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Canas M, Fonseca R, Diaz L, Filippis AD, Afzal H, Aldana JA, Machica C, Leonard J, Liang SY, Bochicchio K, Bochicchio GV. Open Mandible and Maxillary Fractures Associated with Higher Risk of Infection in Victims of Assault. Surg Infect (Larchmt) 2023; 24:376-381. [PMID: 36799978 PMCID: PMC10398716 DOI: 10.1089/sur.2022.295] [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] [Indexed: 02/18/2023] Open
Abstract
Background: Victims of assault (VOA) often present with fractures of the mandible and maxilla. They represent a complex challenge because of possible compromise of the airway, and infection-related complications because of potential involvement of the oral cavity. We hypothesized that open mandible and maxillary fractures in VOA are associated with a higher rate of infection compared with non-VOA patients with open facial fractures. Patients and Methods: Patients admitted to our level 1 trauma center from 2005 to 2020 with a diagnosis of open mandible and maxillary fractures were included. Demographics, mechanisms of injury, fracture location, cultures, infectious complications, antibiotic treatments, and clinical outcomes were abstracted. Patients were stratified by their mechanism of injury into VOA or non-VOA and were compared using χ2 and Student t-test using SPSS (IBM Corp, Armonk, NY). Results: We identified 316 patients with open mandible and maxillary fractures. There were 198 patients categorized as being VOA, and 118 as non-VOA. Nineteen of 316 patients were diagnosed with infection related to the fracture (3.8% abscesses, 1.9% cellulitis, and 1.9% osteomyelitis). Although the Injury Severity Score (ISS) was higher in non-VOA patients (5.8 ± 2.6 vs. 4.9 ± 1.8; p < 0.013), most of the infections were in the VOA cohort (17/19; 89.5%; p < 0.013). Conclusions: Open fractures of the mandible and maxilla in VOA are associated with a greater risk of infection compared with non-victims of assault. The relation between VOA and poor SDH has been studied recently; clinicians should be aware of this association and implement special considerations and appropriate follow-up visits to decrease the rate of infection in this currently expanding population.
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Affiliation(s)
- Melissa Canas
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ricardo Fonseca
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leonardo Diaz
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alejandro De Filippis
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hussain Afzal
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jose A. Aldana
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chris Machica
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer Leonard
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y. Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelly Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grant V. Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Mancera N, Do DP, Griepentrog GJ, Esmaili N. Assault-related Orbital Trauma at an Urban Level I Trauma Center: Racial Segregation and Other Neighborhood-level Social Determinants. Ophthalmic Plast Reconstr Surg 2023; 39:182-186. [PMID: 36190913 DOI: 10.1097/iop.0000000000002286] [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: 11/05/2022]
Abstract
PURPOSE To report the demographics of assault-related orbital fractures over a 7-year period treated at a level I urban trauma center, as well as describe and analyze the variation in assault rates across different racial/ethnic neighborhoods for patients residing in Milwaukee County. METHODS A retrospective chart review was conducted for patients who sustained assault-related orbital fractures from January 1, 2013, through December 31, 2019, at the Froedtert & Medical College of Wisconsin, in Milwaukee, Wisconsin. A series of negative binomial regression models evaluating the association of neighborhood (i.e., US census tract) racial/ethnic composition, poverty, unemployment, percentage female head-of-household, and education level with neighborhood rate of orbital trauma was conducted. RESULTS A total of 410 adult patients with orbital fractures attributed to assault were identified during the seven-year period, of whom 326 (80%) resided in Milwaukee County. Among these patients, 242 (74%) were male, 260 (81%) were single, and 206 (63%) were non-Hispanic Black. Majority non-Hispanic Black, Hispanic, and Other-type minority neighborhoods have 5.30, 3.35, and 3.94 times higher incidence rates of orbital assault, respectively, compared with the majority of non-Hispanic White neighborhoods. The elevated incidence rates were significantly attenuated across all minority neighborhoods after accounting for neighborhood factors of poverty, unemployment, and low education level. Low education had the strongest association with the incidence of assault-related orbital fractures, followed by unemployment. CONCLUSIONS Results indicate that minority neighborhoods suffer from compounded burdens of both social and economic disadvantage as well as violent assaults. Additional resources allocated to poor minority communities are needed.
