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Pope P, Hassan B, Oslin K, Shikara M, Liang F, Vakharia K, Hebert A, Stein DM, Pan J, Justicz N, P Grant M. Traumatic Brain Injury in Patients With Frontal Sinus Fractures. J Craniofac Surg 2024:00001665-990000000-01728. [PMID: 38940592 DOI: 10.1097/scs.0000000000010301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/11/2024] [Indexed: 06/29/2024] Open
Abstract
Traumatic brain injury (TBI) is an insult to the brain from an external mechanical force that may lead to short or long-term impairment. Traumatic brain injury has been reported in up to 83% of craniofacial fractures involving the frontal sinus. However, the risk factors for TBI at presentation and persistent neurological sequelae in patients with frontal sinus fractures remain largely unstudied. The authors aim to evaluate the prevalence and risk factors associated with TBI on presentation and neurological sequelae in these patients. The authors retrospectively reviewed patients who presented with traumatic frontal sinus fractures in 2019. The authors' primary outcome was the prevalence of concomitant TBI on presentation, which authors defined as any patient with neurological symptoms/signs on presentation and/or patients with a Glasgow Coma Scale <15 with no acute drug or alcohol intoxication or history of dementia or other neurocognitive disorder. The authors' secondary outcome was the incidence of neurological sequelae after 1 month of injury. Bivariate analysis and multivariate logistic regression were performed. A total of 56 patients with frontal sinus fractures were included. Their median (interquartile range) age was 47 (31-59) years, and the median (interquartile range) follow-up was 7.3 (1.3-76.5) weeks. The majority were males [n = 48 (85.7%)] and non-Hispanic whites [n = 35 (62.5%)]. Fall was the most common mechanism of injury [n = 15 (26.8%)]. Of the 56 patients, 46 (82.1%) had concomitant TBI on presentation. All patients who had combined anterior and posterior table frontal sinus fractures [n = 37 (66.1%)] had TBI on presentation. These patients had 13 times the odds of concomitant TBI on presentation [adjusted odds ratio (95% CI): 12.7 (2.3-69.0)] as compared with patients with isolated anterior or posterior table fractures. Of 34 patients who were followed up more than 1 month after injury, 24 patients (70.6%) had persistent neurological sequelae, most commonly headache [n = 16 (28.6%)]. Patients who had concomitant orbital roof fractures had 32 times the odds of neurological sequelae after 1 month of injury [adjusted odds ratio (95% CI): 32 (2.4->100)]. Emergency physicians and referring providers should maintain a high degree of suspicion of TBI in patients with frontal sinus fractures. Head computed tomography at presentation and close neurological follow-up are recommended for patients with frontal sinus fracture with combined anterior and posterior table fractures, as well as those with concomitant orbital roof fractures.
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Affiliation(s)
| | - Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
| | | | - Meryam Shikara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
| | - Kalpesh Vakharia
- University of Maryland School of Medicine
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine
| | - Andrea Hebert
- University of Maryland School of Medicine
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine
| | - Deborah M Stein
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Judy Pan
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
| | - Natalie Justicz
- University of Maryland School of Medicine
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
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Oslin K, Shikara M, Yoon J, Pope P, Bridgham K, Waghmarae S, Hebert A, Liang F, Vakharia K, Justicz N. Management of Frontal Sinus Fractures at a Level 1 Trauma Center: Retrospective Study and Review of the Literature. Craniomaxillofac Trauma Reconstr 2024; 17:24-33. [PMID: 38371220 PMCID: PMC10874201 DOI: 10.1177/19433875231155727] [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: 02/20/2024] Open
Abstract
Study Design Case series. Objective This retrospective review of frontal sinus fractures aims to describe our current experience managing these fractures at an urban level I trauma center. Methods An institutional database of 2081 patients who presented with maxillofacial fractures on computed tomography face/sinus in 2019 was queried for all patients with traumatic frontal sinus fractures. Demographics, trauma-related history, management approach, and follow-up data were collected and analyzed. Results Sixty-three (7.3%) patients had at least one fracture involving the frontal sinus. The most common etiologies were assaults, falls, and motor vehicle accidents. Surgical repair was performed in 26.8% of patients with frontal sinus fractures, and the other 73.2% were observed. Fractures that were displaced, comminuted, obstructive of the frontal sinus outflow tract, or associated with a dural tear or cerebrospinal fluid leak were more likely to be operative. Conclusions The majority of frontal sinus fractures in this study were treated with observation. Despite advances in transnasal endoscopic approaches, many surgeons still rely on open approaches to repair frontal sinus fractures.
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Affiliation(s)
- Kimberly Oslin
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Meryam Shikara
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Maryland Medical System, Baltimore, MD, USA
| | - Joshua Yoon
- Division of Plastic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Pharibe Pope
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelly Bridgham
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Andrea Hebert
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Maryland Medical System, Baltimore, MD, USA
| | - Fan Liang
- University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Plastic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kalpesh Vakharia
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Maryland Medical System, Baltimore, MD, USA
| | - Natalie Justicz
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Maryland Medical System, Baltimore, MD, USA
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Terenzi V, Dal Cortivo F, Dell'Aquila A, Pompucci A, Sepe M, Ciarlo S, Gallo A, Valentini V. Multidisciplinary Management of Complex Ophthalmic Craniofacial Trauma During Coronavirus Disease 2019 Pandemic: Considerations for Treatment. J Craniofac Surg 2023; 34:2234-2235. [PMID: 37276339 DOI: 10.1097/scs.0000000000009452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023] Open
Affiliation(s)
- Valentina Terenzi
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
- Otolaryngology University Unit, 'S.M. Goretti Hospital', Latina, Italy
| | - Fiorenza Dal Cortivo
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
| | - Alberto Dell'Aquila
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
| | - Angelo Pompucci
- Department of Neurosurgery, 'S.M.Goretti Hospital', Latina, Italy
| | | | - Silvia Ciarlo
- Department of Neurosurgery, 'S.M.Goretti Hospital', Latina, Italy
- Department of Neurosurgery, UOC Neurosurgery, Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina
| | - Andrea Gallo
- Otolaryngology University Unit, 'S.M. Goretti Hospital', Latina, Italy
- Department of Sense Organs, ENT Section, 'Sapienza' University of Rome, Italy
| | - Valentino Valentini
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
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Tsur N, Talmy T, Radomislensky I, Almog O, Gendler S. Traumatic maxillofacial injuries: Patterns, outcomes, and long-term follow-up of a military cohort. Dent Traumatol 2023; 39:147-156. [PMID: 36345164 DOI: 10.1111/edt.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Nir Tsur
- The Trauma and Combat Medicine Branch, Surgeon General's, Headquarters, Israel Defense Forces, Ramat Gan, Israel.,Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Talmy
- The Trauma and Combat Medicine Branch, Surgeon General's, Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Irina Radomislensky
- The National Center for Trauma & Emergency Medicine Research, Gertner Institute, Tel HaShomer, Israel
| | - Ofer Almog
- The Trauma and Combat Medicine Branch, Surgeon General's, Headquarters, Israel Defense Forces, Ramat Gan, Israel.,The Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Sami Gendler
- The Trauma and Combat Medicine Branch, Surgeon General's, Headquarters, Israel Defense Forces, Ramat Gan, Israel
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