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Gugliotta Y, Roccia F, Sobrero F, Ramieri G, Volpe F. Changing trends in maxillofacial injuries among paediatric, adult and elderly populations: A 22-year statistical analysis of 3424 patients in a tertiary care centre in Northwest Italy. Dent Traumatol 2024; 40:187-194. [PMID: 37915278 DOI: 10.1111/edt.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND This retrospective study analysed the epidemiology of maxillofacial trauma over 22 years to assess whether there have been significant changes in the causes and characteristics of fractures in paediatric, adult and elderly populations. MATERIALS AND METHODS The following data were collected: age, sex, injury cause and mechanism, fracture site, Facial Injury Severity Scale, associated injuries, time of injury, type of treatment and length of hospital stay. The patients were analysed by age group (children [≤16 years], adults [17-60 years] and elderly [>60 years]) and divided into two time groups (group 1: 2001-2011; group 2: 2012-2022) that were compared to each other. Statistical analyses were performed using SPSS software. RESULTS Between 01 January 2001 and 31 December 2022, 3535 patients (2690 males and 845 females, mean age 39.3 years) were admitted for facial fractures. The comparison of the two temporal periods showed a decrease in the prevalence of males (p = .02), in road traffic injuries (p < .001), and in fractures of the lower third of the face (p = .005); there were significant increases in the mean age (p < .001), prevalence of the elderly (p = .006) and in fall- and assault-related injuries (p < .001 and p = .03, respectively). Assault injuries increased only in the 17-60 age group (p = .02) while RTA-related fractures decreased in all age groups (p < .05 for all comparisons). Bicycle accidents increased significantly, with a parallel decrease in motor vehicle accidents (both p < .001). Fall-related fractures increased only in 17-60 and >60 age groups (p < .001 and p = .02, respectively). CONCLUSIONS This study shows significant changing trends in the epidemiology of maxillofacial trauma. While road traffic policies have been effective in the last years, preventive measures for falls in the elderly population and new legislative measures to prevent interpersonal violence should be advocated.
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Affiliation(s)
- Ylenia Gugliotta
- Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Fabio Roccia
- Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Federica Sobrero
- Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabio Volpe
- Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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Boscia J, Rhodes HX, Sanders T, Biswas S. Age Effects in Facial Fracture Trauma: Disparities in Multisystem Injuries in Non-Fall-Related Trauma. Cureus 2023; 15:e48091. [PMID: 38046747 PMCID: PMC10690672 DOI: 10.7759/cureus.48091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Background and objective Facial fractures represent a growing concern among an aging population prone to falls. In light of this, this study aimed to investigate differential facial fracture patterns and outcomes based on age effects. Determining the differences between the severity and type of facial fractures in populations of different ages will help guide clinical decision-making when managing patients with facial fractures. Methods This was a single-center study involving trauma registry data, from July 1, 2016, to January 31, 2022. The inclusion criteria were based on the International Classification of Diseases (ICD-10) diagnosis of facial fracture. A linear regression was performed to ascertain the effects of predictor variables on the likelihood that a facial fracture trauma patient would experience various age effects on injury location, mortality, and morbidity. Results A total of 1575 patients were included in the analysis. A significant regression equation was found (F(47,1476)=42.46, p<0.01), with an R2 of 0.57. Older facial fracture trauma patients were more likely to be female (β=3.13, p<0.01) with fractures to their zygoma (β=2.57, p=0.02). Higher Abbreviated Injury Scale (AIS) facial region scores (β=2.21, p=0.03), longer hospital length of stay (β=0.07, p=0.02), and in-hospital mortality (β=10.47, p<0.01) were also associated with older age. Older age was additionally associated with a higher level of several morbidity markers. Younger facial fracture trauma patients were more likely to be African American (β=-5.46, p<0.01) or other, non-Caucasian race (β=-8.66, p<0.01) and to have mandible fracture patterns (β=-3.63, p<0.01). The younger patients were more likely to be fully activated (β=-3.10, p<0.01) with a higher shock index ratio (SIR) (β=-7.36, p<0.01). Injury mechanisms in younger facial fracture patients were more likely to be assault (β=-12.43, p<0.01), four-wheeler/ATV accident (β=-24.80, p<0.01), gunshot (β=-15.18, p<0.01), moped accident (β=-13.50, p<0.01), motorcycle accident (β=-12.31, p<0.01), motor vehicle accident (β=-16.52, p<.01), or pedestrian being struck by a motor vehicle (β=-10.69, p=0.02). Conclusions Based on our findings, age effects impact facial fracture patterns and outcomes. Younger patients are more likely to experience multisystem injuries via non-fall trauma. On the other hand, older patients are more likely to experience more severe primary facial injuries. Older patients are also at a higher risk of fall-related trauma. Disparities also exist between genders and races, with male and non-Caucasian patients being at a higher risk of injury from facial fractures at a younger age. With an aging population, the prevalence of falls is likely to increase. Thus, facial fractures represent a growing healthcare burden and warrant future investments related to care and treatment.
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Affiliation(s)
- Joseph Boscia
- Surgery, University of South Carolina School of Medicine Columbia, Columbia, USA
| | | | - Thomas Sanders
- Surgery, University of South Carolina School of Medicine Columbia, Columbia, USA
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Khandalavala KR, Boochoon K, Schissel M, Heckman WW, Geelan-Hansen K. Age, ASA-status, and Changes in NSQIP Comorbidity Indices Reporting in Facial Fracture Repair. Laryngoscope 2023; 133:2572-2577. [PMID: 36625305 DOI: 10.1002/lary.30559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the impact of age and the American Society of Anesthesiologists (ASA) classification on post operative outcomes as well as the changes in the National Surgical Quality Improvement Program (NSQIP) database reporting of comorbidity index variables in patients with facial fractures. METHODS The NSQIP database was queried for facial fracture repair CPT codes between 2012 and 2019 and for modified Frailty Index (mFI) and modified Charlson Comorbidity Index (mCCI) variables between years 2006 and 2018. The predominant question analyzed two preoperative risk factors: patient and ASA classification. Chi-square analysis, Kruskal-Wallis, Mann-Whitney, Spearman correlation, and multivariable logistic regression were used to evaluate age and ASA classification with wound dehiscence, superficial surgical site infection (SSSI), deep wound infection (DWI), readmission status, and return to the OR. The reporting of indices variables was evaluated with descriptive statistics. CONCLUSION In this large database with univariate analysis, patients with a higher ASA classification and older patients experience significantly increased risks of readmission, return to the OR, and longer hospital stays. On multivariate analyses, ASA classes II, III, and IV are independently associated with increased risk of readmission and return to the OR, while controlling for patient age. The reporting of all mFI and mCCI variables were consistent from 2006 to 2010, but after 2011, there has been inconsistent or absent reporting of variables, therefore, conclusions on the impact of comorbidities on facial fracture repair are unreliable. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2572-2577, 2023.
