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Mao J, Xue J, Li Y, Zhou Q, Zhou S, Zhou Z. Factors influencing traumatic brain injuries in maxillofacial fractures: A 12-year retrospective analysis of 2841 patients. Dent Traumatol 2024; 40:435-443. [PMID: 38459650 DOI: 10.1111/edt.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND/AIM Results of studies investigating the association between traumatic brain injury (TBI) and maxillofacial fractures (MFs) have varied considerably. The present study aimed to evaluate the correlation between TBIs and MFs, as well as the impact of age, sex, trauma mechanism, and season on TBIs. MATERIALS AND METHODS This 12-year retrospective study of 2841 patients used univariate and multivariate logistic regression to assess the association between MFs and other factors impacting TBIs. RESULTS Among 2841 patients, 1978 TBIs occurred in 829 (29.2%), with intracranial injuries (n = 828) is the most common. Of 829 patients with TBIs, 688 were male and 141 were female, corresponding to a male-to-female ratio of 4.9:1.0. The most common age group was 40-49 years (24.6%). Vehicles (including motor vehicles and electric vehicles) accidents were the primary causes of injuries. Multivariate regression analyses revealed an increased risk for TBIs among males (odds ratio [OR] 0.632, p < 0.001). Patients >40 years of age were at higher risk for TBIs, especially those ≥70 years (OR 3.966, p = 0.001). Vehicle accidents were a high-risk factor for TBIs (OR 6.894, p < 0.001), and winter was the most prevalent season for such injuries (OR 1.559, p = 0.002). Risk for TBI increased by 136.4% in combined midfacial and mandibular fractures (p = 0.016) and by 101.6% in multiple midfacial fractures (p = 0.045). TBIs were less common in single mandibular fractures, notably in single-angle fractures, with a risk of only 0.204-fold. CONCLUSION TBIs in MFs were significantly correlated with sex, age, aetiology, season and fracture location. Maxillofacial surgeons and emergency physicians must be aware of the possible association between TBIs and MFs to assess and manage this complicated relationship in a timely manner.
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Affiliation(s)
- Jingjing Mao
- Ningxia Medical University, Yinchuan, Ningxia, P.R. China
- Ningxia Key Laboratory of Oral Diseases Research, Yinchuan, Ningxia, P.R. China
| | - Jiawen Xue
- Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Yunlong Li
- Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Qi Zhou
- Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Shuo Zhou
- Ningxia Medical University, Yinchuan, Ningxia, P.R. China
| | - Zhongwei Zhou
- Department of Oral and Maxillofacial Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China
- Clinical Research Center for Oral Diseases of Ningxia, Yinchuan, Ningxia, P.R. China
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Kozlowski KM, Rosston PA, Park AC, Hakimi AA, Socolovsky L, Wong BJF. A Thirteen-Year Analysis of Facial Fractures among Professional Soccer Players. Facial Plast Surg 2024; 40:120-126. [PMID: 36509105 DOI: 10.1055/a-1996-7595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study aims to identify the epidemiology and effects of facial fractures on return to play (RTP) in Major League Soccer (MLS) and the English Premier League (EPL). A total of 39 MLS players and 40 EPL players who sustained facial fractures from 2007 to 2019 were identified. Data on player demographics, the injury, and the impact of their injury on RTP were collected. Elbow-to-head was the most common mechanism of injury (20.3%). The most common fracture involved the nasal bone (48.3%). Most players (90%) RTP the same season. Players who sustained nasal fractures missed significantly fewer games (p < 0.001) than those who suffered other craniofacial fractures. Players treated surgically missed significantly more games (3.21 vs. 0.71, p = 0.006) and days (30.1 vs. 8.70, p = 0.002) than those managed nonoperatively. Significantly more EPL players who sustained facial fractures wore headgear upon RTP compared to MLS players (82% vs. 56%, p <0 .01). Most professional soccer players who sustain a facial fracture RTP the same season, but their recovery time can vary depending on the type of fracture, injury management, or injury severity. Our findings can help inform future craniofacial injury management as well as guidelines on player safety and fracture prevention.
