Incidence of Major and Minor Brain Injuries in Facial Fractures:

Traumatic Brain Injury and Its Association With Orbital Fracture Characteristics and Repair

Traumatic brain injury (TBI) is common in up to 50% of patients with facial fractures. Orbital fractures account for 25% of all facial fractures. The authors sought to determine the prevalence and risk factors for TBI in patients undergoing orbital fracture repair (OFR) and assess the impact of TBI on surgical timing. A retrospective review of trauma patients who underwent OFR at a single trauma center from 2015 to 2020 was conducted. Excluded were patients <18 years old and those with unreported GCS on presentation. TBI was defined as GCS <15 or any neurological symptom on presentation. TBI was categorized into mild (GCS=14-15), moderate (GCS=9-13), and severe TBI (GCS=3-8). Our primary and secondary outcomes were the prevalence of TBI on presentation and duration from injury to surgery, respectively. Of the 200 patients analyzed, 99 (49.5%) had concomitant TBI on presentation. The most common neurological symptom on presentation was loss of consciousness [n=80 (40%)]. Patients with TBI were significantly more likely to have an orbital roof [n=11 (11.1%), n=4 (4.0%), P=0.048] and lateral wall fractures [n=25 (25.3%), n=14 (13.9%), P=0.031] compared with patients without TBI. Patients with severe TBI were more likely to have delayed OFR-a significantly greater proportion of patients who had severe TBI had OFR after 60 days of injury compared with those without TBI or with mild TBI [5 (39%), 12 (12%), 4 (5%), P=0.032]. Craniofacial surgeons must suspect and screen for TBI in patients presenting with facial trauma, especially those with orbital roof and lateral wall fractures.

Concomitant head or neck injury increases risk of traumatic brain injury in facial fracture patients

Concomitant traumatic brain injury (TBI) is common in facial fracture patients and prompt intervention is crucially important to minimise the risk of potential long-term sequalae. In order to achieve rapid diagnosis, clinicians need to be aware of the risk factors associated with concomitant TBI and facial fractures. Previous literature suggests that a facial fracture can be considered a significant indicator of TBI. Nevertheless, a large data gap remains on specific injury patterns of facial fractures and associated TBI. Therefore, the objective of this study was to estimate and compare the frequency of and risk factors for TBI in patients with and without different types of additional injuries. The retrospective cohort study included 1836 facial fracture patients aged at least 18 years. The outcome variable was TBI with radiological findings in computed tomography or magnetic resonance imaging. The primary predictor variables were associated injury outside the head and neck, associated cranial fracture and associated neck injury. Based on this study, associated cranial fracture increased the risk of TBI 4.7-fold. Patients with associated neck injury had a 2.1-fold risk of TBI. In addition, significant predictors for TBI were increasing age (p = 0.0004), high energy of injury (p < 0.0001) and anticoagulant medication (p = 0.0003). Facial fracture patients with associated injuries in the head and neck region are at significant risk of TBI. In clinical work, multiprofessional evaluation of facial fracture patients should be routine and repeated survey should be targeted especially at high-risk patients to identify TBIs.

Traumatic brain injuries and maxillofacial fractures: a systematic review and meta-analysis

Traumatic brain injuries (TBIs) associated with maxillofacial fractures (MFFs) are a public health concern worldwide, especially among adult-aged males. There is an urgent need for early detection of associated TBIs in patients with MFFs during the initial assessment and treatment stage to reduce morbidity and mortality. The objective of the present study was to systematically review the literature to determine specific MFF situations associated with TBIs and to identify the factors associated with TBIs in patients with MFFs. The protocol was developed in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020155912. Overall, of 26,774 patients recorded, 13,667 patients (51.04%) sustained MFFs with an associated TBI. The male to female ratio was 4.8:1. RTA was the most common cause. The most common TBIs were concussions, contusions, and closed brain injuries. Within the limits of this study, it was concluded that TBI-related MFFs should be suspected whenever maxillary or mandibular bone fractures occur, especially among adults, males, and people with injuries caused by RTAs and assaults. There is a need to increase the awareness of maxillofacial surgeons on the possible associations of combined maxillofacial trauma and brain injuries.

Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring

Traumatic brain injury is a devastating event associated with substantial morbidity. Pathophysiology involves the initial trauma, subsequent inflammatory response, and secondary insults, which worsen brain injury severity. Management entails cardiopulmonary stabilization and diagnostic imaging with targeted interventions, such as decompressive hemicraniectomy, intracranial monitors or drains, and pharmacological agents to reduce intracranial pressure. Anesthesia and intensive care requires control of multiple physiologic variables and evidence-based practices to reduce secondary brain injury. Advances in biomedical engineering have enhanced assessments of cerebral oxygenation, pressure, metabolism, blood flow, and autoregulation. Many centers employ multimodality neuromonitoring for targeted therapies with the hope to improve recovery.

Long-Term Functional Outcomes of Trauma Patients With Facial Injuries

BACKGROUND

Facial trauma can have long-lasting consequences on an individual's physical, mental, and social well-being. The authors sought to assess the long-term outcomes of patients with facial injuries.

METHODS

This is a prospective multicenter cohort study of patients with face abbreviated injury scores ≥1 within the Functional Outcomes and Recovery after Trauma Emergencies registry. The Functional Outcomes and Recovery after Trauma Emergencies registry collects patient-reported outcomes data for patients with moderate-severe trauma 6 to 12 months after injury. Outcomes variables included general and trauma-specific quality of life, functional limitations, screening for post-traumatic stress disorder, and postdischarge healthcare utilization.

RESULTS

A total of 188 patients with facial trauma were included: 69.1% had an isolated face and/or head injury and 30.9% had a face and/or head injuries as a part of polytrauma injury. After discharge, 11.7% of patients visited the emergency room, and 13.3% were re-admitted to the hospital. Additionally, 36% of patients suffered from functional limitations and 17% of patients developed post-traumatic stress disorder. A total of 34.3% patients reported that their injury scars bothered them, and 49.4% reported that their injuries were hard to deal with emotionally.

CONCLUSIONS

Patients who sustain facial trauma suffer significant long-term health-related quality of life consequences stemming from their injuries.

Traumatic maxillofacial and brain injuries: a systematic review

Concomitant traumatic brain injury (TBI) and maxillofacial fractures carry the risk of significant morbidity and mortality. The aim of this review was to explore the demographics, types of injury, and complications of traumatic maxillofacial and brain injuries, in order to contribute to comprehensive health strategies. The PubMed and Scopus databases were systematically searched. Inclusion criteria were clinical studies investigating combined traumatic maxillofacial and brain injuries. Exclusion criteria were duplicates, non-English publications, non-full-text publications, publication date before 1990, and studies with insufficient data. Of the 754 articles identified, 15 eligible articles representing 1421 cases were included. The mean age was 38.3 years. Most cases were male (79%). The most common mechanism of injury was traffic accidents (53.4%). The most common fracture pattern was middle third fractures (52.4%). Seven studies had an explicit definition for TBI, using the Glasgow Coma Score (GCS), radiological evidence, and/or specific symptoms. There were 147 complications reported in 62 of 253 cases (24.5%), with the most common being infection (n=54, 36.7%). Significant risk factors for complications included delayed surgical repair, low GCS, and upper third fractures. Robust longitudinal evaluations with clear definitions of TBI are required. Gaps in knowledge include risk factors for complications and fracture pattern-GCS correlations.

Brain Injuries and Facial Fractures: A Prospective Study of Incidence of Head Injury Associated with Maxillofacial Trauma

Background

Presence of head injuries in patients with maxillofacial trauma is a lifethreatening condition. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery. Hence, the need to know about the incidence of head injuries associated with maxillofacial trauma becomes an important aspect.

Materials and Methods

A total of 100 patients were included in the study. Patient with head injuries associated with maxillofacial fractures was accounted to determine the incidence and pattern of head injuries accompanying maxillofacial trauma. They were evaluated for epidemiological demographic and clinical characteristics.

