1
|
Deininger C, Wichlas F, Necchi M, Deluca A, Deininger S, Trieb K, Tempfer H, Kriechbaumer L, Traweger A. Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review. J Clin Med 2024; 13:2437. [PMID: 38673709 PMCID: PMC11050981 DOI: 10.3390/jcm13082437] [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: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.
Collapse
Affiliation(s)
- Christian Deininger
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Florian Wichlas
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Marco Necchi
- Department of Surgery and Orthopaedics, Hospital Sterzing, Margarethenstraße 24, 39049 Sterzing, Italy;
| | - Amelie Deluca
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Susanne Deininger
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria;
| | - Klemens Trieb
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
- Department for Orthopaedics and Traumatology, Center for Clinical Medicine, Faculty of Medicine and Dentistry, Danube Private University, 3500 Krems, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Lukas Kriechbaumer
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| |
Collapse
|
2
|
Nogueira LC, Quinto JHS, Trivellato PFB, Sverzut CE, Trivellato AE. Epidemiological Study of Frontal Sinus Fractures: Evaluation of 16 Years of Care at the Faculty of Dentistry of Ribeirão Preto/Brazil. J Maxillofac Oral Surg 2024; 23:371-379. [PMID: 38601249 PMCID: PMC11001839 DOI: 10.1007/s12663-022-01765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Aiming to evaluate and study the epidemiological profile of frontal sinus fractures treated in the region of Ribeirão Preto-Brazil. Methods Sixteen years of activity in the Oral and Maxillofacial service of the Faculty of Dentistry of Ribeirão Preto/SP (FORP/USP), totaling 9,736 consultations, 4,524 with facial fractures, those diagnosed with frontal sinus fracture (113) were evaluated and selected for the study. Results Frontal sinus fractures accounted for 2.5% of facial fractures, the majority occurring in men (89.4%), concentrated in the age group 21-30 years old, with 52.2% of cases being caused by road traffic accidents (RTA). Associations with other facial fractures are common and appeared in 75.2% of cases. Treatment was followed either surgically, by open reduction internal fixation (52.2%) or conservatively (35.4%). Analyzing only the 28 isolated frontal sinus fractures, the most common treatment was conservative (46.4%). surgical treatment dropped to 25%. The most common postoperative complications were temporal branch paralysis and supraorbital nerve paresthesia, both occurring in 30.5% of surgical cases. Conclusion The frequency of frontal sinus fractures may be decreasing, but the pattern of occurrence in young men due to road traffic accidents does not seem to change, fortunately the appearance of serious complications is not common and it is usually associated with more severe trauma.
Collapse
Affiliation(s)
- Lucas Costa Nogueira
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av Do Café, S/nCampus USP, Ribeirão Preto, São Paulo, CEP: 14040-904 Brazil
| | - José Henrique Santana Quinto
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av Do Café, S/nCampus USP, Ribeirão Preto, São Paulo, CEP: 14040-904 Brazil
| | - Priscila Faleiros Bertelli Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av Do Café, S/nCampus USP, Ribeirão Preto, São Paulo, CEP: 14040-904 Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av Do Café, S/nCampus USP, Ribeirão Preto, São Paulo, CEP: 14040-904 Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Av Do Café, S/nCampus USP, Ribeirão Preto, São Paulo, CEP: 14040-904 Brazil
| |
Collapse
|
3
|
Li H, Hao J, Liu X. Research progress and perspective of metallic implant biomaterials for craniomaxillofacial surgeries. Biomater Sci 2024; 12:252-269. [PMID: 38170634 DOI: 10.1039/d2bm01414a] [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: 01/05/2024]
Abstract
Craniomaxillofacial bone serves a variety of functions. However, the increasing number of cases of craniomaxillofacial bone injury and the use of selective rare implants make the treatment difficult, and the cure rate is low. If such a bone injury is not properly treated, it can lead to a slew of complications that can seriously disrupt a patient's daily life. For example, premature closure of cranial sutures or skull fractures can lead to increased intracranial pressure, which can lead to headaches, vomiting, and even brain hernia. At present, implant placement is one of the most common approaches to repair craniomaxillofacial bone injury or abnormal closure, especially with biomedical metallic implants. This review analyzes the research progress in the design and development of degradable and non-degradable metallic implants in craniomaxillofacial surgery. The mechanical properties, corrosion behaviours, as well as in vitro and in vivo performances of these materials are summarized. The challenges and future research directions of metallic biomaterials used in craniomaxillofacial surgery are also identified.