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Affiliation(s)
- Konrad M Kozlowski
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California
| | | | - Asher C Park
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California
| | - Amir A Hakimi
- Department of Otolaryngology - Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Leandro Socolovsky
- Department of Otolaryngology - Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Brian J-F Wong
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California
- Department of Otolaryngology - Head & Neck Surgery, University of California - Irvine, Orange, California
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Adeleke AI, Hlongwa M, Makhunga S, Ginindza TG. Epidemiology of maxillofacial injury among adults in sub-Saharan Africa: a scoping review. Inj Epidemiol 2023; 10:58. [PMID: 37968736 PMCID: PMC10652446 DOI: 10.1186/s40621-023-00470-5] [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: 09/14/2023] [Accepted: 11/05/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Injuries remain one of the leading causes of death globally. These disproportionately affect young adults and are particularly prevalent in sub-Saharan Africa (SSA). Maxillofacial injuries (MI) pose significant challenges to public health systems. However, much remains unknown regarding the epidemiology and extent of the financial burden in resource-limited areas, such as SSA, further necessitating more research and support. This scoping review aims to investigate the mechanism, distribution, and financial impact of MI in adults aged ≥ 18 years in SSA. MAIN BODY The scoping review was guided by the methodological frameworks of Arksey and O'Malley and Levac. An electronic literature search for English-published articles on maxillofacial injuries in adults ≥ 18 years was conducted in Scopus, Medline, PubMed, Science Direct, CINAHL, Health Source: Nursing/Academic Edition, and grey literature. The PRISMA chart was used to document database searches and screening outcomes while reporting was guided by PRISMA-ScR. The data extraction process revolved around the predefined study outcomes, which encompassed the study characteristics and epidemiological parameters. The review used a narrative approach to report findings and evaluate publication quality using the STROBE checklist. The database search yielded 8246 studies, of which 30 met the inclusion criteria. A total of 7317 participants were included, 79.3% of whom were males. The peak age range for incidence was between 18 and 40 years. Road traffic collision (RTC) was the leading cause of MI, 59% of which resulted from motorcycle collisions. Assault/interpersonal violence ranked as the second leading cause of MI. The mandible was MI's most frequently affected hard tissue, followed by the midface. Factors such as alcohol/illicit drug use, poor knowledge of traffic regulations, and non-observance of these regulations were associated with MI. In our study, the cost range for mandibular fractures was $200-$468.6, borne by victims and their families. CONCLUSIONS Maxillofacial injuries are predominantly caused by road traffic collisions and assaults in SSA. The findings can provide valuable insights into policy decisions and prevention strategies aimed at reducing injury burden. Further research is warranted to explore the psychological impact of MI, including PTSD, for tailored support and intervention. Scoping Review Registration The protocol has been registered on the Open Science Framework. Registration DOI: https://doi.org/10.17605/OSF.IO/BWVDK .
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Affiliation(s)
- Adekunle I Adeleke
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Mazisi Kunene Road, Durban, 4041, South Africa.
| | - Mbuzeleni Hlongwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Mazisi Kunene Road, Durban, 4041, South Africa
- Public Health, Societies, and Belonging, Human Sciences Research Council, Pretoria, South Africa
| | - Sizwe Makhunga
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Mazisi Kunene Road, Durban, 4041, South Africa
| | - Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Mazisi Kunene Road, Durban, 4041, South Africa
- Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Othman A, Al-Mofreh Al-Qahtani F, Al-Qahtani H, Jaber M, Bishawi K, Hassan Khamis A, Al-Shanably A. Traumatic brain injuries and maxillofacial fractures: a systematic review and meta-analysis. Oral Maxillofac Surg 2023; 27:373-385. [PMID: 35610526 DOI: 10.1007/s10006-022-01076-9] [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: 02/16/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Ahmad Othman
- Oral and Maxillofacial Surgery Department, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | | | | | - Mohamed Jaber
- Clinical Sciences Department, College of Dentistry, Ajman University, P.O. Box 346, Ajman, United Arab Emirates.
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Adeleke AI, Hlongwa M, Makhunga S, Ginindza TG. Mapping Evidence on the Epidemiology and Cost Associated with Maxillofacial Injury among Adults in Sub-Saharan Africa: A Scoping Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1531. [PMID: 36674286 PMCID: PMC9865531 DOI: 10.3390/ijerph20021531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Maxillofacial injury (MI) occurs universally, for it disregards preference for age, gender, and geographical region. The global incidence and prevalence of facial fractures rose by 39.45% and 54.39%, respectively, between the years 1990 to 2017. Projections indicate that the burden of injuries will persist in sub-Saharan Africa (SSA) in the next twenty years. This scoping review aims to map the literature on MI epidemiology and the economic burden on society in SSA. (2) Methods: The methodology presented by Arksey and O'Malley and extended by Levac and colleagues will be employed in the scoping review. The researcher will report the proposed review through the Preferred Reporting Items for Systematic Review, and Meta-Analysis extension for scoping reviews (PRISMA-ScR). The review will include studies encompassing MI in sub-Saharan African adults 18 years and above. (3) Results: This will be presented as a thematic analysis of the data extracted from the included studies, and the Nvivo version 12 will be employed. (4) Discussion: We anticipate searching for related literature on the prevalence, incidence, risk factors, mortality, and cost associated with MI in the adult population of SSA. The conclusion from the review will assist in ascertaining research gaps, informing policy, planning, authorizing upcoming research, and prioritizing funding for injury prevention and management.
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Affiliation(s)
- Adekunle I. Adeleke
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Mbuzeleni Hlongwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7925, South Africa
| | - Sizwe Makhunga
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Trends of maxillofacial and mandibular fractures in level I and II trauma patients in a tertiary hospital in Saudi Arabia. Saudi Dent J 2022; 34:772-778. [PMID: 36570582 PMCID: PMC9767832 DOI: 10.1016/j.sdentj.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Maxillofacial injury is a major health concern worldwide. Incidence of maxillofacial fractures is influenced by socio-demographic, economic, and cultural factor of the population investigated. Identifying the patterns of these fractures is crucial to establish effective treatments and prevention measures. The aim of the study was to to analyze the incidence, etiology, and types of maxillofacial fractures in a tertiary trauma center. Methods A retrospective analysis was conducted for all patients who were admitted with maxillofacial fractures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of of 422 patients with 978 maxillofacial fractures were enrolled over a 4-year period. Results Among the 422 patients, 387 (91.8%) were males, and 35 (8.2%) were females. The mean age of our population was 31.1 years old. Our study has shown that motor vehicle accidents are the leading cause of maxillofacial fractures, followed by pedestrian trauma. The most common maxillofacial fractures were orbital fractures, followed by maxillary fractures. The mandibular body was most fractured among mandibular fractures. Our data has shown that males have higher incidence of maxillofacial fractures than females. Conclusion Our study further validated that road traffic accidents are the most common cause of maxillofacial fractures in our region. These findings emphasized the importance of improving road safety protocols and enforcing traffic laws.