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Affiliation(s)
- Norberto Mancera
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - D Phuong Do
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, U.S.A
| | - Gregory J Griepentrog
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Neda Esmaili
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
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3
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Gujrathi R, Tang A, Thomas R, Park H, Gosangi B, Stoklosa HM, Lewis-O’Connor A, Seltzer SE, Boland GW, Rexrode KM, Orgill DP, Khurana B. Facial injury patterns in victims of intimate partner violence. Emerg Radiol 2022; 29:697-707. [PMID: 35505264 PMCID: PMC9064123 DOI: 10.1007/s10140-022-02052-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 01/21/2023]
Abstract
Purpose To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV). Methods A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution’s violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns. Results The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19–76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients. Conclusion /advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.
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Affiliation(s)
- Rahul Gujrathi
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Anji Tang
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Richard Thomas
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hyesun Park
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Babina Gosangi
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hanni M. Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA USA
| | - Annie Lewis-O’Connor
- C.A.R.E. Clinic (Coordinated Approach to Resiliency & Empowerment), Brigham and Women’s Hospital, Boston, MA USA
| | - Steven E. Seltzer
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Giles W. Boland
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
- Brigham and Women’s Physicians Organization, Boston, USA
| | - Kathryn M. Rexrode
- Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
| | - Dennis P. Orgill
- Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
| | - Bharti Khurana
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
- Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
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Itakura G, Ito K, Muraoka H, Hirahara N, Okada H, Kaneda T. Risk Assessment of Jawbone Fracture by Mandibular Cortical Bone Width Using Computed Tomography. J HARD TISSUE BIOL 2021. [DOI: 10.2485/jhtb.30.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Go Itakura
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Kotaro Ito
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Naohisa Hirahara
- Department of Radiology, Nihon University School of Dentistry at Matsudo
| | - Hiroyuki Okada
- Department of Oral Pathology, Nihon University School of Dentistry at Matsudo
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo
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Clinical Decision Rule to Identify Orbital Wall Fracture Among Children: Retrospective Derivation and Validation Study. Pediatr Emerg Care 2020; 36:e280-e284. [PMID: 29016519 DOI: 10.1097/pec.0000000000001300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Head and face injuries are leading causes of emergency department visits in children. There is yet no clinical decision rule on face CT such as pediatric head CT rules. The goal was to develop and validate a clinical decision rule for identifying orbital wall fractures in children with periorbital trauma in the emergency department. METHODS This was a retrospective derivation and validation study. Children younger than 18 years who underwent orbit CT after periorbital trauma were included between January 2011 and December 2013 in 3 emergency centers. Among 16 candidate clinical variables, 13 clinical signs and symptoms were selected as clinical predictors. For the fracture model, these clinical predictors were analyzed by 3-fold cross-validation. Diagnostic performance was assessed using the area under the receiver operating characteristic (AUROC) curve in both cohorts. RESULTS Four variables (orbital rim tenderness, periorbital ecchymosis, painful extraocular movement, and nausea/vomiting) had the best predictive model with the highest AUROC value. The AUROC values for fracture prediction were 0.793 (95% confidence interval, 0.741-0.844) and 0.809 (95% confidence interval, 0.742-0.877) in the derivation cohort and validation cohort, respectively. The sensitivity and negative predictive values were 96.4% and 93.4%, respectively, in the derivation cohort, and 97.8% and 98.1%, respectively, in the validation cohort. The sum of these scores ranged from 0 to 4. Patients with a sum of scores of 1 or higher showed significantly increased risk for fracture. CONCLUSIONS The 4-variable predictive model can be useful for finding clinically important orbital wall fractures in children.
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Nissen NJ, Okhah ZI, Basta MN, Hsieh S, Crozier JW, Jehle CC, Rao V, Woo AS. Underdiagnosis of Nasoorbitoethmoid Fractures in Patients with Zygoma Injury. Plast Reconstr Surg 2020; 145:1001-1008. [PMID: 32221221 DOI: 10.1097/prs.0000000000006626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nasoorbitoethmoid fractures commonly accompany midface fractures and may be underdiagnosed, resulting in incomplete reconstruction or inadequate treatment following facial trauma. To better understand the nasoorbitoethmoid fracture diagnosis and treatment tendencies, the authors analyzed concomitant nasoorbitoethmoid injuries in the setting of zygoma fractures. METHODS The facial trauma database at a level I trauma center was evaluated. All patients with diagnosed zygoma fractures from June of 2011 to March of 2016 were assessed for a concomitant nasoorbitoethmoid injury. Documentation of these fractures in radiology, plastic surgery, and operative notes was recorded, as was the rate of nasoorbitoethmoid fracture surgical repair. RESULTS The authors identified 339 eligible patients and completed retrospective analysis of computed tomographic images for their 356 zygoma fractures. The incidence of concomitant nasoorbitoethmoid fractures was 30.6 percent (109 of 356). Documentation rates of nasoorbitoethmoid fractures were 0 percent, 3.7 percent, and 8.3 percent in radiology, plastic surgery, and operative notes, respectively. The rate of surgical correction of nasoorbitoethmoid injuries was 22.9 percent (25 of 109). Of those fractures identified, 44.9 percent (49 of 109) were minimally displaced or nondisplaced. Subset analysis of only significantly displaced fractures yielded an incidence of 16.8 percent (60 of 356). Of significantly displaced fractures, documentation rates were 0 percent, 6.7 percent, and 16.8 percent in radiology, plastic surgery, and operative notes, respectively. The surgical repair rate of significantly displaced fractures was 31.7 percent (19 of 60). CONCLUSIONS These findings suggest a high concomitance rate of nasoorbitoethmoid fractures with zygoma fractures and identify a tendency to underdocument and undertreat this injury pattern. Clinicians managing patients with midface trauma should have a high suspicion for nasoorbitoethmoid trauma. Plastic surgeons and radiologists should be better trained in identifying the nasoorbitoethmoid fracture pattern.