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Affiliation(s)
- Karl R Khandalavala
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kieran Boochoon
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Makayla Schissel
- Department of Biostatics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - W Wesley Heckman
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Katie Geelan-Hansen
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Bracher AI, Klingler S, Koba S, Jakob DA, Exadaktylos A, Klukowska-Rötzler J, Burkhard JP. Trauma Characteristics Associated with E-Scooter Accidents in Switzerland-A Case Series Study. Int J Environ Res Public Health 2023; 20:4233. [PMID: 36901244 PMCID: PMC10002011 DOI: 10.3390/ijerph20054233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
E-scooters have gained popularity worldwide in the last few years. Due to the increase in users, more accidents related to e-scooters can be observed. The present study aimed to analyse epidemiological data, characteristics, and severity of injuries in patients admitted to a Level I trauma centre in Switzerland (Inselspital Bern, University Hospital Bern) after accidents associated with e-scooters. This retrospective case series evaluated 23 patients who presented to the University Hospital of Bern between 1 of May 2019 and 31 of October 2021 after an e-scooter accident. Data were collected on patient demographics, time and cause of the accident, speed, alcohol consumption, helmet use, type and localisation of injury, number of injuries per patient, and outcome. Men were most frequently affected (61.9%). The mean age was 35.8 (STD 14.8) years. Slightly more than half (52.2%) of all accidents were self-inflicted. Most accidents were reported during the night (7 p.m. to 7 a.m., 60.9%) and in summer (43.5%). Alcohol consumption was reported in 43.5% of cases, with a mean blood alcohol level of 1.4 g/l. Most injuries were observed in the face (25.3%) and head/neck area (20.25%). Skin abrasions (56.5%) and traumatic brain injury (43.5%) were the most common types of traumata in terms of total number of patients. Only in one case it was reported that a protective helmet had been worn. Five patients required hospitalisation and four patients underwent surgery. Three patients underwent emergency orthopaedic surgery, and one patient underwent emergency neurosurgery. E-scooter accidents result in a significant number of facial and head/neck injuries. E-scooter riders would potentially benefit from a helmet to protect them in the event of an accident. Additionally, the results of this study indicate that a significant number of e-scooter accidents in Switzerland occurred under the influence of alcohol. Prevention campaigns to raise awareness of the risks of driving e-scooters under the influence of alcohol could help prevent future accidents.
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Affiliation(s)
- Ava Insa Bracher
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Samuel Klingler
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
| | - Sabine Koba
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Dominik Andreas Jakob
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - John-Patrik Burkhard
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
- Cleft and Craniofacial Center Professor J. A. Obwegeser, 8005 Zurich, Switzerland
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Mathan J, Odisho R, Karapanos L, Chiu ZK. Choroidal Rupture in the Setting of Multi-Trauma. Open Access Emerg Med 2023; 15:61-62. [PMID: 36873776 PMCID: PMC9983613 DOI: 10.2147/oaem.s400513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Herein the authors call attention to the importance of ophthalmic evaluation in the setting of multi-trauma, particularly with facial and orbital fractures. In institutions such as ours, a tertiary general hospital, where such fractures are initially managed by a non-ophthalmic team such as trauma or maxillofacial surgeons, we would advocate for prompt referral to the ophthalmology team for assessment as described by our case of a choroidal rupture in the setting of multi-trauma.
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Affiliation(s)
- Jeremy Mathan
- Department of Ophthalmology, Alfred Hospital, Melbourne, VIC, Australia
| | - Ramin Odisho
- Department of Ophthalmology, Alfred Hospital, Melbourne, VIC, Australia
| | - Lewis Karapanos
- Department of Ophthalmology, Alfred Hospital, Melbourne, VIC, Australia
| | - Zelia K Chiu
- Department of Ophthalmology, Alfred Hospital, Melbourne, VIC, Australia
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Karhuketo L, Toivari M, Snäll J, Puolakkainen T. Maxillofacial injuries among ice hockey players: a retrospective study from a Finnish trauma Centre. Acta Odontol Scand 2022:1-5. [PMID: 36538371 DOI: 10.1080/00016357.2022.2158127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Ice hockey players are at risk of a variety of injuries. In our investigation, we aimed to evaluate the types of facial fractures, injury mechanisms and need for surgical intervention in professional and recreational ice hockey players. MATERIAL AND METHODS This retrospective study included all patients presenting to a tertiary trauma centre with any ice hockey-related facial fracture during the period from January 2013 to July 2020. The primary outcome variable was the need for surgical treatment, and the primary predictor variable was the injury mechanism. Demographic and clinically relevant variables were statistically evaluated and presented. RESULTS Of 66 total patients, the most frequent fracture type was isolated mandible fracture (56.1%). Males were overrepresented (98.5%) in the patient population. Puck strikes were the most common mechanism of injury (74.2%). Surgical intervention was performed in nearly half of the patients (48.5%), and was significantly more common in younger patients (p = 0.006). Associated dental injuries were present in 27.3% of the cases and they were significantly associated with puck strikes (p = 0.027). CONCLUSIONS Mandible fractures and puck strikes, the most common injury site and fracture mechanism respectively, sustained by ice-hockey players required surgical intervention in the majority of cases.
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Affiliation(s)
- Lauri Karhuketo
- Department of Oral Diseases, Kanta-Häme Central Hospital, Hämeenlinna, Finland and University of Helsinki, Helsinki, Finland
| | - Miika Toivari
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland and University of Helsinki, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland and University of Helsinki, Helsinki, Finland
| | - Tero Puolakkainen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland and University of Helsinki, Helsinki, Finland
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Varman P, Varman A, Dawson A. Demographic Discrepancies of Vitamin D Deficiency in Cranio facial Fracture Patients. Eplasty 2022; 22:e11. [PMID: 35611154 PMCID: PMC9108432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background The relationship between craniofacial fracture and vitamin D status has not been studied. Given the important role vitamin D status plays in postfracture prognosis, a deep investigation into this relationship is due. The primary objective of this study was to assess the demographic discrepancies in the vitamin D status of patients with craniofacial fracture. Methods The Cerner Health Facts database was used to collect data on serum 25-hydroxyvitamin D, demographics, hospital admission and discharge, and fracture type of 76 craniofacial fracture patients with available vitamin D levels from October 2015 until May 2018. Pairwise Spearman Correlation was used for multivariate data analysis. Results Of the 76 craniofacial fracture patients identified, 55.3% were insufficient in vitamin D and 32.9% were deficient in vitamin D. Vitamin D deficiency and insufficiency were more common in women, African American individuals, and patients over 50 years of age. Conclusions The investigation revealed a high prevalence of vitamin D deficiency and insufficiency in craniofacial fracture patients. Despite the higher incidence of fractures in men and Caucasian individuals, women and African American individuals with craniofacial fractures had poorer vitamin D status. Clinicians should consider empiric vitamin D supplementation following craniofacial fracture in high-risk groups.
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Affiliation(s)
- Pooja Varman
- Creighton University School of Medicine, Omaha, NE
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Thepmankorn P, Choi CB, Haimowitz SZ, Parray A, Grube JG, Fang CH, Baredes S, Eloy JA. ASA Physical Status Classification and Complications Following Facial Fracture Repair. Ann Otol Rhinol Laryngol 2021; 131:1252-1260. [PMID: 34918565 DOI: 10.1177/00034894211059599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. METHODS Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. RESULTS A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P < .001) and risk of overall complications (P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P = .049), postoperative bleeding (P = .036), and failure to wean off ventilator (P = .027). CONCLUSIONS Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.
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Affiliation(s)
- Parisorn Thepmankorn
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Chris B Choi
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sean Z Haimowitz
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aksha Parray
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christina H Fang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, NJ, USA
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Wang HD, Dillon J. Contemporary Management of Zygomaticomaxillary Complex Fractures. Semin Plast Surg 2021; 35:256-262. [PMID: 34819807 DOI: 10.1055/s-0041-1735812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.