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Spinella MK, Jones JP, Sullivan MA, Amarista FJ, Ellis E. Most Facial Fractures Don’t Require Surgical Intervention. J Oral Maxillofac Surg 2022; 80:1628-1632. [DOI: 10.1016/j.joms.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
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Porto DE, da Silva Barbirato D, Cavalcanti AL, de Souza Andrade ES. Pattern of oral and maxillofacial trauma and associated factors: An 8-year prospective study. Dent Traumatol 2022; 38:356-366. [PMID: 35583858 DOI: 10.1111/edt.12758] [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: 06/11/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Oral and maxillofacial trauma (OMFT) is a public health problem due to its high occurrence and demand for resources for its management and the financial and social impact of OMFT victims on the health system. The aim of this study was to conduct an 8-year prospective analysis of OMFT cases from an emergency service. MATERIALS AND METHODS A hospital-based 8-year prospective study on OMFT and associated factors was performed on data from December 2011 to December 2019. Data regarding sociodemographic (gender, age, and skin color) and socio-economic profiles (educational level, family income, and occupation), OMFT profile (etiology, OMFT type, and treatment), associated factors [alcohol consumption and personal protective equipment (PPE) use], OMFT occurrence (injury day and hour), length of hospital stay, and cost were collected. Descriptive and inferential analyses of data were performed. RESULTS Most OMFT cases involved men with low schooling and family income, resulting from traffic accidents. OMFT severity was associated with longer hospital stay, higher hospital costs and nonuse of PPE, midface fractures (mainly orbital-zygomatic fractures), closed reduction, and open reduction/internal fixation. Traffic accidents were the main cause of longer hospital stays for victims aged 41-60 years with better socio-economic status compared with cases that had higher hospital costs. In general, higher hospital costs were associated with victims of violence under 40 years of age, with low schooling and farmers. Alcohol consumption and non-use of PPE also contributed to increasing the length of hospital stay. CONCLUSION Oral and maxillofacial trauma severity was associated with longer hospital stay and higher hospital costs. Associated factors such as alcohol consumption and non-use of PPE contributed to increase the length of hospital stay and OMFT severity.
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Affiliation(s)
- Damião Edgleys Porto
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Pernambuco, Recife, Brazil
| | - Davi da Silva Barbirato
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Pernambuco, Recife, Brazil
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Aleksanyan LV, Poghosyan AY, Misakyan MS, Minasyan AM, Bablumyan AY, Tadevosyan AE, Muradyan AA. Epidemiology of maxillofacial injuries in "Heratsi" No 1 university hospital in Yerevan, Armenia: a retrospective study. BMC Oral Health 2022; 22:123. [PMID: 35413822 PMCID: PMC9002220 DOI: 10.1186/s12903-022-02158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to perform a retrospective analysis of the prevalence, etiologies, types of maxillofacial injuries (MFIs), sites of maxillofacial fractures (MFFs) and their management in Yerevan, Armenia.
Methods A retrospective cross-sectional study was conducted. The extracted data included age, sex, date of referral, mode of injury, etiology, radiology records and treatment methods. Study outcomes were measured using percentages, means, standard deviations and tests of proportions. P < .05 was considered significant. Results A total of 204 patients had a mean age of 36.26 ± 1.08 years (156 males and 48 females), and a total of 259 MFIs were recorded between 2017 and 2020. Interpersonal violence was found to be the most common etiology of MFFs in this study (42.1%), followed by road traffic accidents (RTAs) (27.9%) and falls (18.6%). The nasal bone was the most common injury site (47.5%), followed by the mandible (31.4%) and zygomatic complex (11.7%). The most common fracture site was the mandibular angle (37.9%), followed by the symphysis/parasymphysis (28.1%) and body (12.6%). Isolated soft tissue injuries were reported in 5.9% of the cases. The majority of MFFs were treated by open reduction and internal fixation. Conclusion Interpersonal violence, followed by RTAs and falls, was the most common cause of MFIs. Males in the 21–30 years age group had the highest MFI incidence rate. The nasal bone was the most common injury site, followed by the mandible and zygomatic complex. Social education with the objective of reducing aggression and interpersonal conflict should be improved, and appropriate RTA prevention strategies should be strengthened and implemented.
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Affiliation(s)
- Lusine V Aleksanyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia
| | - Anna Yu Poghosyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia.
