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Cremona G, Paione S, Roccia F, Samieirad S, Lazíc M, Konstantinovic VS, Rae E, Laverick S, Vesnaver A, Birk A, de Oliveira Gorla LF, Pereira-Filho VA, Dediol E, Kos B, Pechalova P, Sapundzhiev A, Dubron K, Politis C, Zavattero E, Bottini GB, Goetzinger M, Sivrić A, Kordić M, Rahman SA, Rahman T, Sohal KS, Aladelusi T, Sobrero F. Policy of fourteen maxillofacial divisions towards titanium plates removal after internal fixation of paediatric maxillofacial fractures: A World Oral Maxillofacial Trauma (WORMAT) project. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101986. [PMID: 39067638 DOI: 10.1016/j.jormas.2024.101986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/08/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION The aim of this 11-year retrospective multicentric study is to evaluate the policy of 14 maxillofacial surgery divisions in terms of titanium plate removal from paediatric patients who had undergone open reduction and internal fixation (ORIF) to treat maxillofacial fractures. MATERIAL AND METHODS Patients ≤ 16 years undergoing surgical treatment for fractures of middle and lower third of the face between January 2011 and December 2022, with a minimum follow-up of 6 months, were included. Age (group A: ≤ 6 years, B: 7-12 years, C: 13-16 years), sex, fracture location and type, surgical approach, number, and location of positioned and removed plates, timing and indications for removal were recorded. RESULTS 191/383 (50 %) patients (median age, 10 years; M:F ratio 2.1:1) underwent removal of 319/708 (45 %) plates. Maxillary dentoalveolar process (91 %), angle/ramus (63 %) and mandibular body (61 %) had a significantly higher removal rate than other fracture sites (p < 0.001). A significant decreasing trend in removal with increasing age was observed, from 83 % in Group A to 24 % in Group C (p < 0.001). On the total of positioned plates, 11 % were removed for symptomatic reasons (5 % infections, 6 % discomfort/pain) and 34 % for other reasons (28 % scheduled removal). DISCUSSION This multicentric study showed that plate removal was not performed routinely in the paediatric population. The incidence and causes of symptomatic plates removal were consistent with the literature, while the plate removal rate from asymptomatic patients was lower. A correlation was found between increasing age and a reduction in the frequency of plate removal procedures.
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Affiliation(s)
- Giulia Cremona
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Serena Paione
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
| | - Fabio Roccia
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marko Lazíc
- Clinic of Maxillofacial Surgery, School of dentistry, University of Belgrade, Belgrade, Serbia
| | | | - Euan Rae
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Luis Fernando de Oliveira Gorla
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University, UNESP, Araraquara, São Paulo, Brazil
| | - Valfrido Antonio Pereira-Filho
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University, UNESP, Araraquara, São Paulo, Brazil
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Boris Kos
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Petia Pechalova
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Angel Sapundzhiev
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Kathia Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Emanuele Zavattero
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Maximilian Goetzinger
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Sajjad Abdur Rahman
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Tabishur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
| | - Karpal Singh Sohal
- Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Timothy Aladelusi
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Federica Sobrero
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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Harrison LM, Dragun AJ, Prezelski K, Hallac RR, Seaward JR, Kane AA. Pediatric Facial Fracture Associated Craniofacial and Cervical Spine Injury. J Craniofac Surg 2024:00001665-990000000-01730. [PMID: 38940552 DOI: 10.1097/scs.0000000000010437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
Management of pediatric facial fractures depends on location and severity, age, and associated injuries. Accurate diagnosis of associated injuries is crucial for effective treatment. This study evaluates the incidence of associated injuries and seeks to determine the influencing factors to provide imaging guidance. A retrospective review of pediatric facial fractures from the American College of Surgeons National Trauma Data Bank from 2017 to 2021 was completed. Associated cervical spine (c-spine), skull fracture, traumatic brain injury (TBI), and intracranial bleeding were evaluated. Demographics, fracture patterns, mechanisms, protective devices, and the Glasgow Coma Scale (GCS) were reviewed. A total of 44,781 pediatric patients with 65,613 facial fractures were identified. Of the total, 5.47% had a c-spine injury, 21.86% had a skull fracture, 18.82% had TBI, and 5.76% had intracranial bleeding. Multiple fractures significantly increased the rate of all associated cranial and c-spine injuries. Single midface fractures had the highest c-spine, TBI, and intracranial bleeding rates. With increasing age, there was a significant increase in c-spine injury and TBI, while there was a decrease in skull fractures. Motor vehicle accidents and GCS <13 were associated with significantly increased rates of all injuries. Among pediatric patients with facial fractures, 5.47% had a c-spine injury, 21.86% had a skull fracture, 18.82% had TBI, and 5.76% had intracranial bleeding. The authors' findings recommend c-spine imaging in older age and cranial imaging in younger patients. Multiple facial fractures, fractures of the midface, decreased GCS, and motor vehicle accidents increase the need for both c-spine and cranial imaging.
