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

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

Accuracy of linear-probe ultrasonography in diagnosis of infraorbital rim fractures

BACKGROUND

Maxillofacial fractures are a common cause of visits to emergency department, accounting for more than 400,000 annual visits in the United States. Gold standard diagnostic tool is conventional computerized tomography (CT) or 3DCT reconstruction. However, the disadvantages of CT are radiation exposure, unavailable in some hospital and expensiveness. Whereas the bony structures overlap is a problem in diagnostic when using plain film X-ray. The objective of this study is to show the accuracy of a linear-probe ultrasound compared to computed tomography and plain film X-ray in diagnosis of infraorbital rim fracture.

METHODS

Patients clinically suspected of an inferior orbital rim fracture underwent linear-probe ultrasonographic investigation, plain film X-ray and CT. CT was used as gold standard in this diagnostic study. A radiologist and senior resident of plastic surgery were the examiner and interobserver for comparison.

RESULT

A total of 34 patients with suspected infraorbital rim fractures were investigated. Sensitivity of the linear-probe ultrasonography versus CT in the detection of infraorbital rim fracture was 92.9% (95% CI 66.1-99.8), specificity was 90.0% (95% CI 68.3-98.8), positive predictive value was 86.7% (95% CI 59.5-98.3), negative predictive value was 94.7% ( 95% CI 74.0-99.9), accuracy 91%.

CONCLUSION

Linear probe ultrasonography is a good diagnostic tool and has better reliability than the plain film X-ray and can be used as alternative to CT in inferior orbital rim fracture.

Patterns of maxillofacial trauma in helmet vs. non helmet wearing two wheeler drivers in a tertiary care center

BACKGROUND/AIMS

The frequency and patterns of maxillofacial fractures vary by country, based on demographic, socioeconomic, cultural and environmental factors. Wearing a helmet is an efficient form of head protection for two-wheeler drivers and is now required in the vast majority of countries. The aim of this study was to compare the patterns of maxillofacial trauma in patients who wore helmets and those who did not.

MATERIALS AND METHODS

The data were gathered from clinical records of patients presenting with maxillofacial trauma between January 2019 and February 2022. The inclusion criteria were met by subjects involved in two-wheeler accidents with comprehensive case records and radiological investigations.

RESULTS

A total of 177 people presented following maxillofacial trauma. The mean age was 34.2 ± 12.7 years. There were 151 (85.3%) males and 26 (14.6%) females. One hundred and two patients had not been wearing a helmet, while 75 patients were wearing a helmet at the time of the accident. Mandible fractures were the most common injury in both groups, followed by zygomatic arch fractures (which were more common in non-helmet users) and dentoalveolar fractures in helmet users.

CONCLUSION

There was a significant difference in the pattern and severity of maxillofacial trauma in helmet users and non-helmet users.

A Comprehensive Review on the Behaviour of Motorcyclists: Motivations, Issues, Challenges, Substantial Analysis and Recommendations

With the continuous emergence of new technologies and the adaptation of smart systems in transportation, motorcyclist driving behaviour plays an important role in the transition towards intelligent transportation systems (ITS). Studying motorcyclist driving behaviour requires accurate models with accurate and complete datasets for better road safety and traffic management. As accuracy is needed in modelling, motorcyclist driving behaviour analyses can be performed using sensors that collect driving behaviour characteristics during real-time experiments. This review article systematically investigates the literature on motorcyclist driving behaviour to present many findings related to the issues, problems, challenges, and research gaps that have existed over the last 10 years (2011-2021). A number of digital databases (i.e., IEEE Xplore®, ScienceDirect, Scopus, and Web of Science) were searched and explored to collect reliable peer-reviewed articles. Out of the 2214 collected articles, only 174 articles formed the final set of articles used in the analysis of the motorcyclist research area. The filtration process consisted of two stages that were implemented on the collected articles. Inclusion criteria were the core of the first stage of the filtration process keeping articles only if they were a study or review written in English or were articles that mainly incorporated the driving style of motorcyclists. The second phase of the filtration process is based on more rules for article inclusion. The criteria of inclusion for the second phase of filtration examined the deployment of motorcyclist driver behaviour characterisation procedures using a real-time-based data acquisition system (DAS) or a questionnaire. The final number of articles was divided into three main groups: reviews (7/174), experimental studies (41/174), and social studies-based articles (126/174). This taxonomy of the literature was developed to group the literature into articles with similar types of experimental conditions. Recommendation topics are also presented to enable and enhance the pace of the development in this research area. Research gaps are presented by implementing a substantial analysis of the previously proposed methodologies. The analysis mainly identified the gaps in the development of data acquisition systems, model accuracy, and data types incorporated in the proposed models. Finally, research directions towards ITS are provided by exploring key topics necessary in the advancement of this research area.

Recurrent mandibular fractures: a retrospective study over 17 years on aetiology, demographics, fracture patterns, and management

Recurrent fractures of the mandible are rare, however in Darwin, Australia, their occurrence is relatively frequent. This retrospective study identified 127 patients with 148 recurrent mandibular fractures treated at Royal Darwin Hospital between 2000 and 2017. Age, sex, ethnicity, marital status, aetiology, risk factors, anatomical location of the fractures, fracture patterns, and management of the fractures were analysed. The majority of patients were male (85.8%) (P < 0.001); 62.8% were unmarried (P < 0.001) and 72.4% were indigenous (P < 0.001). Alcohol was involved in 79.1% of cases (P < 0.001) and assault was the most common mechanism of injury (84.5%) (P < 0.001). The angle of the mandible was the most common site (P < 0.001), and recurrent fractures were more likely to occur at sites different to a previous fracture fixation site (P < 0.001). Smoking, alcohol abuse, and diabetes were strongly associated with recurrent fractures (all P < 0.001). Most patients were managed with open reduction internal fixation. In conclusion, recurrent fractures of the mandible frequently involved the angle of the mandible and occurred at different sites. Their incidence was more common among the unmarried, male, and indigenous population, and smoking, alcohol abuse, and diabetes were found to be significant risk factors.

Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study

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.