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Affiliation(s)
- Howard D Wang
- The Craniofacial Center, Seattle Children's Hospital, Seattle, Washington.,Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington
| | - Jasjit Dillon
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
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Abstract
Panfacial trauma refers to high-energy mechanism injuries involving two or more areas of the craniofacial skeleton, the frontal bone, the midface, and the occlusal unit. These can be distracting injuries in an unstable patient and, as in any trauma, Advanced Trauma Life Support (ATLS) protocols should be followed. The airway should be secured, bleeding controlled, and sequential examinations should take place to avoid overlooking injuries. When indicated, neurosurgery and ophthalmology should be consulted as preservation of brain, vision, and hearing function should be prioritized. Once the patient is stabilized, reconstruction aims to reduce panfacial fractures, restore the horizontal and vertical facial buttresses, and resuspend the soft tissue to avoid the appearance of premature aging. Lost or comminuted bone can be replaced with bone grafts, although adequate reduction should be ensured prior to any grafting. Operative sequencing can be performed from top-down and outside-in or from bottom-up and inside-out depending on patient presentation. All protocols can successfully manage panfacial injuries, and the emphasis should be placed on a systematic approach that works from known areas to unknown areas.
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Affiliation(s)
- Benjamin B Massenburg
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Melanie S Lang
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
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Bicsák Á, Dietmar A, Wruck Y, Hassfeld S, Bonitz L. Evaluation of Pan facial Fractures in a German Supraregional Trauma Center between 2015 and 2017 - A Retrospective Study. Ann Maxillofac Surg 2021; 11:97-102. [PMID: 34522662 PMCID: PMC8407637 DOI: 10.4103/ams.ams_418_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Panfacial fractures represent the most severe injuries to the face. The combination of these fractures determines the treatment strategy. This study aims to retrospectively review the data of adult patients treated for complex facial skull fractures in a hospital in Dortmund, Germany from 2015-2017. Materials and Methods: We extracted related patient data from the hospital electronic repository and reviewed the patient files and radiological images. The fractures were classified based on the AO-Classification. The statistical analysis was performed by descriptive statistical methods. The main goal was to determine the most common fracture combinations. Results: A total of 188 patients with panfacial fractures were identified (181 adults, 7 children and adolescents). The gender and age distribution corresponded to the international literature (male-to-female ratio: 3.1:1, most common injuries among young men). 2–9 fracture sites were identified per patient, resulting in a fracture frequency of 3.13 per patient. 69 different fracture combinations have been identified. The most common ones were combinations of lateral and central mid-face fractures, and combinations of nasal bone fractures with lateral midface fractures or nasal bone fractures combined with mandibular fractures. Between 1 and 13 osteosynthesis implants per patient were used for osteosynthesis; the most commonly used plates were 2.0 mm and 1.5 mm straight plates. The average inpatient stay was 3 days (standard deviation [SD] = 3.0 days), and the average operation time (incision to suture) was 39.5 min (SD = 53.5 min). Discussion: Panfacial fractures are the most complex maxillofacial injuries. The complication rate in this study (4.5%) is below the international data. The treatment of panfacial fractures requires designated centers with experienced teams and good interdisciplinary cooperation.
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Affiliation(s)
- Ákos Bicsák
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Abel Dietmar
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Yannic Wruck
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Stefan Hassfeld
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
| | - Lars Bonitz
- Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University of Witten Herdecke, Witten, Germany
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12
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Erstad BL, Kopp BJ, Tang AL. Antibiotic prophylaxis for traumatic facial fractures. J Clin Pharm Ther 2021; 47:386-395. [PMID: 34490647 DOI: 10.1111/jcpt.13530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The purpose of this paper is to discuss the limitations of the evidence supporting the SIS recommendations for antibiotic prescribing in patients with traumatic facial fractures and to provide suggestions for clinical decision-making and further research in this area given the wide variation in prescribing practices. COMMENT The Surgical Infection Society (SIS) recently published guidelines on antibiotic use in patients with traumatic facial fractures. The guidelines recommend against the use of prophylactic antibiotics for all adult patients with mandibular or non-mandibular facial fractures undergoing non-operative or operative procedures. Despite the available evidence, surveys conducted in the United States and the United Kingdom prior to the publication of the SIS guidelines demonstrate substantial preoperative, intraoperative and postoperative prophylactic prescribing of antibiotics for patients with facial fractures undergoing surgery. WHAT IS NEW AND CONCLUSION With the exception of strong recommendations based on moderate-quality evidence to avoid prolonged postoperative antibiotic prophylaxis, the weak recommendations in the guidelines are a function of low-quality evidence. A logical choice for a narrow-spectrum antibiotic is cefazolin administered within 1 h of surgery and no longer than 24 h after surgery, since it is the gold standard of comparison based on clinical practice guidelines concerning antibiotic prophylaxis.
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Affiliation(s)
- Brian L Erstad
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Brian J Kopp
- Surgical-Trauma ICU, Banner - University Medical Center Tucson, Tucson, AZ, USA
| | - Andrew L Tang
- Department of Surgery, Banner - University Medical Center, Tucson, AZ, USA
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13
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Pandher M, Mukherjee TJ, Halsey JN, Luthringer MM, Povolotskiy R, Hoppe IC, Granick MS. A Single Center Review of Pediatric Nasal Bone Fractures - An Analysis of Concomitant Injuries, Management, and Outcomes. Eplasty 2021; 21:e5. [PMID: 35875510 PMCID: PMC9275413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pediatric nasal bone fractures presenting as isolated fractures or with concomitant facial injuries are rare and not well documented. Analysis of treatment at an urban, level-one trauma center provides insight into their management. METHODS Data were collected for pediatric nasal bone fractures diagnosed between January 2000 and December 2014. Patients were divided into groups based on presence or absence of isolated nasal bone fractures. Groups were compared using Chi-squared analysis, and a Bonferroni correction was used for a more conservative alpha (a = .004). RESULTS Assault was the most common etiology presenting in 46 of 122 pediatric nasal bone fractures. There was no significant difference in surgical versus non-surgical management of isolated and non-isolated nasal bone fractures (P = 0.98). Treatment for both was predominantly watchful waiting in 91% to 95% of the cases followed by closed reduction in 3.2% to 3.3%. In the patients with isolated fractures, 11.5% sustained intracranial hemorrhage, compared to 35.6% of multifracture cases (P = .002); 15.0% of isolated fractures sustained a traumatic brain injury, compared to 55.9% of multifracture cases (P = .000003). No significant difference in fatality existed between groups (P = 0.53). CONCLUSIONS Multi-facial fracture cases were more likely to present with traumatic brain injuries and be admitted to the intensive care unit than isolated nasal bone fractures. Rates of surgical and non-surgical management were not significantly different between the 2 groups. Watchful waiting of pediatric nasal bone fractures was the management approach selected 92% to 95% of the time regardless of the presence or absence of concomitant facial fractures.