| | - Martin S Misakyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia
| | - Armen M Minasyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Aren Yu Bablumyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Artashes E Tadevosyan
- Department of Public Health and Healthcare, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Armen A Muradyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
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Correlation Between Sports-Related Maxillofacial Injuries and Head Injuries: A Five-Year Retrospective Study. J Craniofac Surg 2021; 33:1170-1173. [PMID: 34930879 DOI: 10.1097/scs.0000000000008435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE As sports have become more diverse and demanding, the number of patients with a maxillofacial injury accompanied by a cranial injury or neurological symptoms has increased. This study examined the correlation between sports-related maxillofacial injuries and head injuries. PATIENTS AND METHODS Among the patients who visited the emergency department of Pusan National University Dental Hospital due to a maxillofacial injury from sporting activities between 2014 and 2018, those who additionally had head injuries were retrospectively examined. Sporting activities were classified according to the American Academy of Pediatrics classification, and severity of injuries was determined using the Facial Injury Severity Scale (FISS). Patients whose medical records showed neurological symptoms and who underwent brain computed tomography for concomitant head injury were selected. The association between each of these variables, including age and gender, was statistically analyzed. RESULTS A total of 95 patients were included in this study, most of whom were male teenagers, and cycling was the most common cause of injuries. The mean FISS score was 0.79. Brain computed tomography was conducted for 91 patients, and 28 patients reported neurological symptoms. Only 11 patients underwent advanced evaluation in the neurology or neurosurgery department. Most patients were diagnosed with contusion and concussion and were monitored without any treatment. CONCLUSIONS Higher FISS values did not reflect the severity of maxillofacial and head injury. In this study, there were some patients with cranial fracture and cerebral hemorrhage with mild neurosurgical symptoms of facial trauma. Although the incidence of head trauma is not high, the necessity of wearing protective equipment cannot be overemphasized because severe trauma is permanent. Neurological signs and symptoms of patients with maxillofacial trauma should not be overlooked and require a thorough evaluation.
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A Prediction Model for Selective Use of Facial Computed Tomography in Blunt Head Trauma Patients. Plast Reconstr Surg 2021; 148:583e-591e. [PMID: 34550943 DOI: 10.1097/prs.0000000000008371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Head trauma patients may have concomitant facial fractures, which are usually underdetected by head computed tomography alone. This study aimed to identify the clinical indicators of facial fractures and to develop a risk-prediction model to guide the discriminative use of additional facial computed tomography in head trauma. METHODS The authors retrospectively reviewed head trauma patients undergoing simultaneous head and facial computed tomography at a Level II trauma center from 2015 to 2018. Multivariate logistic regression analysis was used to evaluate independent risk factors for concomitant facial fractures in head trauma patients using data collected from 2015 to 2017, and a risk-prediction model was created accordingly. Model performance was validated with data from 2018. RESULTS In total, 5045 blunt head trauma patients (development cohort, 3534 patients, 2015 to 2017; validation cohort, 1511 patients, 2018) were enrolled. Concomitant facial fractures occurred in 723 head trauma patients (14.3 percent). Ten clinical and head computed tomographic variables were identified as predictors, including age, male sex, falls from elevation, motorcycle collisions, Glasgow Coma Scale scores less than 14, epistaxis, tooth rupture, facial lesions, intracranial hemorrhage, and skull fracture. In the development cohort, the model showed good discrimination (area under the receiver operating characteristic curve = 0.891), calibration (Hosmer-Lemeshow C test, p = 0.691), and precision (Brier score = 0.066). In the validation cohort, the model demonstrated excellent discrimination (area under the receiver operating characteristic curve = 0.907), good calibration (Hosmer-Lemeshow C test, p = 0.652), and good precision (Brier score = 0.083). With this model, 77.1 percent of unnecessary facial computed tomography could be avoided. CONCLUSION This model could guide the discriminative use of additional facial computed tomography to detect concomitant facial fractures in blunt head trauma. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Porto P, Cavalcanti YW, Forte FD. Maxillofacial trauma due to traffic accidents and falls: an exploratory study of associated factors. Med Oral Patol Oral Cir Bucal 2021; 26:e349-e356. [PMID: 33340082 PMCID: PMC8141322 DOI: 10.4317/medoral.24229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- P Porto
- Health Science Center, Paraíba Federal University campus universitário I, Castelo Branco I. João Pessoa, Paraíba, Brazil. Zip-code 58051-900
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Juncar M, Tent PA, Juncar RI, Harangus A, Mircea R. An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients. BMC Oral Health 2021; 21:128. [PMID: 33731083 PMCID: PMC7968332 DOI: 10.1186/s12903-021-01503-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention.
Methods
A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients’ medical records. Statistical analysis was performed. A value of p < 0.05 was considered statistically significant. Results The incidence of maxillofacial fractures was high among patients in the 20–29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions (p = 0.001, p = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks (p = 0.001). Conclusions Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20–29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01503-5.
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Affiliation(s)
- Mihai Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Paul Andrei Tent
- Department of Oral and Maxillofacial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania.
| | - Raluca Iulia Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Antonia Harangus
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu" University of Medicine and Pharmacy, 400337, Cluj-Napoca, Romania
| | - Rivis Mircea
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania
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Mousavinejad M, Mozafari J, Ilkhchi RB, Hanafi MG, Ebrahimi P. Intravenous Tranexamic Acid for Brain Contusion with Intraparenchymal Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial. Rev Recent Clin Trials 2021; 15:70-75. [PMID: 31744452 DOI: 10.2174/1574887114666191118111826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery. METHODS This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS). RESULTS 40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively). CONCLUSION Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.