Results

The present study had 91% predominance of male patients with age ranging from 1 to 75 years. 91% cases were as a result of RTA. The most frequent maxillofacial injury represented was the fractured mandible. The incidence of head injuries associated with maxillofacial trauma was 67 %. Among all the patterns of head injuries, concussion was the most common head injury associated with maxillofacial trauma.

Conclusion

In our study, the risk of head injury increased significantly as the Glasgow Coma Scale score decreased and with increase in the number of facial fractures. There was association between head injury and maxillofacial trauma.

Association of traumatic head injuries and maxillofacial fractures: A retrospective study

BACKGROUND/AIMS

The association of traumatic head injury (THI) with maxillofacial fractures (MFF) is a major health concern worldwide. In spite of the close anatomical proximity of maxillofacial bones to the cranium, the association of THI with MFF is controversial. The aim of this study was to assess the association between THI and MFF. Other factors associated with THI in patients with MFF were also investigated.

MATERIALS AND METHODS

A hospital-based retrospective study was conducted at the OMFS Unit, Hospital USM, Kelantan, Malaysia. From 12 June 2013 to 31 December 2015, 473 patient records with MFF were reviewed to evaluate the association of THI and MFF.

RESULTS

A total of 331 patients (69.98%) presented with concomitant THI. The most common associated THI were cranial bone fractures (68.6%) followed by intracranial injuries and concussion. A significant association existed between the Glasgow coma scale (GCS) score and the presence of THI concomitant MFF with P-value <.001. The univariable logistic regression analysis revealed that age group (31-40 years), cause of injury (road traffic accident-RTA), all midface fracture types and most of the mandibular fracture types were statistically associated with the presence of THI. The multivariable logistic regression analysis revealed that the cause of the injury (RTA) and MFF types (nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and the alveolar process of mandible fractures) were statistically significantly associated with THI in patients with MFF.

CONCLUSION

There was a high prevalence of THI among patients with MFF (69.98%). RTA, nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and mandibular alveolar process fractures were significantly associated with THI in patients who sustained a MFF.

Video analysis of the biomechanics of a bicycle accident resulting in significant facial fractures

INTRODUCTION

This study aimed to use video analysis techniques to determine the velocity, impact force, angle of impact, and impulse to fracture involved in a video-recorded bicycle accident resulting in facial fractures. Computed tomographic images of the resulting facial injury are presented for correlation with data and calculations. To our knowledge, such an analysis of an actual recorded trauma has not been reported in the literature.

MATERIALS AND METHODS

A video recording of the accident was split into frames and analyzed using an image editing program. Measurements of velocity and angle of impact were obtained from this analysis, and the force of impact and impulse were calculated using the inverse dynamic method with connected rigid body segments. These results were then correlated with the actual fracture pattern found on computed tomographic imaging of the subject's face.

RESULTS

There was an impact velocity of 6.25 m/s, impact angles of 14 and 6.3 degrees of neck extension and axial rotation, respectively, an impact force of 1910.4 N, and an impulse to fracture of 47.8 Ns. These physical parameters resulted in clinically significant bilateral mid-facial Le Fort II and III pattern fractures.

DISCUSSION

These data confer further understanding of the biomechanics of bicycle-related accidents by correlating an actual clinical outcome with the kinematic and dynamic parameters involved in the accident itself and yielding a concrete evidence of the velocity, force, and impulse necessary to cause clinically significant facial trauma. These findings can aid in the design of protective equipment for bicycle riders to help avoid this type of injury.

Helping anesthesiologists understand facial fractures

Injuries to the oral and maxillofacial region are commonly encountered, and the appropriate management of patients with these injuries frequently requires the expertise of an anesthesiologist. Injuries to this region may involve any combination of soft tissue, bone, and teeth. Injuries to these structures often produce anesthesia-related challenges, which must be overcome to achieve optimal outcomes. This article addresses the common challenges faced by anesthesiologists specific to patients with facial fractures.