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Affiliation(s)
- Meher Pandher
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Thayer J. Mukherjee
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordan N. Halsey
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Margaret M. Luthringer
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roman Povolotskiy
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ian C. Hoppe
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mark S. Granick
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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14
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Pandher M, Mukherjee TJ, Halsey JN, Luthringer MM, Povolotskiy R, Hoppe IC, Granick MS. A Single Center Review of Pediatric Nasal Bone Fractures - An Analysis of Concomitant Injuries, Management, and Outcomes. Eplasty 2021; 21:e4. [PMID: 35603017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pediatric nasal bone fractures presenting as isolated fractures or with concomitant facial injuries are rare and not well documented. Analysis of treatment at an urban, level-one trauma center provides insight into their management. METHODS Data were collected for pediatric nasal bone fractures diagnosed between January 2000 and December 2014. Patients were divided into groups based on presence or absence of isolated nasal bone fractures. Groups were compared using Chi-squared analysis, and a Bonferroni correction was used for a more conservative alpha (a = .004). RESULTS Assault was the most common etiology presenting in 46 of 122 pediatric nasal bone fractures. There was no significant difference in surgical versus non-surgical management of isolated and non-isolated nasal bone fractures (P = 0.98). Treatment for both was predominantly watchful waiting in 91% to 95% of the cases followed by closed reduction in 3.2% to 3.3%. In the patients with isolated fractures, 11.5% sustained intracranial hemorrhage, compared to 35.6% of multifracture cases (P = .002); 15.0% of isolated fractures sustained a traumatic brain injury, compared to 55.9% of multifracture cases (P = .000003). No significant difference in fatality existed between groups (P = 0.53). CONCLUSIONS Multi-facial fracture cases were more likely to present with traumatic brain injuries and be admitted to the intensive care unit than isolated nasal bone fractures. Rates of surgical and non-surgical management were not significantly different between the 2 groups. Watchful waiting of pediatric nasal bone fractures was the management approach selected 92% to 95% of the time regardless of the presence or absence of concomitant facial fractures.
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Affiliation(s)
- Meher Pandher
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Thayer J Mukherjee
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordan N Halsey
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Margaret M Luthringer
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roman Povolotskiy
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ian C Hoppe
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mark S Granick
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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15
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Wickwire P, Kahlon S, Kazemi S, Tollefson T, Steele T, Chang J, Strong B. Improving Patient Education of Facial Fractures Using 3-Dimensional Computed Tomography. Otolaryngol Head Neck Surg 2021; 166:657-661. [PMID: 34280047 DOI: 10.1177/01945998211028523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Advances in 3-dimensional modeling have revolutionized presurgical planning for maxillofacial reconstruction, yet little is known about how this technology may affect patient education. This study was designed to evaluate the efficacy of 2-dimensional computed tomography versus 3-dimensional computed tomography for patient education in maxillofacial reconstruction. STUDY DESIGN Crossover study. SETTING General otolaryngology outpatients from a tertiary referral center were recruited. METHODS A single computed tomography data set of a zygomaticomaxillary complex fracture was used to generate 2 educational video tutorials: one in a 2-dimensional format and one in a 3-dimensional format. The tutorials were embedded into the QualtricsXM platform. Participants were randomly assigned into 2 groups. Group 1 viewed the 2-dimensional tutorial, took a self-assessment survey, took an information recall survey, viewed the 3-dimensional tutorial, and finally took a tutorial comparison survey. Group 2 followed the same sequence but viewed the 3-dimensional tutorial followed by the 2-dimensional tutorial. RESULTS Group 2 participants (viewing the 3-dimensional tutorial first) scored better on the self-assessment survey than their counterparts in group 1 did (P = .023). Group 2 also scored better on the recall survey (P = .042). Of all participants, 61% preferred the 3-dimensional tutorial, and 31% preferred the use of both tutorials together in the comparison survey. CONCLUSIONS Three-dimensional patient educational tutorial regarding a zygomaticomaxillary complex fracture resulted in better knowledge retention and was preferred over the 2-dimensional format.
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Affiliation(s)
- Peter Wickwire
- Department of Otolaryngology-Head & Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Sukhraj Kahlon
- Department of Radiology, UC Davis Medical Center, Sacramento, California, USA
| | - Soroush Kazemi
- School of Medicine, UC Davis Medical Center, Sacramento, California, USA
| | - Travis Tollefson
- Department of Otolaryngology-Head & Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Toby Steele
- Department of Otolaryngology-Head & Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Jennifer Chang
- Department of Radiology, UC Davis Medical Center, Sacramento, California, USA
| | - Bradley Strong
- Department of Otolaryngology-Head & Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
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16
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de Boutray M, Kün-Darbois JD, Sigaux N, Lutz JC, Veyssiere A, Sesque A, Savoldelli C, Dakpe S, Bertin H, Lallemant B, Llobet A, du Cailar M, Lauwers F, Davrou J, Foletti JM. Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study. Int J Oral Maxillofac Surg 2020; 50:750-755. [PMID: 33172710 PMCID: PMC7648505 DOI: 10.1016/j.ijom.2020.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/20/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.
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Affiliation(s)
- M de Boutray
- Department of Maxillofacial Surgery, Gui de Chauliac University Hospital Centre, Montpellier University, Montpellier, France.
| | - J-D Kün-Darbois
- Department of Maxillofacial and Oral Surgery, Angers University Hospital, Angers, France.
| | - N Sigaux
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital Centre, Hospices Civils de Lyon, Pierre-Benite, France.
| | - J-C Lutz
- Department of Maxillofacial Surgery and Stomatology, Strasbourg University Hospital Centre, Strasbourg, France.
| | - A Veyssiere
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France.
| | - A Sesque
- Oral and Maxillofacial Surgery Department, Estaing University Hospital, Clermont Ferrand, France.
| | - C Savoldelli
- Head and Neck University Institute, Nice University Hospital, Nice, France.
| | - S Dakpe
- Department of Maxillofacial Surgery, Amiens University Hospital Centre, Amiens, France; UR CHIMERE 7516, Picardie Jules Verne University, Amiens, France.
| | - H Bertin
- Department of Oral and Maxillofacial Surgery, Nantes University Hospital, Nantes, France.
| | - B Lallemant
- Department of Head and Neck Surgery, University Hospital Centre of Nîmes, Nîmes, France.
| | - A Llobet
- Department of Maxillofacial and Oral Surgery, Perpignan Hospital Centre, Perpignan, France.
| | - M du Cailar
- Maxillofacial Surgery Unit, Purpan University Hospital, Toulouse, France.
| | - F Lauwers
- Maxillofacial Surgery Unit, Purpan University Hospital, Toulouse, France.
| | - J Davrou
- Department of Maxillofacial Surgery and Stomatology, La Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.
| | - J-M Foletti
- Aix Marseille University, APHM, IFSTTAR, LBA, La Conception University Hospital, Department of Maxillofacial Surgery, Marseille, France.