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Affiliation(s)
- Maryam Mousavinejad
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Mozafari
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Bahrami Ilkhchi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Pouya Ebrahimi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Saponaro G, Gasparini G, Pelo S, Todaro M, Soverina D, Barbera G, Doneddu P, Moro A. Influence of SARS-CoV-2 lockdown on the incidence of facial trauma in a tertiary care hospital in Rome, Italy. Minerva Dent Oral Sci 2020; 71:96-100. [PMID: 33245227 DOI: 10.23736/s2724-6329.20.04446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Italy has been the first affected country in the western hemisphere by SARS-CoV-2 with over 200,000 cases during the first months of the pandemics. To control the spread of the virus, the whole country was placed under lockdown with limitations in the circulation of people and vehicles from March 2020 to the first half of the month of May. METHODS We aimed to analyze the incidence and type of facial traumas referred to our tertiary care hospital during the months of Italy lockdown due to SARS-CoV-2 spread compared with those during the same months of 2019 to determine eventual variations in the incidence, type and causes of trauma. RESULTS During the 2 months of COVID-19-related lockdown, a dramatic decrease in facial trauma patients was observed at our tertiary care hospital with a shift toward older age ranges. Regarding the causes of trauma, the largest percentage reduction was found in road, sports and work accidents; this percentage reduction was not found in aggressions. CONCLUSIONS A small increase in the percentage was also found regarding surgical indications, likely because more severe cases were more prone to be referred to the hospital despite the fear of being infected.
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Affiliation(s)
- Gianmarco Saponaro
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Giulio Gasparini
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sandro Pelo
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Mattia Todaro
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Davide Soverina
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giorgio Barbera
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Piero Doneddu
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Moro
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
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Azadani EN, Townsend J, Peng J, Wheeler K, Xiang H. The association between traumatic dental and brain injuries in American children. Dent Traumatol 2020; 37:114-122. [PMID: 33128842 DOI: 10.1111/edt.12611] [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: 07/18/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM It is crucial that dentists who treat traumatic dental injuries rule out concomitant brain injuries. Despite anatomic proximity, controversy exists regarding association between facial trauma and head injury. The aim of this study was to examine the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBI) using a national dataset of emergency department (ED) visits. MATERIAL AND METHODS Nationwide Emergency Department Sample (NEDS) data, one of the Healthcare Cost and Utilization Project (HCUP) datasets, were analyzed. Encounters of patients age 0-18 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with DAT and TBI in the 2010-2014 NEDS were identified. Data were analyzed using descriptive statistics, chi-square test, and logistic regression models to investigate the association between DAT and TBI and factors associated with TBI in DAT-positive patients. RESULTS During the study period, 6 281 658 ED visits were associated with traumatic injuries. DAT was recorded in 93 408 (1.5%) and TBI was recorded in 996 334 (15.9%) of these traumatic injury visits. Within the group of DAT-positive encounters, 7035 (7.5%) had codes associated with TBI. Of trauma encounters where a DAT was not involved (6 188 250 encounters), 989 299 (16%) had an associated TBI code. Patients with DAT had 0.20 odds of having TBI (95% CI, 0.19-0.20, P < .0001) compared with patients who did not have DAT when all other confounding variables were kept constant. Having multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT. CONCLUSIONS There was an inverse association between DAT and TBI in this study population.
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Affiliation(s)
- Ehsan N Azadani
- Department of Dentistry, Nationwide Children's Hospital and Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Janice Townsend
- Department of Dentistry, Nationwide Children's Hospital and Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Jin Peng
- Research Information Solutions and Innovation Research & Development, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Krista Wheeler
- Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.,Center for Pediatric Trauma Research and Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research and Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital and Division of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Pattern of Maxillofacial Trauma and Associated Factors in Traffic Accident Victims. J Craniofac Surg 2020; 32:1010-1013. [PMID: 32956302 DOI: 10.1097/scs.0000000000007002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Ţent PA, Juncar RI, Juncar M. Epidemiological Analysis of Zygomatic Bone Fractures in North-Western Romanian Population: A 10-Year Retrospective Study. In Vivo 2020; 34:2049-2055. [PMID: 32606181 DOI: 10.21873/invivo.12006] [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: 04/05/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Midface fractures represent a challenge for medical practitioners due to the severe esthetic and functional consequences. This study aimed to determine the causes and to provide a demographic analysis of zygomatic bone fractures in our geographical area, with a view to implementing the necessary prevention methods, training the medical staff for a certain type of patients and decreasing the required costs. PATIENTS AND METHODS A retrospective statistical epidemiological analysis of 242 patients with zygomatic bone fractures over a 10-year period was performed. RESULTS The most affected age group was 20-29 years (27.27%). The most affected were men (n=211, 87.19%) from urban areas (n=140, 57.85%), and without education (n=122, 50.41%). The most frequent cause was interpersonal violence (54.04%), followed by falls (17.36%) and road traffic accidents (16.53%). CONCLUSIONS Interpersonal violence as a cause of zygomatic bone fractures is currently reaching epidemic proportions. Taking legal measures to prevent aggression is a public health emergency that would considerably decrease the incidence of these fractures in our population.