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Affiliation(s)
- Lucas M Harrison
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Yi Y, He X, Wu Y, Wang D. Global, regional, and national burden of incidence, prevalence, and years lived with disability for facial fractures from 1990 to 2019: a systematic analysis for the Global Burden of Disease study 2019. BMC Oral Health 2024; 24:435. [PMID: 38600477 PMCID: PMC11005257 DOI: 10.1186/s12903-024-04206-9] [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: 12/28/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Facial fractures are common injuries causing cosmetic, functional, and psychological damage. The purpose of this study was to assess the incidence, prevalence, and years lived with disability (YLDs) of facial fractures from 1990 to 2019 using the Global Burden of Disease (GBD). METHODS Detailed data for the disease burden of facial fractures were obtained from online available public data (Global Health Data Exchange) derived from the GBD study. The incidence, prevalence, and YLDs of facial fractures from 1990 to 2019 were analyzed by country, region, age, gender, sociodemographic index (SDI), and cause. The age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized YLDs rate (ASYR), and estimated annual percentage change (EAPC) were calculated to evaluate the disease burden and quantify the trends over time. The main causes of facial fractures in different years and ages were assessed. RESULTS Globally, there were 8.9 million incident cases, 1.5 million cases prevalent cases, and 98.1 thousand years YLDs in 2019. Compared with 1990, the number of incident cases, prevalent cases, and YLDs increased, while ASIR (EAPC, - 0.47; 95% uncertainty interval [UI], - 0.57 to - 0.37), ASPR (EAPC, - 0.39; 95% UI, - 0.46 to - 0.31), ASYR (EAPC, - 0.39; 95% UI, - 0.47 to - 0.32) showed a downward trend. The high SDI region held the highest ASIR, ASPR, and ASYR both in 1990 and 2019, such as New Zealand, Slovenia, and Australia. The burden was higher in men than in women from 1990 to 2019, while the ASRs in women exceeded that of men in the elderly. The ASIR peaked in the young adult group, however, the ASPR and ASYR increased with age. Falls and road injuries were the leading causes of facial fractures. CONCLUSIONS Facial fractures continue to cause a heavy burden on public health worldwide. More targeted strategies need to be established to control the burden of facial fractures.
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Affiliation(s)
- Yi Yi
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China
| | - Xiao He
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Yiping Wu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China
| | - Dawei Wang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China.
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Kelimu K, Wusiman P, Li W, Huang B, Wu J, Zhan J, Moming A. Epidemiology and Pattern of Pediatric Maxillofacial Trauma: A 5-Year Retrospective Study. J Craniofac Surg 2024; 35:150-153. [PMID: 37754755 DOI: 10.1097/scs.0000000000009723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/02/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE To analyze the epidemiology, pattern, and prevent measurement of pediatric maxillofacial trauma in Xinjiang, China. PATIENTS AND METHODS Clinical records of patients aged 0 to 18 years with maxillofacial trauma over the 5 years were reviewed. Epidemiological features of data were collected for the cause of injury, age and sex distribution, frequency and type of injury, localization and frequency of soft tissue injuries, facial bone fractures, and presence of associated injuries. Statistical analyses performed included descriptive analysis, χ 2 test, and logistic regression analyses. RESULTS Among the 450 patients, 333 were male and 117 were female, with a male-to-female ratio of 3.8:1, the mean age was 9.2±5.4 years; 223 cases were soft tissue injuries and 227 cases were maxillofacial fractures. The 16 to 18-year-old group was the highest, with the prevalence of maxillofacial fractures. The most common cause of pediatric maxillofacial trauma was traffic injuries. CONCLUSION The incidence of maxillofacial trauma in pediatric patients correlates with a number of factors, including age, sex, and etiology of trauma. The 16 to 18-year-old group is the most prevalent group for maxillofacial trauma in pediatric patients, and traffic accidents are the leading cause of maxillofacial trauma in pediatric patients.