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17
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Zosa BM, Ladhani HA, Sajankila N, Elliott CW, Claridge JA. Pre-Operative Antibiotic Agents for Facial Fractures: Is More than One Day Necessary? Surg Infect (Larchmt) 2020; 22:516-522. [PMID: 33035118 DOI: 10.1089/sur.2020.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Despite a paucity of evidence, patients with facial fractures often receive long courses of pre-operative antibiotic agents. This study compared the effect of a short versus long pre-operative antibiotic course on the development of post-operative head/neck infections in this population. Patients and Methods: All adult patients admitted between January 2010 and May 2015 to a level 1 trauma center with isolated head/neck injuries who underwent surgery for facial fracture(s) were included. Patients with infections prior to surgery were excluded. Our primary analysis compared head/neck infections between patients given a short (≤24 hours) versus long (>24 hours) course of pre-operative antibiotic agents. Bivariate analysis and multivariate logistic regression (MLR) were performed to identify risk factors for head/neck infections. Results: This study included 188 patients; median age was 38.5 years, 83% were male, 81% had blunt injuries, 51.6% had fractures in multiple facial thirds, and 48.9% required intensive care unit (ICU) admission. One hundred twenty-five (66.5%) patients received a short course and 63 (33.5%) received a long course of pre-operative antibiotic agents. Head/neck infections were higher in the long course group (28.6% vs 15.2%; p = 0.034), but median days to infection were similar. Factors associated with head/neck infections included penetrating injury, mandible fracture, involvement of multiple facial thirds, ICU admission, operative time, and receiving a long pre-operative antibiotic course. Multivariable logistic regression found mandible fracture (odds ratio [OR], 2.9; p = 0.01) and ICU admission (OR, 3.3; p = 0.003) to be independent predictors of head/neck infections (area under the curve [AUC] = 0.706), but pre-operative antibiotic course was not. Patients with isolated mandible fractures (n = 42) had higher rates of head/neck infections in the long course group (29.4% vs 4.0%; p = 0.032), despite similar demographics. Conclusion: Long (>24 hours) course of continuous pre-operative antibiotic prophylaxis before surgery for facial fractures did not reduce the development of head/neck infections.
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Affiliation(s)
- Brenda M Zosa
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Husayn A Ladhani
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Nitin Sajankila
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Charles W Elliott
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Jeffrey A Claridge
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
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18
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Abstract
OBJECTIVES Sequelae after maxillofacial fractures are frequent and may affect the patient's quality of life. This study examined sequelae associated with maxillofacial fractures of severely traumatized patients focusing mainly on nerve injuries. METHODS A retrospective study including trauma patients with relevant facial fractures admitted to our Trauma Center in the period 2011-2016. Presence of posttraumatic maxillofacial sequelae was identified by examining the medical records of the included patients. Focusing on facial sensory deficits and facial nerve paralysis, but also comprising data on diplopia, blindness, malocclusion, trismus, eye globe malposition, flattening of the malar, facial contour changes, and wound infections. RESULTS Two-hundred-seventy-five severely traumatized patients were included, comprising 201 men (73%), with a median age of 40 years and ISS of 20. 163 (59%) patients only had assessments within 3 months from trauma of which 79 patients (48.5%) had facial complications at initial examination, mostly malocclusion and trismus. Most patients in this group had no or only minor sequelae at their last clinical assessment, mainly being sensory deficits. 112 (41%) patients had assessments both within and beyond 3 months of which 73 patients (65.2%) had facial complications at initial examination, while 91 patients (81%) had reported sequelae within 3 months decreasing to 47 patients (42%) at their last clinical assessment beyond 3 months from trauma, mostly sensory deficits. An improvement of most sequelae was observed. CONCLUSION Objective sequelae were found to be quite common after maxillofacial fractures in severely traumatized patients, especially sensory deficits. However, most of the addressed sequelae seemed to improve over time.
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Affiliation(s)
- Lasse Østrup Petersen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Emil Ørskov Ipsen
- Trauma Centre and Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Ascanius Felding
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Steinmetz
- Trauma Centre and Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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19
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Gray WK, Day J, Morton M. Can elective surgery for mandibular and zygomatic complex fractures reduce overall hospital stay without compromising outcomes? Analysis of administrative datasets by the GIRFT programme. Br J Oral Maxillofac Surg 2020; 58:1151-1157. [PMID: 32800609 DOI: 10.1016/j.bjoms.2020.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/31/2020] [Indexed: 11/18/2022]
Abstract
When patients attend the emergency department with facial fractures that require surgery and are immediately admitted, surgery can be delayed as theatre time is prioritised for other more urgent patients. One solution is to send the patient home and admit them as an elective patient at a later date. The aim of this study was to investigate the outcomes of patients admitted directly and those seen as elective patients following fracture of the mandible or zygomatic complex. Data were taken from the hospital episodes statistics (HES) dataset for 2011-2018, and all hospital admissions for mandibular and zygomatic complex fractures within the National Health Service (NHS) in England were extracted. Patients were categorised as those admitted on attendance at the emergency department and given definitive treatment during the admission, and those not admitted on attendance at the emergency department but discharged home and seen as elective admissions within 30 days of attendance. Data were available for 39 606 patients. For both types of fracture there was substantial variation between NHS trusts in the proportion of patients admitted electively and the proportion admitted directly as emergencies. Elective admission was independently associated with shorter overall stay and lower emergency readmission rates. We found no evidence that delays to definitive surgery through elective admission had a negative impact on emergency readmission rates. Patients admitted electively had a significantly shorter hospital stay.
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Affiliation(s)
- W K Gray
- Getting It Right First Time programme, NHS England and NHS Improvement, London, UK
| | - J Day
- Getting It Right First Time programme, NHS England and NHS Improvement, London, UK
| | - M Morton
- Getting It Right First Time programme, NHS England and NHS Improvement, London, UK; East Lancashire Hospitals NHS Trust, Blackburn, UK.
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20
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Forrester JD, Wolff CJ, Choi J, Colling KP, Huston JM. Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures. Surg Infect (Larchmt) 2020; 22:274-282. [PMID: 32598227 DOI: 10.1089/sur.2020.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Facial fractures are common in traumatic injury. Antibiotic administration practices for traumatic facial fractures differ widely. Methods: The Surgical Infection Society's (SIS's) Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic administration in the management of traumatic facial fractures. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Pre-operative antibiotics were defined as those administered more than 1 hour before surgery. Peri-operative antibiotics were those administered within 1 hour of the start of surgery depending on the type of antibiotic and as late as ≤24 hours after surgery. Post-operative antibiotics were defined as those administered >24 hours after surgery. Prophylactic antibiotics were those administered for >24 hours without a documented infection. Evaluation of the published evidence was performed with the GRADE system. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. Results: We recommend that in adult patients with non-operative upper face, midface, or mandibular fractures, prophylactic antibiotics not be prescribed and that in adult patients with operative, non-mandibular fractures, pre-operative antibiotics likewise not be prescribed. We recommend that in adult patients with operative, mandibular fractures, pre-operative antibiotics not be prescribed; and in adult patients with operative, non-mandibular facial fractures, post-operative (>24 hours) antibiotics again not be prescribed. We recommend that in adult patients with operative, mandibular facial fractures, post-operative antibiotics (> 24 hours) not be prescribed. Conclusions: This guideline summarizes the current SIS recommendations regarding antibiotic management of patients with traumatic facial fractures.
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Affiliation(s)
- Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Chris J Wolff
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Jeff Choi
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | | | - Jared M Huston
- Departments of Surgery and Science Education, Zucker School of Medicine, Northwell Health, Hempstead, New York, USA
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21
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Barbat A, Partiali B, Oska S, Folbe A. Head, Face, and Neck Fractures Secondary to Ladder-Related Injuries Treated in United States Emergency Departments in 2009-2018. J Emerg Med 2020; 59:186-192. [PMID: 32561108 DOI: 10.1016/j.jemermed.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ladders are a commonly used piece of equipment; however, their use is accompanied by a significant potential for injury. Fractures of the head, face, and neck are potential consequences of ladder use and can be devastating due to potential for severe sequalae. OBJECTIVES To describe the frequency and pattern of ladder-related head, face, and neck fractures from 2009-2018. METHODS The National Electronic Injury Surveillance System (NEISS) was searched for ladder-related head, face, and neck fractures treated in U.S. emergency departments. Demographics, mechanism of injury, fracture type, setting in which fracture occurred, and patient disposition were analyzed. RESULTS There were 601 total cases (weighted national estimate of 20,450 total cases) of ladder-related head, face, and neck fractures obtained from the NEISS from 2009 to 2018. The mean age of injury was 53 years, and the majority of cases occurred in home settings. Approximately 25% of the cases were patients aged older than 65 years. The majority of fractures in individuals younger than 18 years and older than 46 years of age resulted in admission. The most commonly fractured locations included the face (51.0%), followed by cervical spine (28.3%) and cranial (20.7%) fractures. CONCLUSIONS Admission rates for ladder-related head, face, and neck fractures are substantially higher than those previously reported for all types of ladder-related injuries. Injury and admission patterns vary by age. Rigorous safety precautions may be indicated for the high-risk groups identified by this study, especially the elderly.