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Affiliation(s)
- Nicholas J Nissen
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Zachary I Okhah
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Marten N Basta
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Sun Hsieh
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Joseph W Crozier
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Charles C Jehle
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Vinay Rao
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Albert S Woo
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
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Facial trauma as physical violence markers against elderly Brazilians: A comparative analysis between genders. Arch Gerontol Geriatr 2016; 67:55-60. [PMID: 27420151 DOI: 10.1016/j.archger.2016.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/04/2016] [Accepted: 06/19/2016] [Indexed: 11/21/2022]
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Long SJ, Fone D, Gartner A, Bellis MA. Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales. BMJ Open 2016; 6:e011169. [PMID: 27558900 PMCID: PMC5013358 DOI: 10.1136/bmjopen-2016-011169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission. DESIGN Database analysis of 7 years' hospital admissions using the Patient Episode Database for Wales (PEDW). SETTING AND PARTICIPANTS Wales, UK, successive annual populations ∼2.8 million aged 0-74 years. PRIMARY OUTCOME The first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position. RESULTS A total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18-19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10-14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages. CONCLUSIONS Despite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of admission for violence are discussed.
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Affiliation(s)
- Sara Jayne Long
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - David Fone
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Andrea Gartner
- Division of Population Medicine, Cardiff University, Cardiff, UK
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An analysis of 711 victims of interpersonal violence to the face, Turin, Italy. J Craniomaxillofac Surg 2016; 44:1025-8. [DOI: 10.1016/j.jcms.2016.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/14/2016] [Accepted: 05/30/2016] [Indexed: 11/21/2022] Open
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Farneze RDB, Prosdocimo ML, Nogueira AP, Cavalcante MA, Hespanhol W, Teixeira TF, Valdetaro EMC, Gonçalves LS, Ferreira DDC. Study of the causes of facial fractures in a reference center in Rio de Janeiro, Brazil from 2003-2012. Dent Traumatol 2016; 32:507-509. [PMID: 27245692 DOI: 10.1111/edt.12286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study describes the facial fractures of patients at a reference center in oral and maxillofacial surgery of a Public University Hospital in the city of Rio de Janeiro, from January 2003 to December 2012. METHODS The data were collected from medical records and included the fractured bones, etiology, gender, and age of the patients. A total of 202 cases were identified, and 159 were included in the study (129 men and 30 women). RESULTS The mandible was the most commonly injured bone (90 cases, 73 men and 17 women) with a mean age of 33.7 years old (±15.2), and traffic accidents (75 cases) were shown to be the major cause. CONCLUSION In the city of Rio de Janeiro, young men in their fourth decade of life are prone to trauma to their facial bones, especially the mandible, and they are most commonly caused by traffic accidents.