Collapse
Affiliation(s)
- Huafang Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
| | - Jiaqi Hao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
| | - Xiwei Liu
- Lepu Medical Technology Co., Ltd, Beijing 102200, China
| |
Collapse
|
4
|
Ismayılov R, Özgür B. Indications and use of cone beam computed tomography in children and young individuals in a university-based dental hospital. BMC Oral Health 2023; 23:1033. [PMID: 38129827 PMCID: PMC10740269 DOI: 10.1186/s12903-023-03784-4] [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: 09/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the indications of cone beam computed tomography (CBCT) in children and young individuals in a university-based dental hospital and their association with age, gender and field of view. METHODS 7131 CBCT scans, taken during 3-year period, were reviewed and a total of 649 pediatric patients (0-18 years) with complete request forms were included. Data related to gender, age, referring department, CBCT indications, field of view (FOV), region of interest (ROI), need for re-exposure and patients received more than one CBCT examination were recorded. RESULTS The mean age was 13.57 ± 3.52 years and "malocclusion and dentofacial anomaly" (28.7%) was the most common clinical indication. Facial trauma, dental trauma and supernumerary tooth in males; "malocclusion and dentofacial anomaly" and implant planning in females were recorded more frequently compared to other gender. Maxilla was the most frequently monitored ROI (35.1%) for patients. Small (≤ 10 cm) FOV was preferred in 58.1% of all patients. Large FOV was selected in the majority of patients who underwent CBCT scan for "malocclusion and dentofacial anomaly" (89.6%). The repeated scans constituted 2.3% of patients and 105 patients (16.2%) underwent multiple CBCT scans on different dates for mainly orthodontic follow-up. CONCLUSIONS The justification of CBCT scans was not fully compatible with current guidelines and mainly larger FOV was preferred. The number of CBCT examination in children and young individuals tends to increase. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- Rovshan Ismayılov
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Altındağ, Ankara, 06100, Turkey
| | - Beste Özgür
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Altındağ, Ankara, 06100, Turkey.
| |
Collapse
|
5
|
Adetayo AM, Somoye MS, Fasesan OA, Oyedele AT, Adetayo MO. Factors Associated with Deterioration in Quality of Life of Subjects after Maxillofacial Fractures - A Prospective Study. Ann Maxillofac Surg 2023; 13:189-194. [PMID: 38405566 PMCID: PMC10883217 DOI: 10.4103/ams.ams_38_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/28/2023] [Accepted: 07/19/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction Maxillofacial fractures (MFs) are quite common and are managed by oral and maxillofacial surgeons. Despite these interventions, a pre-traumatic facial profile is often not achieved with consequent social and psychologic consequences. Materials and Methods Patients with fractures to the middle and lower third of the face that presented within 48 hours and healthy controls (subjects without facial fracture) that were sex- and age-matched with the fracture patients were recruited into the study. World Health Organization Quality of Life - Brief Version (WHOQOL-BREF) questionnaire was used to compare the Quality of Life (QoL) values according to age, gender, educational status, employment status, marital status, site of trauma and type of fracture. Results Only the age of subjects was associated with deterioration in QoL after MF while other variables were not. Discussion Increasing age of the patients was associated with higher QoL possibly because those with age <30 years are single and unemployed and may have fear and anxiety that the fracture could affect their chances of getting married or being employed, causing reduced QoL. Psychosocial rehabilitation is very important in patients with MF, especially for the young age group.