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Affiliation(s)
- Antonio Barbat
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Benjamin Partiali
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Sandra Oska
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Adam Folbe
- Division of Otolaryngology Head and Neck Surgery, Rhinology and Endoscopic Skull Base Surgery, William Beaumont Hospital, Royal Oak, Michigan
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22
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Paw E, Canner JK, Haut ER, Manukyan M. The effect of alcohol on facial Trauma outcomes: an analysis of the National Trauma Data Bank. Int J Oral Maxillofac Surg 2020; 49:1174-1182. [PMID: 32014317 DOI: 10.1016/j.ijom.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/19/2022]
Abstract
Maxillofacial trauma costs emergency departments approximately one billion dollars annually. Facial trauma has increased since 2000 and has been attributed to both increased use of computed tomography and interpersonal violence. Alcohol, male sex, and age 18-35 years are significant risk factors for interpersonal violence. This study is novel in using a large database to look at the effect of alcohol on clinical outcomes in facial trauma. A data analysis was performed in Stata/MP 14.2 using variables coded from the National Trauma Data Bank (NTDB); logistic regression was applied. A total 580,313 patient records were analyzed. Operations for facial fractures were performed in 20.19% of cases (n = 117,139). A positive alcohol test reduced the odds of requiring operative fixation in both the unadjusted (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.79-0.82, P < 0.001) and adjusted (OR 0.67, 95% CI 0.66-0.68, P < 0.001) models. Age and being struck (adjusted OR 1.99, 95% CI 1.91-2.07, P < 0.001) or shot (adjusted OR 1.95, 95% CI 1.84-2.06, P < 0.001) had a significant effect on operative fixation. Injury mechanisms related to interpersonal violence appeared to have higher operative fixation rates. This study did not find a correlation between acute intoxication and the need for an operative intervention. This further demonstrates the multifactorial nature of facial trauma and stresses the importance of injury and violence prevention on clinical outcomes.
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Affiliation(s)
- E Paw
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA.
| | - J K Canner
- Johns Hopkins Department of Surgery, Division of Acute Care Surgery, Trauma, Emergency Surgery, and Critical Care, Baltimore, MD, USA
| | - E R Haut
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA; Johns Hopkins Department of Surgery, Division of Acute Care Surgery, Trauma, Emergency Surgery, and Critical Care, Baltimore, MD, USA; Johns Hopkins Department of Anesthesiology and Critical Care Medicine, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - M Manukyan
- Johns Hopkins Department of Surgery, Division of Acute Care Surgery, Trauma, Emergency Surgery, and Critical Care, Baltimore, MD, USA
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23
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Dobitsch AA, Oleck NC, Liu FC, Halsey JN, Hoppe IC, Lee ES, Granick MS. Sports-Related Pediatric Facial Trauma: Analysis of Facial Fracture Pattern and Concomitant Injuries. Surg J (N Y) 2019; 5:e146-e149. [PMID: 31602397 PMCID: PMC6785318 DOI: 10.1055/s-0039-1697627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022] Open
Abstract
Objective
Sports-related injuries, such as facial fractures, are potentially debilitating and may lead to long-term functional and aesthetic deficits in a pediatric patient. In this study, we analyze sports-related facial fractures in the urban pediatric population in an effort to characterize patterns of injury and improve management strategies and outcomes.
Methods
Retrospective chart review was performed for all facial fractures resulting from sports injuries in the pediatric population at a level-1 trauma center (University Hospital, Newark, NJ).
Results
Seventeen pediatric patients were identified as having sustained a fracture of the facial skeleton due to sports injury. Mean age was 13.9 years old. A total of 29 fractures were identified. Most common fracture sites included the orbit (
n
= 12), mandible (
n
= 5), nasal bone (
n
= 5), and zygomaticomaxillary complex (
n
= 3). The most common concomitant injuries included skull fracture (
n
= 3), intracranial hemorrhage (
n
= 4), and traumatic brain injury (
n
= 4). One patient was intubated upon arrival to the emergency department. Hospital admission was required in 13 patients, 4 of which were admitted to an intensive care setting. Nine patients required operative intervention. Mean length of hospital stay was 2.4 days. No patients were expired.
Conclusions
Sports-related facial fractures are potentially debilitating injuries in the pediatric population. Analysis of fracture pattern and concomitant injuries is imperative to develop effective management strategies and prevention techniques.
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Affiliation(s)
- Andrew A Dobitsch
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nicholas C Oleck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Farrah C Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jordan N Halsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ian C Hoppe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Mark S Granick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Abstract
OBJECTIVES "Young adulthood" is a term used to define individuals falling within the 18- to 22-year-old age range. Injuries account for more than a third of emergency department visits in this population. A particular area of concern is accidents that lead to injuries of the facial bones because they can have long-term functional, aesthetic, and psychosocial impacts. As many as 30 million young adults participate in some sort of sport in the United States per year, and facial injuries from these activities are not uncommon and thus require further exploration. METHODS The National Electronic Injury Surveillance System was used to conduct a retrospective review to explore patterns of maxillofacial fractures in young adult patients between the ages of 18 and 22 years from 2004 through 2017. The data analyzed yielded information about patient demographics, diagnoses, and associated products. RESULTS A total of 3486 emergency department visits were included in the study. The most common facial fractures were nasal fractures (64.4%), mandible fractures (12.3%), and orbital fractures (6.1%). The most common causes of fractures were sports (55.48%), fixed structures (6.39%), and stairs or steps (5.60%). The top 3 sports associated with facial fractures were basketball (25.4%), baseball (11.6%), and football (10.4%). CONCLUSIONS For young adult individuals, some sort of sporting activity is common outside of the National Collegiate Athletic Association. The overwhelming majority of facial fractures in this population were caused by sports, and the authors believe this issue warrants further exploration and discussion. According to the Centers for Disease Control and Prevention, an estimated 8.6 million sports- and recreation-related injuries occurred per year between 2011 and 2014. Despite ever growing research and guidelines into sports injury incidence and prevention, it is clear that sports are the cause of a large portion of maxillofacial fractures in the United States.