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Affiliation(s)
- Keyimu Kelimu
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Patiguli Wusiman
- Orthodontic Department of the First Affiliated Hospital of Xinjiang Medical University (Stomatological Hospital of Xinjiang Medical University), Urumqi, Xinjiang
- Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang
| | - Weidong Li
- Department of Oral & Maxillofacial Surgery, The First Affiliated Hospital Xinjiang Medical University (Stomatological hospital of Xinjiang Medical University), Urumqi, Xinjiang, People's Republic of China
| | - Bi Huang
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Jianming Wu
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Jinliang Zhan
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
| | - Adili Moming
- Stomatological Institute of Stomatological Institute of Guangdong Meizhou Gucheng Hospital
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Capote R, Preston K, Kapadia H. Craniofacial Growth and Development: A Primer for the Facial Trauma Surgeon. Oral Maxillofac Surg Clin North Am 2023; 35:501-513. [PMID: 37302949 DOI: 10.1016/j.coms.2023.04.007] [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: 06/13/2023]
Abstract
Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implications of pediatric facial fractures.
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Affiliation(s)
- Raquel Capote
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
| | - Kathryn Preston
- Center for Cleft and Craniofacial Care, Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Orthodontics, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA
| | - Hitesh Kapadia
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA; Department of Orthodontics, School of Dentistry, University of Washington, Seattle, WA, USA
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Shah J, Wang F, Ricci JA. Concomitant Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An 11 Year Review of the National Trauma Data Bank. J Oral Maxillofac Surg 2023; 81:413-423. [PMID: 36620992 DOI: 10.1016/j.joms.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Craniofacial trauma with concomitant cervical fractures (CCFs) is responsible for significant morbidity and mortality in the pediatric population. We aim to characterize its incidence, injury patterns, outcomes, and risk factors, along with identifying any association between mandible fractures and cervical injuries via the National Trauma Databank. METHODS A retrospective cohort study was performed using National Trauma Databank records between 2007 and 2017 to identify patients equal or under the age of 18 years hospitalized for maxillofacial trauma and with recorded cervical injury. Variables of interest include age, gender, race/ethnicity, trauma type (blunt vs penetrating), Injury Severity Score, area involved, mechanism of injury, comorbid conditions, inpatient complications, and discharge disposition. Retrospective cohorts were separated by CCF status. Univariate, bivariate, and multivariable regression analysis was utilized, with P-value <.05 considered statistically significant. RESULTS A total of 32,952 patients were included in the study, with the majority being White (60.8%), male (68.2%), and between the ages of 13 and 18 years (65%). Of these, 8.2% experienced CCF. Most common mechanisms of injury were motor vehicle trauma (32.6%), interpersonal violence (18.8%), and falls (13.5%). Univariate analysis revealed patients with CCF were significantly older (15.2 vs 12.9; P < .001), more likely to be motor vehicle occupants (46.6 vs 31.9%; P < .001), and suffer polyfacial fractures (62.6 vs 60.7%; P < .001). Longer length of stay (9.4 vs 3.6 days; P < .001) and significantly higher inpatient complications such as deep vein thrombosis, pulmonary embolism, unplanned intubation, severe sepsis, pressure ulcer, ventilator-associated pneumonia, and unplanned return to operating room were observed in the CCF cohort. Female gender (1.5 [1.37 to 1.64; 95% confidence interval {CI}] P < .001) and higher Injury Severity Score (1.12 [1.11 to 1.11; 95% CI] P < .001) were associated with significantly higher odds on multivariable analysis. The presence of a mandible fracture was not associated with increased CCF on multivariate analysis (1.06 [0.92 to 1.22; 95% CI] P = .36). CONCLUSIONS There are statistically significant differences in demographics, outcomes, and injury patterns in maxillofacial patients with CCF that may help guide treatment. No association between mandible fractures and cervical trauma was identified.
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Affiliation(s)
- Jinesh Shah
- Resident, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Fei Wang
- Research Assistant, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Joseph A Ricci
- Assistant Professor, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.
