PATTERNS OF FACIAL FRACTURES AND ASSOCIATED SOFT TISSUE INJURIES: A RETROSPECTIVE STUDY ON 1007 PATIENTS

Background

Knowing the severity of a pathology in a population helps to both establish a rapid diagnosis and to prepare medical staff to provide adequate and complete treatment. The aim of this study was to determine the patterns of maxillofacial fractures and their associated soft tissue injuries in order to identify the specific types of maxillofacial fractures with the highest incidence of associated soft tissue injuries.

Methods

A 10-year retrospective evaluation of maxillofacial trauma was performed on 1007 patients. All 1007 patients were clinically and paraclinically confirmed to have facial skeletal injuries.

Results

The highest incidence of maxillofacial fractures was found in the mandible (62.16%), the mandibular angle being the most frequently involved (28.84%). Most of the fractures were complete (97.82%), displaced (87.98%) and closed (86.30%). Hematoma was the most common associated soft tissue injury (44.79%). In mandibular trauma, the incidence of hematoma and laceration was the highest in angle and simultaneous multiple fracture lines (p=0.002). In the midface, hematoma was more frequently associated with non-comminuted zygomatic bone fractures (p=0.003), while laceration was associated with multiple underlying fracture lines (p=0.002).

Conclusions

Patients presenting with hematomas will most frequently have an underlying single closed fracture line, while patients with lacerations will most frequently present underlying multiple and displaced fractures.

Etiology, pattern, and treatment of nose fractures: A 10-year cross-sectional cohort retrospective study

Background

Determining the etiology, epidemiology, pattern, and treatment of nasal bone fractures and the associated soft tissue injuries in a population will be beneficial for the prevention, rapid and correct diagnosis, and adequate management of this pathology in order to minimize postoperative complications.

Patients and Methods

This study retrospectively evaluated the patients admitted and treated for nasal bone fractures in a university clinic of oral and maxillofacial surgery in Romania over a 10-year period. Following statistical analysis, evaluation and correlation of the monitored variables, a P value < 0.05 was considered statistically significant.

Results

Nasal bone fractures had the highest incidence among men (88.30%), aged 20-29 years (33.33%), with no education (33.33%), interpersonal violence being the main cause in this category of patients (P = 0.004; P = 0.005; P = 0.005). In urban environment (55.9%), nasal bone fractures through aggression and road traffic accidents were predominant, while in rural areas (44.10%), those caused by domestic accidents and animal attacks prevailed (P = 0.551). Nondisplaced (81.10%), closed (85.60%) and involving the nasal septum fractures (51.35%) were preponderant. Hematoma was the most frequent associated soft tissue injury (86.49%), its incidence being increased in the case of displaced (P = 1.000) and open fractures (P = 0.692). The most frequent treatment method was close nasal reduction (CNR) + closed septoplasty (51.35%). The most frequent complication was malunion (7.2%), secondary to CNR without septoplasty (P = 0.037).

Conclusions

The main etiology of nasal bone fractures was interpersonal violence, which mainly affected men, aged 20-39 years, with a low level of education, living in urban areas. Implementing laws to fight interpersonal aggression and increase the education level of the population would lead to a considerable reduction in the incidence of this pathology. Patients treated by CNR + closed septoplasty and ORIF had the best postoperative evolution. Immediate septoplasty in the case of associated septal fractures significantly decreased the rate of postoperative complications.

Cryobiopsy in Lung Cancer Diagnosis-A Literature Review

Optimizing the diagnosis of lung cancer represents a challenge, as well as a necessity, for improving the low survival of these patients. Flexible bronchoscopy with forceps biopsy is one of the key diagnostic procedures used for lung tumors. The small sample size and crush artifacts are several factors that can often limit access to a complete diagnosis, therefore leading to the need of repeating the bronchoscopy procedure or other invasive diagnostic methods. The bronchoscopic cryobiopsy is a recent technique that proved its utility in the diagnosis of both endobronchial and peripheral lung tumors. In comparison with conventional forceps biopsy, studies report a higher diagnostic yield and a superior quality of the collected samples for both the histopathological and the molecular diagnosis of lung cancer. This method shows promising results in sampling lung tissue, alone, or in conjunction with fluoroscopy or radial endobronchial ultrasound (r-EBUS). With a good safety and cost-benefit profile, this novel method has the potential to improve the diagnosis, and therefore the management of lung cancer patients. The objective of this narrative review is to provide a comprehensive review of the recent data regarding the advantages of cryobiopsy and r-EBUS in lung cancer diagnosis.

