplay between orbital bones and intraorbital soft tissues, commonly accepted patterns of the blow-out type of trauma within the human orbit require more thorough investigation to assess the minimal health-threatening impact value. Two different three-dimensional finite element method (FEM) models of the human orbital region were developed to simulate the pure “buckling” mechanism of orbital wall fracture in two variants: the model of orbital bone elements and the model of orbital bone, orbit and intraorbital tissue elements. The mechanical properties of the so-defined numerical skull fragment were applied to the model according to the unique laboratory tensile stress tests performed on small and fragile specimens of orbital bones as well as using the data available in the literature. The nonlinear transient analysis of the contact problem between bodies that differ substantially in terms of the Young’s modulus was carried out to investigate the interaction of different bodies within an instant injury. Potential damage areas were found within the lower orbital wall as well as the destructive load values for both FEM skull models (7,660 N and 8,520 N). Moreover, numerical simulations were validated by comparing them with computed tomography scans of real injuries.

Pattern of Maxillofacial Trauma and Associated Factors in Traffic Accident Victims

INTRODUCTION

Maxillofacial trauma (MFT) due to road traffic accidents are responsible for part of care provided at trauma centers.

PURPOSE

This research aimed to analyze the pattern of MFTs and associated factors in victims of road traffic accidents.

METHODS

A total of 873 medical records of patients with MFTs in 2 reference hospitals for trauma in Northeastern Brazil during the period from January 2011 to December 2018 were analyzed. Data were included in the Tweedie multiple regression analysis to estimate the prevalence ratio (PR), with 95% confidence interval (95%CI) and P < 0.05.

RESULTS

Motorcycle accidents were the most prevalent (76.4%). Higher hospital costs were the result of patients victims of motorcycle accidents (PR = 1.56; 95%CI = 1.29-1.88; P < 0.001), diagnosed with mandible fracture (PR = 1.41; 95%CI = 1.07-1.86; P = 0.001) who had consumed alcoholic beverages (PR = 1.12; 95%CI = 1.00-1.25; P = 0.04) and did not use personal protective equipment (PPE) (PR = 1.29; 95%CI = 1.10-1.50; P = 0.001). Patients victims of motorcycle accidents remained in hospital longer than other etiologies (PR = 1.47; 95%CI = 1.23-1.76; P < 0.001). The consumption of alcoholic beverages resulted in more severe MFTs (PR = 2.05; 95%CI = 1.34-3.14; P = 0.001).

CONCLUSION

Victims of motorcycle accidents remained hospitalized longer and resulted in higher hospital costs compared to other etiologies. Alcohol consumption increases hospital costs and the severity of MFTs. Higher hospital costs were also observed in patients who did not use PPE. Strategies need to be adopted to understand associated factors in MFTs such as the reallocation of resources to fund, implement and improve services and the surveillance in roads and highways, as well as prevention programs aimed at this health problem.

Maxillofacial injuries in severely injured patients after road traffic accidents-a retrospective evaluation of the TraumaRegister DGU® 1993-2014

Objectives

It was the aim of the study to analyse the prevalence of maxillofacial trauma (MFT) in severely injured patients after road traffic accidence (RTA) and to investigate associated factors.

Materials and methods

In a retrospective study, data from patients after RTA by the TraumaRegister DGU® from 1993 to 2014 were evaluated for demographical and injury characteristics. The predictor variable was mechanism of injury and the outcome variables were type of injury, severity and hospital resources utilization.

Results

During the investigation period, n = 62,196 patients were enclosed with a prevalence of maxillofacial injuries of 20.3% (MFT positive). The injury severity score of MFT-positive patients was higher than in the MTF-negative subgroup (27 ± 12.8 vs. 23.0 ± 12.7). If MFT positive, 39.8% show minor, 37.1% moderate, 21.5% serious and 1.6% severe maxillofacial injuries. Injuries of the midface occurred in 60.3% of MTF-positive patients. A relevant blood loss (> 20% of total blood volume) occurred in 1.9%. MFT-positive patients had a higher coincidence with cervical spine fractures (11.3% vs. 7.8%) and traumatic brain injuries (62.6% vs. 34.8%) than MFT-negative patients. There was a noticeable decrease in the incidence of facial injuries in car/truck drivers during the study period.

Conclusions

Every 5th patient after RTA shows a MFT and the whole trauma team must be aware that this indicates a high prevalence of traumatic brain and cervical spine injuries.

Clinical relevance

Even if sole injuries of the face are seldom life threatening, maxillofacial expertise in interdisciplinary trauma centres is strongly recommended.