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Cheng KY, Yang CY, Liu SC. Assessing the risks of children with preoperative comorbidities undergoing comminuted fracture surgery. Front Pediatr 2023; 11:1118954. [PMID: 36891228 PMCID: PMC9986599 DOI: 10.3389/fped.2023.1118954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Comminuted fractures are characterized by bones broken in at least two places, destabilizing the bone and requiring surgery. Children whose bones are still developing and maturing tend to have a higher risk of sustaining comminuted fractures as the result of trauma. Trauma is a major cause of death in children and constitutes a major issue in orthopedics because of the unique properties of children's bones compared to adult bones and the associated complications. Methods This retrospective, cross-sectional study aimed to refine the association between comorbid disease and comminuted fractures in pediatric subjects using a large, national database. All data were extracted from the National Inpatient Sample (NIS) database from 2005 to 2018. Logistic regression analysis was used to evaluate associations between comorbidities and comminuted fracture surgery and between various comorbidities and LOS or unfavorable discharge. Results A total of 2,356,483 patients diagnosed with comminuted fractures were selected initially, of whom 101,032 patients aged younger than 18 years who underwent surgery for comminuted fractures were included. Study results suggest that patients with any comorbidities undergoing orthopedic surgery for comminuted fracture appear to have longer LOS and a higher proportion of discharge to long-term care facilities. Discussion Almost all comorbidities were significantly associated with poor in-hospital outcomes and longer LOS. The analysis of comminuted fractures in children may provide useful information to help first responders and medical personnel evaluate and manage comminuted fractures appropriately.
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Affiliation(s)
- Kai-Yuan Cheng
- Department of Orthopedics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yu Yang
- Department of Orthopedics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shih-Chia Liu
- Department of Orthopedics, MacKay Memorial Hospital, Taipei, Taiwan
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Yesantharao PS, Jenny HE, Lopez J, Chen J, Lopez CD, Aliu O, Redett RJ, Yang R, Steinberg JP. The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland. Craniomaxillofac Trauma Reconstr 2021; 14:308-316. [PMID: 34707791 PMCID: PMC8543597 DOI: 10.1177/1943387520983634] [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: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective, quasi-experimental difference-in-differences investigation. OBJECTIVE Pediatric craniofacial fractures are often associated with substantial morbidity and consumption of healthcare resources. Maryland's All Payer Model (APM) represents a unique case study of the health economics surrounding pediatric craniofacial fractures. The APM implemented global hospital budgets to disincentivize low-value care and encourage preventive, community-based efforts. The objective of this study was to investigate how this reform has impacted pediatric craniofacial fracture care in Maryland. METHODS Children (≤18 years) receiving inpatient craniofacial fracture-related care in Maryland between January, 2009 through December, 2016 were investigated. New Jersey was used for comparison. Data were abstracted from the Kid's Inpatient Database (Healthcare Cost and Utilization Project). RESULTS Between 2009-2016, 3,655 pediatric patients received inpatient care for craniofacial fractures in Maryland and New Jersey. Prior to APM implementation, around 20% of Maryland patients received care outside of urban teaching hospitals. After APM implementation, less than 6% of patients received care outside of urban teaching hospitals (p = 0.003). Implementation of the APM in Maryland also resulted in fewer pediatric craniofacial fracture admissions than New Jersey, though this only reached borderline significance (adjusted difference-in-differences estimate: -1.1 fewer admissions, 95% confidence interval: -2.1 to 0.0, p = 0.05). Inpatient costs for pediatric craniofacial care and mean did not change post-APM. CONCLUSIONS Maryland's APM consolidated pediatric craniofacial fracture inpatient care at urban, teaching hospitals. Inpatient costs and lengths of stay did not change after policy implementation, but overall admission rates decreased. Such considerations are important when considering national expansion of global hospital budgeting.