Collapse
Affiliation(s)
- Adekunle Moses Adetayo
- Department of Surgery, Psychiatry Unit, Benjamin Carson (Snr) School of Medicine, Babcock University, Ogun State, Nigeria
| | - Mayowa Solomon Somoye
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - Oluwatoyin Adetutu Fasesan
- Department of Internal Medicine, Psychiatry Unit, Benjamin Carson (Snr) School of Medicine, Babcock University, Ogun State, Nigeria
| | - Ayodeji Titus Oyedele
- Department of Surgery, Psychiatry Unit, Benjamin Carson (Snr) School of Medicine, Babcock University, Ogun State, Nigeria
| | | |
Collapse
|
6
|
Fang CY, Tsai HY, Yong CY, Ohiro Y, Chang YC, Teng NC. A 10-year retrospective study on mandibular fractures in Northern Taiwan. J Dent Sci 2023; 18:1330-1337. [PMID: 37404622 PMCID: PMC10316488 DOI: 10.1016/j.jds.2023.04.010] [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: 02/25/2023] [Revised: 04/12/2023] [Indexed: 07/06/2023] Open
Abstract
Background/purpose The mandible is an independent and protruding bone structure in the lower third portion of the human facial skeleton. Because of its prominent and unprotected position, the mandible is a primary site of facial trauma. Previous studies have not comprehensively discussed the association between the mandibular fractures and concomitant fractures of facial bones, the trunk, or limbs. This study analyzed the epidemiology of mandibular fractures and their correlation with concomitant fractures. Materials and methods The present study enrolled 118 patients with a total of 202 mandibular fracture sites during at any time from January 1, 2012, to December 31, 2021, in northern Taiwan. Results According to the study results, the patients between 21 and 30 years of age had the highest occurrence of trauma, and road traffic accidents (RTAs) constituted the primary cause of mandibular fractures. Fall-related injuries were significant in patients >30 years of age. By the analysis of Pearson's contingency coefficient, the number of mandibular fractures was not significantly associated with concomitant fractures of the extremities or the trunk. However, accompanying maxillary fractures can be regarded as an indication of concomitant extremity or trunk fractures in patients with mandibular fractures. Conclusion Three-site mandibular fractures are not necessarily accompanied by extremity and trunk fractures; however, clinicians should implement multidisciplinary examination and management in patients with mandibular fractures accompanied by maxillary fractures. Maxillary fractures can be regarded as an indication of concomitant fractures of other facial bones, the extremities, or the trunk.
Collapse
Affiliation(s)
- Chih-Yuan Fang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Yu Tsai
- Department of Dentistry, Wang Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chen-Yin Yong
- Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yoichi Ohiro
- Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yu-Chao Chang
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Nai-Chia Teng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| |
Collapse
|
7
|
Rivis M, Juncar RI, Moca AE, Moca RT, Juncar M, Țenț PA. Patterns of Mandibular Fractures through Human Aggression: A 10-Year Cross-Sectional Cohort Retrospective Study. J Clin Med 2023; 12:4103. [PMID: 37373796 DOI: 10.3390/jcm12124103] [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: 05/06/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and guide these patients. This retrospective study was conducted in 478 patients with mandibular fractures caused by interpersonal violence over 10 years in a university clinic. The most affected were male patients (95.19%), 20-29 years of age (46.86%), under the influence of alcohol (83.26%) and without education (43.9%). The majority of mandibular fractures were displaced (89.3%) and intraorally open (64.0%). The most frequent location was the mandibular angle (34.84%). The most frequent soft tissue lesions were hematomas (45.04%) and abrasions (34.71%), being associated frequently with closed (p = 0.945/p = 0.237), displaced (p = 0.001/p = 0.002), single angle fractures (p = 0.081/p = 0.222). Educating the population and fighting alcohol consumption would decrease the occurrence of mandibular fractures through aggression. Clinical diagnosis should be made, keeping in mind that the severity of associated soft tissue lesions is directly proportional to the pattern and number of underlying fracture lines.
Collapse
Affiliation(s)
- Mircea Rivis
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeș" University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 30041 Timișoara, Romania
| | - Raluca Iulia Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Abel Emanuel Moca
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Rahela Tabita Moca
- Doctoral School of Biomedical Sciences, University of Oradea, 1 Universității Street, 410087 Oradea, Romania
| | - Mihai Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Paul Andrei Țenț
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| |
Collapse
|
8
|
Jia Y, Duan M, Yang Y, Wang D, Dong Q, Liao J, Mao L, Liu P, Feng L, Chen J, Tang Z. The Promoting Effect of a Local Pulsatile Parathyroid Hormone Delivery on Healing of the Mandibular Fracture in Rats. Tissue Eng Part A 2023; 29:69-79. [PMID: 36200640 DOI: 10.1089/ten.tea.2022.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Parathyroid hormone (PTH) can promote bone formation and mineralization in mandibular fractures, and is systemically administered through daily injections. In this study, the local delivery of PTH using carboxymethyl chitosan/polyvinyl alcohol and alginate was investigated. Bovine serum albumin was used as a drug substitute, and the delivery system was verified to release drugs in a pulsed rhythm. After the delivery system was subcutaneously implanted in Sprague-Dawley (SD) rats, no rejection reaction was detected, indicating that it has good biocompatibility and biodegradability in vivo. Then, an SD rat model of mandibular fracture was established, and 24 rats were randomly divided into two groups. The control group was reduced and fixed with screws and a microplate, and the experimental group received pulsatile PTH release system (14 μg PTH) + screws and microplate fixation. The animals were euthanized on postoperative weeks 1-4. Observation of gross specimens, digital radiography, and hematoxylin and eosin showed that the local PTH pulsatile release system promoted osteogenesis and accelerated fracture healing. In summary, PTH can be loaded by biomaterials to locally target the fracture and stimulate bone formation. Moreover, the pulsatile PTH release system provides a potential therapeutic protocol for mandibular fracture. Impact statement Our study prepares a drug release system that could impulsively release parathyroid hormone. The system could enhance bone regeneration in rats with mandibular fracture. These data provide a foundation for future studies aimed to understand and optimize the use of bioactive molecule pulsatile delivery for bone regeneration and tissue engineering applications.