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Affiliation(s)
- Roman Povolotskiy
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Pavly Youssef
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Kaye
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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25
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Kinzinger M, Steele TO, Chin O, Strong EB. Degree of Frontal Bone Exposure via Upper Blepharoplasty Incision: Considerations for Frontal Sinus Fracture. Otolaryngol Head Neck Surg 2019; 160:468-471. [PMID: 30667301 DOI: 10.1177/0194599818825456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The upper eyelid blepharoplasty incision affords direct access to the frontal bone for skull base surgery and trauma reconstruction with a well-hidden scar. The goal of this study is to quantify frontal bone exposure that can be achieved with an upper eyelid blepharoplasty incision. DESIGN Anatomic study with human cadaver heads. SETTING UC Davis Medical Center. SUBJECTS/METHODS Fourteen human cadaver heads were used to perform 26 upper blepharoplasty approaches. Exposure was measured with virtual planning software to create virtual reference points at the midline of the superior orbital rim. Surgical navigation was used with a 3-dimensionally printed drill model to measure the maximum exposure achievable relative to the virtual reference point at 5 standardized angles. RESULTS Mean ± SD exposures at medial 60°, medial 30°, 0°, lateral 30°, and lateral 60° were 16.1 ± 1.3 mm, 17.8 ± 1.3, 18.3 ± 1.4, 19.3 ± 1.9, and 20.9 ± 1.9, respectively. Significant differences were detected between exposures at 60° laterally and 60° medially and between exposures 60° laterally and 30° medially ( P < .05). CONCLUSIONS The upper eyelid blepharoplasty incision provides direct surgical access to the inferior frontal bone. Access was greatest with far lateral extension (mean, 20.9 mm) and most limited with far medial extension (mean, 16.1 mm). Treatment of injuries above this level could be achieved with additional percutaneous incisions for screw placement.
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Affiliation(s)
- Michael Kinzinger
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Toby O Steele
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA.,2 Department of Surgery, VA Northern California Healthcare System, Sacramento, California, USA
| | - Oliver Chin
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Edward B Strong
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
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26
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Abstract
Purpose The purpose of this study is to compare the association of diplopia after orbital fracture repair using titanium mesh and high-density polyethylene-coated titanium mesh. Materials and Methods Retrospective review of records of consecutive patients who presented for primary/secondary correction of orbital fracture attending author's institute was done. Patients attending the institution between January 2013 and December 2017 (5 years' period) fulfilling the inclusion and exclusion criteria were included for this study. Results In all, 44 patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The mean age was 31.86 ± 9.1 years and the mean period of follow-up was 9.37 ± 2.1 months postoperatively, with a range of 6.5-24 months. There were 65.91% males, and the most common etiology was road traffic accident (50%). In all, 11 (25%) cases had postoperative diplopia. Of the 11 cases that had diplopia, 6 had Class 1 and 5 had Class 2 diplopia. Of these 11 cases, 8 cases had completion or partial resolution of diplopia by the end of 8 weeks' period, and in 3 cases, it persisted even after 3 months of care. The occurrence of diplopia was compared by demographic factor using Chi-square test, and the mesh type was only statistically significant (P = 0.026). Discussion The present study indicates that both types of mesh provide reliable, clinically better results. However, with passage of time, it was clinically observed that removing uncoated mesh poses extreme difficulty by the adherences and growth penetrating the meshes. In certain instances, clinically, it was observed that such adhesions may be a cause of compromise of eyeball movement. Conclusion Noncoated titanium orbital implants may lead to the adherence of orbital and periorbital structures, resulting in restrictive diplopia. High-density polyethylene-coated titanium mesh shows better performance as compared to noncoated mesh in preventing adherence situations.
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Affiliation(s)
- S M Balaji
- Director and Consultant, Oral and Craniomaxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
| | - Preetha Balaji
- Director and Consultant, Oral and Craniomaxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
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27
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Ambrose E, Sokoya M, Eustaquio M. Pseudoaneurysm Following Endoscopic-Assisted Repair of Subcondylar Fracture. Craniomaxillofac Trauma Reconstr 2018; 11:302-304. [PMID: 30574274 DOI: 10.1055/s-0037-1607064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/17/2017] [Indexed: 10/18/2022] Open
Abstract
Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present a case of a 33-year-old man who developed pseudoaneurysm after endoscopic-assisted ORIF as well as a review of the literature on this topic. While uncommon, this is a potential complication that should be recognized with the use of endoscopic-assisted repair of mandibular fractures.
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Affiliation(s)
- Emily Ambrose
- Department of Otolaryngology, University of Colorado, Aurora, Colorado
| | | | - Marcia Eustaquio
- Department of Otolaryngology, Denver Health and Hospital Authority, Denver, Colorado
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28
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Abosadegh MM, Rahman SA, Saddki N. Association of traumatic head injuries and maxillo facial fractures: A retrospective study. Dent Traumatol 2017; 33:369-374. [PMID: 28504848 DOI: 10.1111/edt.12349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS The association of traumatic head injury (THI) with maxillofacial fractures (MFF) is a major health concern worldwide. In spite of the close anatomical proximity of maxillofacial bones to the cranium, the association of THI with MFF is controversial. The aim of this study was to assess the association between THI and MFF. Other factors associated with THI in patients with MFF were also investigated. MATERIALS AND METHODS A hospital-based retrospective study was conducted at the OMFS Unit, Hospital USM, Kelantan, Malaysia. From 12 June 2013 to 31 December 2015, 473 patient records with MFF were reviewed to evaluate the association of THI and MFF. RESULTS A total of 331 patients (69.98%) presented with concomitant THI. The most common associated THI were cranial bone fractures (68.6%) followed by intracranial injuries and concussion. A significant association existed between the Glasgow coma scale (GCS) score and the presence of THI concomitant MFF with P-value <.001. The univariable logistic regression analysis revealed that age group (31-40 years), cause of injury (road traffic accident-RTA), all midface fracture types and most of the mandibular fracture types were statistically associated with the presence of THI. The multivariable logistic regression analysis revealed that the cause of the injury (RTA) and MFF types (nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and the alveolar process of mandible fractures) were statistically significantly associated with THI in patients with MFF. CONCLUSION There was a high prevalence of THI among patients with MFF (69.98%). RTA, nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and mandibular alveolar process fractures were significantly associated with THI in patients who sustained a MFF.
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Affiliation(s)
- Maher M Abosadegh
- Maxillofacial Surgery Unit, School of Dental Sciences, Universiti Sains Malaysia 16150, Kubang Kerian, Kelantan, Malaysia
| | - Shaifulizan Ab Rahman
- Maxillofacial Surgery Unit, School of Dental Sciences, Universiti Sains Malaysia 16150, Kubang Kerian, Kelantan, Malaysia
| | - Norkhafizah Saddki
- Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia 16150, Kubang Kerian, Kelantan, Malaysia
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29
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Abstract
The frontal bone serves a protective role, representing the transition between the facial skeleton and the cranium. Within its enclosure, the frontal sinus lies adjacent to many important intracranial structures, and injury to this region has severe complications if not properly managed. Historically, the goals of frontal sinus fracture management have been to best prevent intracranial complications with invasive procedures, but a recent shift favoring conservative management now aims to preserve the form and function of the frontal sinus and its outflow tract. With the advancement of endoscopic techniques and the development of new technologies, many alternatives to aggressive surgical management are available.
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Affiliation(s)
- Kelly Schultz
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tara L Braun
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tuan A Truong
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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30
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Abstract
Skull base fractures extend through the floor of the anterior, middle, or posterior cranial fossa. They are frequently associated with complex facial fractures and serious complications such as cranial nerve or vascular injury, cerebrospinal fluid leak, or meningitis. Several distinct patterns of skull base fractures have been recognized, each of them associated with different complications. Recognition of, often subtle, skull base fracture is essential to prevent or allow early treatment of these serious complications.