An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients

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.

Interrelation between facial soft tissue lessions, underlying fracture patterns and treatment of zygomatic bone trauma: a 10 year retrospective study

Background

The pattern of zygomatic bone fractures varies in the literature, their features being frequently masked by the presence of associated soft tissue lesions. In this context the clinical diagnosis and the therapeutic indications can be difficult. The aim of this study was to evaluate the clinical features of zygomatic bone fractures and their interrelation with concomitant overlying soft tissue injuries, as well as to assess the type of treatment methods applied depending on the fracture pattern and the results achieved depending on the incidence rate of postoperative complications. We will use these results in order to improve the diagnosis and the establishment of correct treatment of this pathology.

Methods

A 10-year retrospective evaluation of midface fractures was performed in patients diagnosed and treated in a tertiary Clinic of Oral and Maxillofacial Surgery. Statistical analysis was performed with the MedCalc Statistical Software version 19.2 (MedCalc Software bvba, Ostend, Belgium; 53 https://www.medcalc.org; 2020). Nominal data were expressed as frequency and percentage. The comparisons of the frequencies of a nominal variable among the categories of another nominal variable were made using the chi-square test. Multivariate logistic regressions were used in order to establish the independent association between variables and lacerations/excoriations. After using the Bonferroni correction for multiple comparisons, a value of p < 0.025 was considered statistically significant.

Results

The study included 242 patients with zygomatic bone fractures. The majority of the fractures were displaced n = 179 (73.9%), closed n = 179 (73.9%) and complete n = 219 (90.5%). Hematoma was the most frequent associated soft tissue lesion n = 102 (42.1%) regardless of the fracture pattern (p = 1.000). Complete zygomatic fracture (OR – 2.68; p = 0.035) and fractures with displacement (OR – 3.66; p = 0.012) were independently associated with the presence of laceration. Fractures with displacement (OR – 7.1; p = 0.003) were independently associated with the presence of excoriation. The most frequent type of treatment applied was Gillies reduction (61.9%), followed by ORIF (30.9%). The most frequent postoperative complication was malunion secondary to Gillies treatment (4,6%).

Conclusions

Patients presenting lacerations and excoriations on clinical soft tissue examination will most frequently have an underlying complete, displaced or comminuted zygomatic fracture. In the case of displaced, open or comminuted fractures we achieved the best results secondary to ORIF treatment method, while in the case of non-displaced and closed fractures, the best results achieved were secondary to conservative treatment.

The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections

Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.

Midfacial fractures: A retrospective etiological study over a 10-year period in Western Romanian population

Introduction

Midfacial fractures are extremely important oral and maxillofacial problems because they take varied forms and are frequently accompanied by major long-term esthetic or functional complications. Their etiology and epidemiology vary significantly in the literature, and the main causes are varied by population. The aim of this study is to identify the main traumatic etiology of midfacial fractures, along with the main categories of affected patients in our geographical area, in order to establish the need for measures that can prevent fractures in the future.

Materials and Methods

We conducted a retrospective study over a 10-year period in 379 patients. Data were extracted from the patients' charts, and the following variables were taken into consideration: sex, age, environment of origin, education level, and traumatic etiology.

Results

Midfacial fractures most frequently affected the 20-29 years age group (31.93%), male sex (n = 333, 87.86%, M:F = 7.23:1), patients from urban areas (n = 206, 54.35%), and patients without education (46.70%). The most frequent etiology was interpersonal violence (44.85%), followed by fall trauma (16.62%) and road traffic accidents (15.30%). Statistical correlations evidenced that urban environment favors midfacial fractures caused by interpersonal violence and road traffic accidents or sports injuries, while in rural areas, domestic accidents and animal attacks are predominant (P = 0.000).

Conclusions

The overwhelming incidence of interpersonal violence in our population is currently a major public health problem. Implementing laws and initiating national programs for the prevention of interpersonal violence would lead to a considerable reduction of midfacial fractures in the Western Romanian population.