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Affiliation(s)
- Renan de Barros Farneze
- Department of Oral and Maxillofacial Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maria Luiza Prosdocimo
- Department of Oral and Maxillofacial Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Nogueira
- Department of Oral and Maxillofacial Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maria Aparecida Cavalcante
- Department of Oral and Maxillofacial Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wagner Hespanhol
- Department of Oral and Maxillofacial Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Facial Fracture in the Setting of Whole-Body CT for Trauma: Incidence and Clinical Predictors. AJR Am J Roentgenol 2015; 205:W4-10. [PMID: 26102417 DOI: 10.2214/ajr.14.13589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of our study was to identify the incidence and clinical predictors of facial fracture in the setting of whole-body MDCT for trauma. MATERIALS AND METHODS The clinical data from the electronic medical records, including the final radiology reports, of 486 consecutive patients who underwent MDCT for trauma (head, cervical spine, chest, abdomen, and pelvis examinations) with dedicated maxillofacial reconstructions from October 1, 2011, to July 31, 2013, were studied. The clinical variables were compared between cohorts of patients with and those without facial fracture. The two-sample t test was used to compare continuous variables, and the Fisher exact test was used to compare categoric variables. RESULTS Two hundred sixteen (44.4%) patients had at least one fracture on the dedicated maxillofacial CT examinations, 215 of whom had facial physical examination findings (sensitivity = 99.5%). Of the 28 patients without documented physical examination findings, 27 did not have a facial fracture (negative predictive value = 96.4%). Statistically significant differences were found between positive and negative cases of facial fracture in patients with a Glasgow coma scale (GCS) score of 8 or less (p < 0.0001), an injury severity score of 16 or greater (p < 0.0001), acute alcohol intoxication according to blood alcohol concentration (BAC) (p = 0.0387), intubation at presentation (p < 0.0001), positive physical examination findings (p < 0.0001), and loss of consciousness (p = 0.0364). Falls from a height greater than standing height and open-vehicle collisions had the highest fracture rates (80.0% and 58.3%, respectively). CONCLUSION A negative finding at facial physical examination reliably excluded fracture. Clinical variables positively associated with facial fracture included the following: GCS score of 8 or less, ISS of 16 or greater, alcohol intoxication according to BAC, intubation at presentation, loss of consciousness, and the presence of abnormal facial findings at physical examination.
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Goulart DR, Colombo LDA, de Moraes M, Asprino L. What is expected from a facial trauma caused by violence? EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 5:e4. [PMID: 25635211 PMCID: PMC4306322 DOI: 10.5037/jomr.2014.5404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this retrospective study was to compare the peculiarities of maxillofacial injuries caused by interpersonal violence with other etiologic factors. MATERIAL AND METHODS Medical records of 3,724 patients with maxillofacial injuries in São Paulo state (Brazil) were retrospectively analyzed. The data were submitted to statistical analysis (simple descriptive statistics and Chi-squared test) using SPSS 18.0 software. RESULTS Data of 612 patients with facial injuries caused by violence were analyzed. The majority of the patients were male (81%; n = 496), with a mean age of 31.28 years (standard deviation of 13.33 years). These patients were more affected by mandibular and nose fractures, when compared with all other patients (P < 0.01), although fewer injuries were recorded in other body parts (χ(2) = 17.54; P < 0.01); Victims of interpersonal violence exhibited more injuries when the neurocranium was analyzed in isolation (χ(2) = 6.85; P < 0.01). CONCLUSIONS Facial trauma due to interpersonal violence seem to be related to a higher rate of facial fractures and lacerations when compared to all patients with facial injuries. Prominent areas of the face and neurocranium were more affected by injuries.
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Affiliation(s)
| | | | - Márcio de Moraes
- Division of Oral and Maxillofacial Surgery, FOP-UNICAMP, Piracicaba, São Paulo Brazil
| | - Luciana Asprino
- Division of Oral and Maxillofacial Surgery, FOP-UNICAMP, Piracicaba, São Paulo Brazil
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Ogura I, Kawashima Y, Muramatsu T, Ito K, Kaneda T. Characteristic computed tomographic findings of midface fractures relative to the cause of injury: a fall or violence. Oral Radiol 2014. [DOI: 10.1007/s11282-014-0195-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Ogura I, Sasaki Y, Kaneda T. Multidetector computed tomography of maxillofacial fractures. JAPANESE DENTAL SCIENCE REVIEW 2014. [DOI: 10.1016/j.jdsr.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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15
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Bilateral mandibular fractures. Pediatr Emerg Care 2014; 30:668-9. [PMID: 25186515 DOI: 10.1097/pec.0000000000000224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Peltola EM, Koivikko MP, Koskinen SK. The spectrum of facial fractures in motor vehicle accidents: an MDCT study of 374 patients. Emerg Radiol 2013; 21:165-71. [PMID: 24221020 DOI: 10.1007/s10140-013-1173-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022]
Abstract
Road traffic accidents are a major health problem worldwide resulting frequently in maxillofacial injuries. The purpose of the study was to assess the incidence and spectrum of facial fractures in patients involved in a motor vehicle accident (MVA). Using picture archiving and communication system, all requests for suspected facial trauma were retrieved during a 62-month period; 374 met the inclusion criteria. Two researchers interpreted the multidetector computed tomography images by consensus. The motor vehicles involved were divided into two groups: those involving a passenger car or a larger vehicle and those involving a motorized two-wheeler. Furthermore, the motor vehicle accidents were divided into collisions and run-off-road accidents. Of the 374 patients (aged 15-80, mean 34), 271 (72 %) were male and 103 (28 %) female. Of all patients, 262 (70 %) had a facial or skull base fracture; of these, multiple separate fractures were present in 56 %. Nasal fractures were the most common fractures followed by orbital, skull base, and maxillary fractures. Frontal bone, LeFort, and zygomatic arch fractures were always accompanied by other fractures. Fractures were more frequent in the group of collisions compared with run-off-road accidents. In the two-wheeled group, only 15 % did not have facial or skull base fractures. Fractures often occur in multitudes as 39 % of all patients have multiple facial or skull bone fractures, and thus, emergency radiologists should be familiar with the complexity of the injuries. Negative clear sinus sign and low-energy sentinel injuries should be trusted as indications of undetected injuries in MVA victims.