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Affiliation(s)
- Paul Andrei Ţent
- Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Raluca-Iulia Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Mihai Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
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Hilaire CS, Johnson A, Loseth C, Alipour H, Faunce N, Kaminski S, Sharma R. Facial fractures and associated injuries in high- versus low-energy trauma: all are not created equal. Maxillofac Plast Reconstr Surg 2020; 42:22. [PMID: 32601595 PMCID: PMC7312115 DOI: 10.1186/s40902-020-00264-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Facial fractures (FFs) occur after high- and low-energy trauma; differences in associated injuries and outcomes have not been well articulated. Objective To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms. Methods We conducted a 6-year retrospective local trauma registry analysis of adults aged 18–55 years old that suffered a FF treated at the Santa Barbara Cottage Hospital. Fracture patterns, concomitant injuries, procedures, and outcomes were compared between patients that suffered a high-energy mechanism (HEM: motor vehicle crash, bicycle crash, auto versus pedestrian, falls from height > 20 feet) and those that suffered a low-energy mechanism (LEM: assault, ground-level falls) of injury. Results FFs occurred in 123 patients, 25 from an HEM and 98 from an LEM. Rates of Le Fort (HEM 12% vs. LEM 3%, P = 0.10), mandible (HEM 20% vs. LEM 38%, P = 0.11), midface (HEM 84% vs. LEM 67%, P = 0.14), and upper face (HEM 24% vs. LEM 13%, P = 0.217) fractures did not significantly differ between the HEM and LEM groups, nor did facial operative rates (HEM 28% vs. LEM 40%, P = 0.36). FFs after an HEM event were associated with increased Injury Severity Scores (HEM 16.8 vs. LEM 7.5, P <0.001), ICU admittance (HEM 60% vs. LEM 13.3%, P <0.001), intracranial hemorrhage (ICH) (HEM 52% vs. LEM 15%, P <0.001), cervical spine fractures (HEM 12% vs. LEM 0%, P = 0.008), truncal/lower extremity injuries (HEM 60% vs. LEM 6%, P <0.001), neurosurgical procedures for the management of ICH (HEM 54% vs. LEM 36%, P = 0.003), and decreased Glasgow Coma Score on arrival (HEM 11.7 vs. LEM 14.2, P <0.001). Conclusion FFs after HEM events were associated with severe and multifocal injuries. FFs after LEM events were associated with ICH, concussions, and cervical spine fractures. Mechanism-based screening strategies will allow for the appropriate detection and management of injuries that occur concomitant to FFs. Type of study Retrospective cohort study. Level of evidence Level III.
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Affiliation(s)
| | - Arianne Johnson
- Santa Barbara Cottage Hospital, Santa Barbara, California USA
| | - Caitlin Loseth
- Santa Barbara Cottage Hospital, Santa Barbara, California USA
| | - Hamid Alipour
- Santa Barbara Cottage Hospital, Santa Barbara, California USA
| | - Nick Faunce
- Santa Barbara Cottage Hospital, Santa Barbara, California USA
| | | | - Rohit Sharma
- Santa Barbara Cottage Hospital, Santa Barbara, California USA
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Salehi PP, Heiser A, Torabi SJ, Azizzadeh B, Lee J, Lee YH. Facial Fractures and the National Basketball Association: Epidemiology and Outcomes. Laryngoscope 2020; 130:E824-E832. [DOI: 10.1002/lary.28690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Parsa P. Salehi
- Department of Surgery, Otolaryngology–Head and Neck Surgery Yale University School of Medicine New Haven Connecticut U.S.A
| | - Alyssa Heiser
- Department of Otolaryngology–Head and Neck Surgery The University of Vermont Medical Center Burlington Vermont U.S.A
| | - Sina J. Torabi
- Department of Surgery, Otolaryngology–Head and Neck Surgery Yale University School of Medicine New Haven Connecticut U.S.A
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery Beverly Hills California U.S.A
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery David Geffen School of Medicine at the University of California Los Angeles California Los Angeles U.S.A
| | - Jonathan Lee
- Department of Surgery, Division of Plastic Surgery Baystate Medical Center Springfield Massachusetts U.S.A
| | - Yan H. Lee
- Department of Surgery, Otolaryngology–Head and Neck Surgery Yale University School of Medicine New Haven Connecticut U.S.A
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Rostyslav Y, Yakovenko L, Irina P. Fractures of the lower jaw in children (causes, types, diagnosis and treatment). Retrospective 5 year analysis. J Oral Biol Craniofac Res 2020; 10:1-5. [PMID: 32025479 DOI: 10.1016/j.jobcr.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022] Open
Abstract
Background/aim Epidemiology of the lower jaw fractures varies between populations. This study explores the epidemiology of the lower jaw fractures at the Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University. Methods This is a retrospective analysis of 210 case histories of children with traumatic fractures of the lower jaw, from the age of 6 months-18 years old, carried out at the Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, from January 2014 to December 2018. Results The most common cause of the mandibular fractures was falling 142 (67%). Mostly, qualified help was sought on the first day of injury (n = 103-49%). X-ray diagnostics was performed for all patients, but in different forms: orthopantomography was performed in 57 cases (27%), panoramic radiographs of the lower jaw in a direct projection - 17 (8%), and CT studies - in 136 (65%) children. The immobilization of fractured fragments of the lower jaw is mainly carried out using the double jaw splinting according to Tigerstedt 153 (73%), in combination with osteosynthesis - 29 (14%) cases. Conclusion Fractures of the lower jaw occurred more commonly between the ages of 7 and 17 years, the cause of which in most cases was a fall. The most common location of the mandibular fractures was-the condylar process. The most common method of fixing fragments of the lower jaw was double jaw splinting.