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Affiliation(s)
- Pooja S. Yesantharao
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hillary E. Jenny
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Lopez
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonlin Chen
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher D. Lopez
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oluseyi Aliu
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J. Redett
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin Yang
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jordan P. Steinberg
- Assistant Professor of Plastic and Reconstructive Surgery, Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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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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The Association of Zygomaticomaxillary Complex Fractures with Naso-Orbitoethmoid Fractures in Pediatric Populations. Plast Reconstr Surg 2021; 147:777e-786e. [PMID: 33835093 DOI: 10.1097/prs.0000000000007836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Naso-orbitoethmoid fractures associated with ipsilateral zygomaticomaxillary complex fractures are more challenging injuries than zygomaticomaxillary complex fractures alone. However, there is a paucity of information on this complex fracture pattern in the pediatric population. This study investigated the cause, treatment, and outcomes of combined zygomaticomaxillary complex and naso-orbitoethmoid fractures versus isolated zygomaticomaxillary complex fractures in pediatric patients. METHODS This was a 25-year retrospective cohort study of pediatric patients who presented to a single institution with zygomaticomaxillary complex fractures. Baseline patient demographics and clinical information, and concomitant injuries, treatment/operative management, and postoperative complications/deformities were recorded and compared between patients with combined zygomaticomaxillary complex and naso-orbitoethmoid fractures and patients with isolated zygomaticomaxillary complex fractures. RESULTS Forty-nine patients were identified to have had zygomaticomaxillary complex fractures in the authors' 25-year study period, of whom 46 had adequate clinical documentation and follow-up. Seventeen patients had combined zygomaticomaxillary complex-naso-orbitoethmoid fractures, of whom six had panfacial fractures. Both patient groups (zygomaticomaxillary complex only and combined zygomaticomaxillary complex-naso-orbitoethmoid fractures) were similar in terms of demographics. However, a significantly greater proportion of combined fracture patients experienced postoperative complications compared to isolated zygomaticomaxillary complex fracture patients, even after excluding those with panfacial fractures (87.5 percent versus 35.3 percent; p < 0.001). Enophthalmos (37.5 percent) and midface growth restriction (37.5 percent) were the two most common complications/deformities in all combined fracture patients. CONCLUSIONS High-impact trauma can lead to zygomaticomaxillary complex fractures with associated naso-orbitoethmoid fractures in children. This injury pattern was found to cause significantly greater postoperative morbidity than isolated zygomaticomaxillary complex fractures alone. Thus, pediatric patients presenting with this complex facial fracture pattern should be closely monitored. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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da Silva BCL, Souto-Souza D, de Souza GM, Magesty RA, de Cassia Ávila B, Galvão EL, Falci SGM. Comparison between resorbable plates vs. titanium plates for treatment of zygomatic fractures: a systematic review with meta-analysis. Oral Maxillofac Surg 2021; 25:289-301. [PMID: 33398647 DOI: 10.1007/s10006-020-00937-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare resorbable plates with titanium plates for the fixation of zygomatic fractures, taking into account postoperative complications. METHODS This systematic review followed the guidelines of PRISMA and the recommendations of the Cochrane Handbook and was registered in PROSPERO. The electronic search was performed in the Web of Science, PubMed, Virtual Health Library, and Cochrane Library databases and in the gray literature. The study selection and the data extraction were performed by three calibrated and independent researchers. The assessment of the risk of bias in the studies was performed using the Cochrane Risk of Bias Tool for clinical trials. Meta-analyses were performed using Review Manager Software version 5.3, using the Peto's Odds Ratios (PORs), and when I2 > 30, the random effect model was used. The evaluation of the quality of the evidence was carried out through GRADE. RESULTS A total of 2651 studies were screened and only nine were included; 7 of which were used for quantitative assessment. The follow-up time for patients ranged from 6 months to 5 years. All studies showed a low risk of bias in the "incomplete outcome data" domain. The need for plate removal (POR: 0.11, 95% CI: 0.02 to 0.81, I2 = 0%) and dehiscence (POR 0.12, 95% CI 0.02 to 0.63, I2 = not applied) was lower for the group of patients who used resorbable plates than for titanium plates. CONCLUSION There was no difference in the occurrence of infection, diplopia, or paresthesia between the fixation methods. Resorbable plates showed better postoperative clinical performance.
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Affiliation(s)
- Bianca Cristina Lopes da Silva
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Debora Souto-Souza
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Rafael Alvim Magesty
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Bruna de Cassia Ávila
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Endi Lanza Galvão
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil.
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Fore! A 10-year Analysis of Golf-related Facial Fractures. Plast Reconstr Surg Glob Open 2020; 8:e3128. [PMID: 33173669 PMCID: PMC7647656 DOI: 10.1097/gox.0000000000003128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022]
Abstract
Over 30 million people in the United States play golf, which, while considered a low-impact sport, involves balls and clubs moving >100 miles/h (>160.93 km/h), creating potential for a significant facial trauma. The objective of this study was to characterize the epidemiology of golf-related facial fractures in the United States.