Collapse
Affiliation(s)
- Yuanyuan Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China.,Department of Physiology and Pathology, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, China
| | - Mianmian Duan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China
| | - Yan Yang
- Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang, China
| | - Dongxiang Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China
| | - Qiang Dong
- Department of Prosthodontics and Implantology, School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China
| | - Jian Liao
- Department of Prosthodontics and Implantology, School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China
| | - Ling Mao
- The Laboratory of Head and Neck Cancer Research, School and Hospital of stomatology, Guizhou Medical University, Guiyang, China
| | - Poyu Liu
- Department of Oral Radiology, and School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China
| | - Ling Feng
- Department of Oral Histopathology, School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China
| | - Jin Chen
- Key Laboratory of Biology and Medical Engineering/Immune Cells and Antibody Engineering Research Center of Guizhou Province, School of Biology and Engineering, Guiyang, China
| | - Zhenglong Tang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang, China.,Department of Physiology and Pathology, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, China
| |
Collapse
|
9
|
Al-Ali MA, Alao DO, Abu-Zidan FM. Factors affecting mortality of hospitalized facial trauma patients in Al-Ain City, United Arab Emirates. PLoS One 2022; 17:e0278381. [PMID: 36445878 PMCID: PMC9707776 DOI: 10.1371/journal.pone.0278381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Facial injuries affect one-third of severely injured patients. These injuries have devastating long-term negative impacts on quality of life. We aimed to study the epidemiology of facial injuries and factors affecting the mortality of hospitalized facial trauma patients in Al-Ain City, United Arab Emirates. METHODOLOGY This is a retrospective analysis of prospectively collected data from Al-Ain Hospital Trauma Registry. All patients with facial injury who were hospitalized for more than 24 hours or who died after arrival at the hospital during the period from January 2014 to December 2017 were studied. Two sample data analysis was used to compare patients who died and those who survived. Significant factors were then entered into a backward logistic regression model to define factors affecting mortality. RESULTS 408 patients having a mean age of 31.9 years were studied, 87.3% were males. The main mechanisms of injury were road traffic collisions (52.2%) and fall from height (11.3%). 289 (70.8%) patients had associated injuries which were mainly in the head and chest. The backward logistic regression model showed that the Glasgow Coma Scale (GCS) was the only factor that predicted mortality, p<0.0001 with the best cut-off point of 7.5, having a sensitivity of 0.972 and a specificity of 0.8. The ROC had an area under the curve of 0.924. CONCLUSION The majority of facial injury patients in our setting are young males who were involved in road traffic collisions or falls from height. The most important factor predicting the mortality of these patients was the low GCS. Those having a GCS of 8 and more had a better chance of survival. This information is very important when counseling patients or their relatives for facial surgery.