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Affiliation(s)
- Yehorov Rostyslav
- Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, 13, T. Shevchenko Blvd, Kyiv, 01601, Ukraine
| | - Lyudmila Yakovenko
- Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, 13, T. Shevchenko Blvd, Kyiv, 01601, Ukraine
| | - Primak Irina
- Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, 13, T. Shevchenko Blvd, Kyiv, 01601, Ukraine
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AlHammad Z, Nusair Y, Alotaibi S, Ababtain R, Alsulami S, Aljumah G. A cross-sectional study of the prevalence and severity of maxillofacial fractures resulting from motor vehicle accidents in Riyadh, Saudi Arabia. Saudi Dent J 2019; 32:314-320. [PMID: 32874072 PMCID: PMC7452011 DOI: 10.1016/j.sdentj.2019.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/19/2019] [Accepted: 09/29/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To investigate the prevalence and severity of maxillofacial fractures resulting from motor vehicle accidents (MVAs) at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Materials and methods A cross-sectional study of 325 males (89%) and 47 females (9%) was conducted that retrospectively reviewed records of patients referred to oral and maxillofacial surgery department from emergency department from 1st January 2016 to 31st December 2017 at KAMC, Riyadh. Results A total of 372 subjects were included in the study. MVAs (80%) were the most prevalent cause of trauma. The age range most susceptible to MVAs was between 20 and 24 years old (28%). The most common site of fracture was the midface (64%), specifically orbit (32%). For mandibular fractures, the subcondylar was the most common site of fractures (19%). The most common treatment approach was conservative (65%). In terms of severity, approximately half of patients needed admission to the intensive care unit (ICU) (50%); the mean score on the Glasgow Coma Scale (GCS) was 11.34, but most scores fell in the mild range; and (68%) of subjects presented with other associated systemic injuries, especially orthopedic injuries (36%). Conclusions MVAs were the main cause of trauma and affected mainly young males. The most common site of fracture was midface, specifically orbit. Subcondylar was the most prevalent fracture site for mandibular fractures. The severity of MVAs injuries was significantly higher compared to non-MVAs injuries. We suggest enforcing legislation and regulations on road safety such as the use of compulsory seat belts.
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Affiliation(s)
- Ziyad AlHammad
- Saudi Board of Oral and Maxillofacial Surgery, Riyadh, Saudi Arabia
| | - Yanal Nusair
- Oral and Maxillofacial Surgery, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami Alotaibi
- Saudi Board of Oral and Maxillofacial Surgery, Riyadh, Saudi Arabia
| | - Razan Ababtain
- Saudi Board of Oral and Maxillofacial Surgery, Riyadh, Saudi Arabia
| | - Salma Alsulami
- Internal Medicine, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Ghada Aljumah
- Department of Oral and Maxillofacial Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Rêgo ICQ, Vilarinho SMM, Rodrigues CKF, Correia PVDAR, Junqueira JLC, Oliveira LB. Oral and cranio-maxillofacial trauma in children and adolescents in an emergency setting at a Brazilian hospital. Dent Traumatol 2019; 36:167-173. [PMID: 31541558 DOI: 10.1111/edt.12515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS Very few studies have been performed to evaluate cranio-maxillofacial trauma diagnosed in hospitals in children and adolescents. The aim of this study was to perform an analysis of oral and cranio-maxillofacial trauma in the aforementioned population. MATERIALS AND METHODS A hospital-based retrospective study, which reviewed 1438 patient records, was conducted at the "Teresina Emergency Hospital", Brazil. Data regarding demographics, day of the week on which trauma occurred, type of injury, etiology, anatomic trauma site, time of hospital admission, and associated comorbidities (or injuries) were collected. RESULTS There were 1092 (75.9%) males and 346 (24.1%) females. The largest group was adolescents aged between 13 and 18 years (956, 66.5%). The majority lived in urban areas (69%). Trauma occurred most frequently during the week. The most prevalent etiology was road traffic accidents involving motorcycles (771, 53.6%) causing facial and skull fractures (598, 41%). The most prevalent soft tissue lesions were facial abrasions (49%), followed by injuries to the cheek (16.7%). Comorbidities associated with craniofacial trauma were present in 82%, with complications from traumatic brain injuries being the most prevalent (65.6%) Dental trauma was recorded in only 81 cases (5.6%). CONCLUSION Male adolescents living in urban areas were most affected by craniofacial trauma. The most common cause was road traffic accidents involving motorcycles, resulting in facial and skull fractures. Complications from traumatic brain injuries were the most common associated injuries.
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Affiliation(s)
- Isabel Cristina Quaresma Rêgo
- School of Dentistry, Uninovafapi, Teresina, Brazil.,School of Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil
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Jariod Ferrer ÚM, Blanco Sanfrutos S, Gavin Clavero MA, Simon Sanz MV, Uson Bouthelier T, Nadal Cristobal B. Epidemiological Study of the Socioeconomic Impact of Mandible Fractures in a Spanish Tertiary Hospital: Review of the Literature. J Maxillofac Oral Surg 2019; 18:217-223. [PMID: 30996541 DOI: 10.1007/s12663-018-1148-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Mandibles fractures are one of the most frequent pathologies treated in an Oral and Maxillofacial Department and represent a serious public health problem. Materials and Methods We present a retrospective study of patients treated for mandible fractures by the Oral and Maxillofacial Surgery Department in a Spanish tertiary hospital during 2010-2012. Results One hundred and thirty-nine patients with 201 mandible fracture sites were assisted in our department; 15% were female and 85% were male, with a male-to-female ratio of 5.5:1. The observed mean age was 35 years with a range between 15 and 89 years. The most frequent etiology of fractures was the assault (43%) followed by falls (32%). The most common fracture site was the mandibular angle (35%), followed by the parasymphysis (30%). Concerning combined fractures (60%), the most repeated association was the angle and the parasymphysis. The principal imaging test for diagnosis was the orthopantomography. The intermaxillary fixation was performed in the 25% of cases, and the rest of mandible fractures were fixed by osteosynthesis. The surgical treatment had an average of 4.2 days after the trauma, and the mean time of hospitalization was 6.5 days. Conclusion The principal aim of the treatment of mandible fractures is to restore the function of the patient occlusion. A malocclusion after surgery may decrease the patient quality of life, so a correct fracture reduction could shrink health spending. After the result shown in the present study, the social education should be improved in the developed countries with the objective of decline in the amount of aggressiveness.