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Bicsák Á, Abel D, Tack L, Smponias V, Hassfeld S, Bonitz L. Complications after osteosynthesis of craniofacial fractures-an analysis from the years 2015-2017. Oral Maxillofac Surg 2020; 25:199-206. [PMID: 32885304 DOI: 10.1007/s10006-020-00903-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Complications mean a recurring problem in everyday clinical practice. Complication rates between 6 and 13% are described for the treatment of bony injuries to the head and neck area. This paper aims to provide a detailed analysis of the complications after osteosynthesis in facial skull fractures. MATERIAL AND METHOD In this retrospective study, we reviewed all patient records of injured treated in the Department of Cranial and Maxillofacial Surgery at the Dortmund General Hospital between 2015 and 2017. RESULTS Of the 22,031 head and neck injuries, 685 were treated with osteosynthesis. A clinically significant complication was reported in 32 patients (4.76%). The number of total complications was 63. In total, 66.7% of all complications have been identified in the paramedian mandible (44%), median mandible, mandibular angle, and in the collar area (each 12.7%). Eleven implants (in 5 patients) showed a cancellous bone impaction. Broken implants have been recognized in two cases. In 8 cases, there was a pseudarthrosis in the fracture area; in one case, there was a broken implant and pseudarthrosis in combination. CONCLUSION Osteosynthesis is a safe method of treating facial skull fractures, which is why we consider it the gold standard of therapy. The complication rate is well below 5%. The 3-dimensional adaptation (bending) and shortening of the osteosynthesis implants do not lead to an increase in complications.
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Affiliation(s)
- Ákos Bicsák
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany.
| | - Dietmar Abel
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Laurence Tack
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Velissarios Smponias
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Stefan Hassfeld
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
| | - Lars Bonitz
- Department of Cranio-, Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Muensterstrasse 240, D-44145, Dortmund, Germany
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Analysis of pediatric maxillofacial trauma in North China: Epidemiology, pattern, and management. Injury 2020; 51:1561-1567. [PMID: 32471687 DOI: 10.1016/j.injury.2020.04.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze epidemiology, pattern, and management of pediatric maxillofacial trauma in North China. PATIENTS AND METHODS Clinical records of patients aged 0-18 years with maxillofacial trauma, from January 2008 to December 2016 were reviewed. 390 patients with an average age of 9.8 ±5.8 years (range: 8 months-18 years) and a male:female ratio of approximately 2:1 were included in the study. Epidemiological features (age, sex, etiology), characteristics of injuries (locations, types, associated injuries), treatments, and complications were analyzed. RESULTS Among 55 patients with soft tissue injuries, palate was the most common site (32.7%). Among 335 fracture cases, the most common age group was 16-18 years (25.1%); falls was the main cause (38.2%). Overall, there were 450 fractures (1.78 per capita), primarily mandible (69.3%), followed by zygoma (12.9%), maxilla (7.7%) and other sites. Multiple fractures occurred in 61.5% of patients. The most common site of mandibular fractures was condyle. The proportion of mid-face fractures to mandibular fractures increased with age (p < 0.01) and stabilized gradually after 12 (approximately 1.14:1). 77.5% of fractures were treated surgically. There was an independent association of surgical intervention with age older than 6 years old (p < 0.05). Absorbable plates were mainly applied to mandibular fractures in patients aged 0-7 and only 1 was removed because of insufficient fixation strength. CONCLUSIONS The primary cause of pediatric maxillofacial fractures in North China was falls; traffic accidents led more multiple fractures and associated injuries. Palate and mandible were the most common sites of pediatric maxillofacial soft tissue injuries and fractures, respectively. The proportion of mandibular fractures to mid-face fractures decreased with the increase of age until 12.
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Characterization of Age-Related Injury Patterns and Surgical Treatment of Pediatric Facial Fractures. J Craniofac Surg 2019; 30:2189-2193. [DOI: 10.1097/scs.0000000000005789] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Reich W, Aust O, Eckert A. Prospective analysis of mid-facial fractures in a single-center pediatric-adolescent cohort. Int J Pediatr Otorhinolaryngol 2019; 119:151-160. [PMID: 30708183 DOI: 10.1016/j.ijporl.2019.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The complex architecture of the midface renders diagnosing and treating fractures challenging, especially for young patients who present the additional risk of suffering growth and development deficiencies, which is to be avoided at all costs. OBJECTIVES This study sought to characterize pediatric mid-facial fractures considering the possible complications. METHODS Between September 2008 and September 2018, data was collected on inpatients aged <18 years, treated for mid-facial fractures at the Halle University Hospital. Evaluated parameters were age, gender, cause and type of fracture, associated injuries, treatment, and complications. RESULTS In total, 31 patients were examined; 20 were boys. The most common cause of injury was road traffic accident (41.9%). Orbital floor fracture was the most common type of injury (58.1%). In 54.8% of cases, surgery was performed. CONCLUSION The incidence of complications associated with mid-facial fractures was low (n = 7), requiring treatment in only three cases (orthodontic, ophthalmological).