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Affiliation(s)
- Elina M Peltola
- Helsinki Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, 00029 HUS, Helsinki, Finland,
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Bali R, Sharma P, Garg A, Dhillon G. A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India. J Inj Violence Res 2013; 5:108-16. [PMID: 23594725 PMCID: PMC3683414 DOI: 10.5249/jivr.v5i2.331] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/08/2013] [Indexed: 11/23/2022] Open
Abstract
Background: The Department of Oral and Maxillofacial Surgery, D.A.V [C] Dental College and Hospital, Yamuna Nagar, Haryana, India conducted a study on patients with maxillofacial fractures in a time span of seven years (2003-2010). The purpose of this study was to evaluate their aetiology, incidence, patterns and different modalities employed for management. Methods: In this study, 740 patients with 1054 fractures were evaluated clinically and radiographically, based on which closed reduction and open reduction was undertaken. Review of patient records included: Age, sex, time, mechanism and etiology of injury, history of bleeding, unconsciousness and prior first aid, type of vehicle and use of preventive measures, type of fracture and treatment modalities. Results: Road traffic accidents accounted for highest number of fractures predominantly occurring in the age group of 21-30 years (38.3%)1,2. Males incurred more fractures with a male female ratio of 4.2: 1.Mandible was the most commonly fractured bone with parasymphysis being the commonest affected site.76.66% patients had associated head injury and 15.68 % had history of unconsciousness. Open reduction and internal fixation was the preferred modality for mandible whereas the mid face fractures were treated more often by closed methods. Conclusions: Injuries occurred more commonly in 20 – 40 age range with road traffic accident being the major etiological factor. Majority of the patients were driving two wheelers and most were under the effect of alcohol. Most of the injuries occurred during night and road traffic accidents (71.89%) were found to be the major etiological factor. Out of 532 road traffic accidents, 490 patients (66.2%) were on two wheelers, among whom 49(10%) were wearing helmet. In the mandible, fractures occurred most commonly in the parasymphyseal region (224, 30.2%), and out of the 314 fractures of the middle third showed, 155 (49.4%) ZMC. OPG was the most commonly advised X-ray. With regard to treatment modalities, 36.8% of all the mandibular fractures (740) were treated by closed reduction, 62.6% were treated using open reduction and 0.5% was under observation only.
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Affiliation(s)
- Rishi Bali
- Department of OMFS, D.A.V. Dental College and M.M. General Hospital, Yamunanagar-135001, India.
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Ogura I, Kaneda T, Mori S, Sekiya K, Ogawa H, Tsukioka T. Characterization of mandibular fractures using 64-slice multidetector CT. Dentomaxillofac Radiol 2012; 41:392-5. [PMID: 22282503 DOI: 10.1259/dmfr/67127210] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to characterize mandibular fracture locations using 64-slice multidetector CT (MDCT). METHODS CT scans of 138 patients with mandibular fractures who underwent 64-slice MDCT were studied. Mandibular fractures were classified into five types: median, paramedian, angle, condylar and coronoid process. Statistical analysis for the relationship between multiple fractures and type of mandibular fractures was performed using χ(2) test with Fisher's exact test. RESULTS The percentage of multiple mandibular fractures was 80.9% median type, 74.3% paramedian type, 52.9% angle type and 60.9% condylar type. The resultant data showed a significant relationship between multiple fractures and the median type (p = 0.000), paramedian type (p = 0.002) and condylar type (p = 0.003). CONCLUSION The results suggest that multiple fractures are related to the type of mandibular fractures.
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Affiliation(s)
- I Ogura
- Department of Radiology, Nihon University School of Dentistry, Matsudo, Chiba, Japan.
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