Collapse
Affiliation(s)
- Mohamed A. Al-Ali
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Department of Otolaryngology, Al-Ain Hospital, Al-Ain, United Arab Emirates
- * E-mail:
| | - David O. Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Fikri M. Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| |
Collapse
|
10
|
Spalthoff S, Oetzel F, Dupke C, Zeller AN, Jehn P, Gellrich NC, Korn P. Quantitative analysis of soft tissue sagging after lateral midface fractures: A 10-year retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e619-e625. [PMID: 35202862 DOI: 10.1016/j.jormas.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lateral midface fractures occasionally require open reduction and internal fixation to restore function and facial symmetry. However, some patients retain facial asymmetry despite undergoing surgery due to hard tissue displacement or soft tissue sagging. This study aimed to determine the influence of soft tissue sagging on the postoperative facial symmetry. METHODS We examined the medical records of 590 patients who underwent planned plate removal after lateral midface or zygomatic bone fractures. After applying the inclusion and exclusion criteria, we analyzed 106 cases of lateral midface fractures for hard tissue displacement and soft tissue sagging using pre- and postoperative radiological imaging and postoperative face scanning. RESULTS We observed significantly larger soft tissue sagging (p < 0.001) and hard tissue displacement (p = 0.006) on the fractured side than on the non-fractured side. There was no correlation between differences in the soft tissue sagging and those in the hard tissue displacement (|rho|=0). Linear regression analysis showed no statistical influence of sex or age group on the soft tissue sagging and hard tissue displacement. CONCLUSION Therefore, we recommend treating soft tissue sagging as a discrete aspect of midfacial fracture treatment to achieve optimal postoperative facial symmetry. From a clinical perspective, we recommend better soft tissue management during open fracture treatment than focusing mainly on the reduction of bony hard tissues.
Collapse
Affiliation(s)
- S Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany.
| | - F Oetzel
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - C Dupke
- Department of Biometry and Environmental System Analysis, University of Freiburg, Tennenbacher Straße 4, 79106 Freiburg, Germany
| | - A-N Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - P Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - N-C Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - P Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| |
Collapse
|
11
|
AlGhamdi S, Alasmari FS, Alarjani MB, Alamri HS, Aldamkh AA, Alanazi IA, Alarjani MB, Moafa AI, Alrusayyis NS. Association between maxillofacial fractures and brain injuries in trauma patients: a cross-sectional study in the Kingdom of Saudi Arabia. Pan Afr Med J 2022; 43:193. [PMID: 36942138 PMCID: PMC10024553 DOI: 10.11604/pamj.2022.43.193.36283] [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: 07/11/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction trauma is on the rise in the Kingdom of Saudi Arabia (KSA) due to rapid urbanization and motorization, posing increased risks of traumatic maxillofacial and brain injuries. Given the high morbidity and mortality associated with these injuries, this study aimed to measure the prevalence and associated factors of brain injury among head injury trauma patients. Methods a cross-sectional study was conducted at the King Khalid hospital and Prince Sultan Centre for Healthcare in Al-Kharj City and the Al Kharj Military Industries Corporation Hospital in Al-Kharj City in the KSA. Multivariable logistic regression modelling was performed to ascertain clinical factors associated with Traumatic Brain Injury (TBI). Results we included 109 participants aged median 25 and IQR (18-35) years 26.95 ± 14.73 years. Most participants were males (92.7%, n = 101) and 68% (n = 75) had Saudi nationality. About 47.7% (n = 52) had maxillofacial/skull fractures and 44% (n = 48) had TBI. Participants in the age group of 31-40 years experienced a greater risk of TBI than those in the age group of 10 or less years (aOR: 6.2, CI = 1.1p = 0.041). Participants with parietal bone fractures (aOR = 23.1, CI = 3.0 - 181.3, p = 0.003) and frontal bone fractures (aOR = 19.1, CI = 1.7 - 217.0, p = 0.017) were more likely to have TBI compared to those with other skull and facial fractures. Conclusion fractures of parietal and frontal bones are associated with a higher risk of TBI in the KSA. Patients with TBI following road accidents with fractures of the frontal or parietal bones, particularly those in the 31-40 age group should therefore be treated with strong suspicion of underlying traumatic brain injury.
Collapse
Affiliation(s)
- Sameer AlGhamdi
- Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia
- Corresponding author: Sameer AlGhamdi, Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia.
| | | | - Mohammed Bader Alarjani
- Dental Surgery, Advanced Education in General Dentistry Program, Royal Saudi Land forces, Riyadh, Saudi Arabia
| | - Hassan Sultan Alamri
- Dental Surgery, Advanced Education in General Dentistry Program, Royal Saudi Land forces, Riyadh, Saudi Arabia
| | | | - Ibrahim Abdullah Alanazi
- Dentistry, Advanced Education in General Dentistry Program King Salman Armed Forces Hospital, North-western Region, Riyadh, Saudi Arabia
| | | | | | | |
Collapse
|
12
|
Rehman U, Sarwar MS, Shafiq U, Brennan PA. Facial trauma education within two English medical schools. Br J Oral Maxillofac Surg 2021; 60:817-822. [DOI: 10.1016/j.bjoms.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
|