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Affiliation(s)
- Waldemar Reich
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, D-06120, Halle (Saale), Germany.
| | - Oliver Aust
- Dental Practice, Waldkerbelstraße 12, D-04329, Leipzig, Germany.
| | - Alexander Eckert
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, D-06120, Halle (Saale), Germany.
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Hollier LH. Discussion: Pediatric Zygomaticomaxillary Complex Fracture Repair: Location and Number of Fixation Sites in Growing Children. Plast Reconstr Surg 2018; 142:61e-62e. [PMID: 29952899 DOI: 10.1097/prs.0000000000004488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Larry H Hollier
- From the Division of Plastic Surgery, Baylor College of Medicine
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Analysis of Pediatric Maxillofacial Fractures Requiring Operative Treatment: Characteristics, Management, and Outcomes. J Craniofac Surg 2016; 26:2368-74. [PMID: 26517461 DOI: 10.1097/scs.0000000000002087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Maxillofacial fractures in pediatric trauma patients require significant force and frequently are associated with concomitant injuries. The anatomic and developmental differences between the adult and child that impact patterns of injury also affect management and outcomes. The aim of this study was to analyze fracture location, mechanism, concomitant injuries as well as methods of surgical treatment and outcomes, to improve management of this patient population. A retrospective review was conducted of pediatric patients with maxillofacial fractures presenting to a level-1 trauma center during an 8-year span. Only patients requiring surgical intervention, 204, were included in this study. Data pertaining to the location of injury, mechanism, associated injuries, surgical treatment, outcomes, and complications were analyzed. The most common fracture location was the mandible (36.3%), then the nasal bone (35.3%), followed by the tripod fracture (10.8%). A total of 30.7% of patients were involved in motor vehicle accidents, with the next most common mechanisms being sports (24.4%), and assault (13.7%). A total of 46% of the patients sustained concomitant injuries, with the majority involving cerebral trauma (14.7%) or the extremities (9.3%). Total 75.4% of all fractures, excluding the nose, were treated with open reduction and internal fixation (ORIF). Our complication rate was 11.2%. Pediatric craniofacial trauma remains a frequent presentation to the emergency department of trauma centers. Facial fracture patterns and mechanism of trauma observed in the pediatric population presenting to this facility are consistent with incidences reported in the literature. Knowledge of treatment options and potential complications is an important tool in the management of the pediatric trauma patient.
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Abstract
PURPOSE OF REVIEW This article reviews the trends in management of preadolescent facial fractures - a challenging population because of the need to consider growth, dynamic changes in dentition, and evolving fracture patterns. RECENT FINDINGS Recent findings are a more thorough understanding of fracture patterns and distribution because of recent comprehensive studies isolating the preadolescent age cohort; the role of rigid internal fixation for significantly displaced fractures; and the potential applications and indications for the use of resorbable hardware for fracture fixation in the preadolescent. SUMMARY As preadolescent fractures occur in a period of growth and evolving dentition in the facial skeleton, it is mandatory for the treating surgeon to have a thorough knowledge of standard and alternative treatment options to optimally manage these patients.
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Abstract
Trauma is a leading cause of death in children. The pediatric facial skeleton goes through progressive development and major changes, including change in the size ratio of the cranium to the face; change in the ratio of facial soft tissue to bone, and pneumatization of the sinuses. The main goal of maxillofacial fracture repair is to reestablish normal or preinjury structure and function. Follow-up is typically recommended until children reach skeletal maturity as trauma may affect growth of the facial skeleton. Problems not obvious immediately after the injury may become an issue later, and secondary surgery might be needed to address such issues.
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Affiliation(s)
- Robert M Kellman
- Department of Otolaryngology, Upstate Medical University, State University of New York, 750 E Adams Street, Syracuse, NY 13210, USA
| | - Sherard A Tatum
- Departments of Otolaryngology and Pediatrics, Upstate Medical University, State University of New York, 750 E Adams Street, Syracuse, NY 13210, USA.
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