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Affiliation(s)
- Úrsula M Jariod Ferrer
- 1Oral and Maxillofacial Department, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.,2Faculty of Medicina, Zaragoza University, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Sara Blanco Sanfrutos
- Oral and Maxillofacial Department, Can Misses Hospital, Carrer de Corona 11, 07800 Eivissa, Ibiza (Illes Balears) Spain
| | - Marina A Gavin Clavero
- 1Oral and Maxillofacial Department, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Maria Victoria Simon Sanz
- 1Oral and Maxillofacial Department, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Tomas Uson Bouthelier
- 1Oral and Maxillofacial Department, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Bartolomeu Nadal Cristobal
- 1Oral and Maxillofacial Department, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
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The Characteristics and Cost of Le Fort Fractures: A Review of 519 Cases From a Nationwide Sample. J Oral Maxillofac Surg 2019; 77:1218-1226. [PMID: 30853420 DOI: 10.1016/j.joms.2019.01.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE The aims were to report the characteristics of Le Fort fractures and to quantify the associated hospital costs. MATERIALS AND METHODS From October 2015 to December 2016, the National Inpatient Sample was searched for patients admitted with a primary diagnosis of a Le Fort fracture. Predictor variables were drawn from demographic, admission, and injury characteristics. The outcome variable was hospital cost. Summary statistics were calculated and compared among Le Fort patterns. Univariate comparisons and multivariate regression analyses were conducted to determine predictors associated with cost. RESULTS A total of 519 patients were identified in this cohort. Associated injuries included skull fractures (28%), intracranial hemorrhage (13%), cervical spine injury (9.8%), and concussion (9.1%). Seventy-three percent of patients received open reduction and internal fixation (ORIF) for their facial fractures during their admission, 13% received a tracheostomy, and 10% were mechanically ventilated for at least 1 day. The ventilation (P < .01) and tracheostomy (P < .01) rates increased with Le Fort complexity, as did length of stay (LOS; P < .01), costs (P < .01), and charges (P < .01). The mean costs of treating Le Fort I, II, and III fractures were $25,836, $28,415, and $47,333, respectively. Increased cost was independently associated with younger age, male gender, African-American ethnicity, Le Fort II and III patterns, motor vehicle accident etiology, mechanical ventilation requirement, tracheostomy, ORIF, transfer to an outside facility, and increased LOS. CONCLUSIONS The prevalence of head injuries and the need for respiratory support substantially increased with Le Fort complexity. Hospital costs were not markedly influenced by the diagnosis and management of associated injuries. Instead, costs were predominantly driven by fracture complexity and the need for necessary procedures, such as ORIF, tracheostomy, and mechanical ventilation.
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Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9024763. [PMID: 30895196 PMCID: PMC6393910 DOI: 10.1155/2019/9024763] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/14/2019] [Indexed: 11/18/2022]
Abstract
Background/Aim Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM). Methods A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05. Results Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively). Conclusion Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle.
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Povolotskiy R, Youssef P, Kaye R, Paskhover B. Facial Fractures in Young Adults: A National Retrospective Study. Ann Otol Rhinol Laryngol 2019; 128:516-523. [PMID: 30735056 DOI: 10.1177/0003489419830114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES "Young adulthood" is a term used to define individuals falling within the 18- to 22-year-old age range. Injuries account for more than a third of emergency department visits in this population. A particular area of concern is accidents that lead to injuries of the facial bones because they can have long-term functional, aesthetic, and psychosocial impacts. As many as 30 million young adults participate in some sort of sport in the United States per year, and facial injuries from these activities are not uncommon and thus require further exploration. METHODS The National Electronic Injury Surveillance System was used to conduct a retrospective review to explore patterns of maxillofacial fractures in young adult patients between the ages of 18 and 22 years from 2004 through 2017. The data analyzed yielded information about patient demographics, diagnoses, and associated products. RESULTS A total of 3486 emergency department visits were included in the study. The most common facial fractures were nasal fractures (64.4%), mandible fractures (12.3%), and orbital fractures (6.1%). The most common causes of fractures were sports (55.48%), fixed structures (6.39%), and stairs or steps (5.60%). The top 3 sports associated with facial fractures were basketball (25.4%), baseball (11.6%), and football (10.4%). CONCLUSIONS For young adult individuals, some sort of sporting activity is common outside of the National Collegiate Athletic Association. The overwhelming majority of facial fractures in this population were caused by sports, and the authors believe this issue warrants further exploration and discussion. According to the Centers for Disease Control and Prevention, an estimated 8.6 million sports- and recreation-related injuries occurred per year between 2011 and 2014. Despite ever growing research and guidelines into sports injury incidence and prevention, it is clear that sports are the cause of a large portion of maxillofacial fractures in the United States.
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Affiliation(s)
- Roman Povolotskiy
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Pavly Youssef
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Kaye
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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