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Affiliation(s)
- Matthew Bobinski
- Department of Radiology, University of California-Davis School of Medicine, Sacramento, California, United States
| | - Peter Y Shen
- Department of Radiology, University of California-Davis School of Medicine, Sacramento, California, United States
| | - Arthur B Dublin
- Department of Radiology, University of California-Davis School of Medicine, Sacramento, California, United States
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31
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Raikundalia M, Svider PF, Hanba C, Folbe AJ, Shkoukani MA, Baredes S, Eloy JA. Facial fracture repair and diabetes mellitus: An examination of postoperative complications. Laryngoscope 2016; 127:809-814. [PMID: 27658923 DOI: 10.1002/lary.26270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our objectives included using a nationally representative resource to evaluate charges, demographics, and complication rates among diabetics undergoing surgical repair of facial fractures. METHODS We evaluated the Nationwide Inpatient Sample, a database encompassing nearly 8 million hospitalizations, for patients with a diagnosis of a facial fracture who underwent surgical intervention during their hospitalization. Patients were organized by whether they had a diagnosis of diabetes mellitus (DM). RESULTS Of 45,509 inpatients included, diabetics had greater costs, longer length of stays, and were significantly more likely to have a host of baseline comorbidities. On multivariate logistic regression corrected for age, race, gender, and preexisting cardiac disease, DM patients had significantly greater odds for cardiac complications (3.3; P < 0.001) and hepatic failure (15.0; P = 0.007). There were no significant differences associated with DM in the rates of enophthalmos, epiphora, and diplopia among patients with orbital fractures. Diabetics did have a significantly greater risk of postoperative infection after mandible repair. CONCLUSION In addition to a significant association with greater length of stay and increased hospital charges, DM patients undergoing surgical repair of facial fractures had a significantly greater risk of postoperative complications, including cardiac complications. Diabetics undergoing mandible repair had a greater risk of postoperative infection, even upon controlling for demographic factors, suggesting the need for further study evaluating the role of postoperative antibiotic prophylaxis in this patient population. These findings reveal the potential value of developing and using standardized postoperative care algorithms aimed at minimizing complications in this susceptible population. LEVEL OF EVIDENCE 2c. Laryngoscope, 127:809-814, 2017.
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Affiliation(s)
- Milap Raikundalia
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Curtis Hanba
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Mahdi A Shkoukani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A
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32
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Spinelli G, Lazzeri D, Arcuri F, Valente D, Agostini T. Management of Mandibular Angle Fractures by Two Conventional 2.0-mm Miniplates: A Retrospective Study of 389 Patients. Craniomaxillofac Trauma Reconstr 2016; 9:206-10. [PMID: 27516834 DOI: 10.1055/s-0036-1582457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022] Open
Abstract
Fractures of the mandibular angle account for 23 to 42% of all facial fractures with a high complication rate (0-32%). Although the ideal treatment remains debatable, two main procedures are commonly used to manage the majority of mandibular angle fractures that are open reduction and internal fixation by a noncompression miniplate placed on the external oblique ridge with or without a second miniplate on the outer cortex. The purpose of this study was to describe our management of mandibular angle fractures by two noncompression miniplates placed on the outer cortex via a transbuccal approach. Medical records and radiographic examination of 389 patients (258 males [66.3%] and 131 females [33.7%]) operated from January 2000 to December 2012 were retrospectively reviewed. Postoperative complications including malocclusion, infection, wound dehiscence, nonunion, and reoperative surgery were recorded and analyzed. Fifty-three patients developed postoperative complications (overall complication rate: 13.6%). No significant difference was found in the complication rate by age and gender variables and regarding the interval between the trauma and the operation and the presence of the teeth in the line of fracture. A higher rate of complications was found among patients with alcohol/drug addiction and in patients with multiple-site involvement. The findings of this study suggest that the use of two transbuccal miniplates placed on the outer cortex for the internal fixation of mandibular angle fracture provided a low rate of complications. The global incidence of screw loosening, wound dehiscence, plate exposure, infection, reoperation, and plate removal were similar with the data reported in the literature with improved health outcomes, lower postoperative morbidity, and a faster return to normal life.
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Affiliation(s)
- Giuseppe Spinelli
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
| | - Francesco Arcuri
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
| | - Domenico Valente
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
| | - Tommaso Agostini
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
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33
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Hojjat H, Svider PF, Lin HS, Folbe AJ, Shkoukani MA, Eloy JA, Zuliani G. Adding Injury to Insult: A National Analysis of Combat Sport-Related Facial Injury. Ann Otol Rhinol Laryngol 2016; 125:652-9. [PMID: 27189152 DOI: 10.1177/0003489416644617] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics. METHODS The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics. RESULTS There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting. CONCLUSIONS The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.
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Affiliation(s)
- Houmehr Hojjat
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mahdi A Shkoukani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA
| | - Giancarlo Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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Carniol ET, Shaigany K, Svider PF, Folbe AJ, Zuliani GF, Baredes S, Eloy JA. "Beaned": A 5-Year Analysis of Baseball-Related Injuries of the Face. Otolaryngol Head Neck Surg 2015; 153:957-61. [PMID: 26354029 DOI: 10.1177/0194599815602668] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/05/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Baseball remains one of the most popular and safest games played by children and adults in America and worldwide. Rules and equipment changes have continued to make the game safer. For youth leagues, pitching restrictions, safety balls, helmets, and face mask equipment continue to make the game safer. With increased utilization of safety equipment, the objective was to analyze recent trends in baseball-related facial injuries. STUDY DESIGN Cross-sectional analysis of a national database. METHODS The National Electronic Injury Surveillance System was searched for baseball-related facial injuries with analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations. RESULTS From 2009 to 2013, there were 5270 cases entries, or 187,533 estimated emergency department (ED) visits, due to baseball-related facial injuries. During this time, there was a significant decline in the incidence of ED visits (P = .014). Inclusion criteria were met by 3208 visits. The majority of injuries occurred in patients ≤18 years old (81.5%). The most common injury was laceration (33.2%), followed by contusion (29.7%) and fracture (26.9%), while the most common injury site on the face was the nose (24.9%). The injuries were most commonly due to impact from a baseball (70%) or a bat (12.5%). CONCLUSION The overall incidence of ED visits due to baseball-related facial injuries has decreased over the past 5 years, concurrent with increased societal use of protective equipment. Nonetheless, these injuries remain a common source for ED visits, and a continued effort to utilize safety measures should be made, particularly in youth leagues.
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Affiliation(s)
- Eric T Carniol
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kevin Shaigany
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Giancarlo F Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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35
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Denney BD, Ray PR. Systematic method for initial rapid analysis of maxillofacial computed tomography scans for surgeons in training. ANZ J Surg 2015; 86:184-7. [PMID: 25982891 DOI: 10.1111/ans.13182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reading maxillofacial computed tomography (CT) scans is a basic skill for any surgeon who operates on the face. A standard systematic approach for how to read a maxillofacial CT scan from a surgeon's perspective is lacking in literature, particularly for those in the early stages of training. We present a method of initial rapid analysis which our residents in training have responded to and report to be conceptually simple to apply. METHODS The senior author reviewed over 250 consults for face trauma and performed a detailed composite of the most common elements of each consult as well as the clinically relevant decision points. These elements were then bundled into a conceptual sketch of the skull-face-mandible with an accompanying standardized clinical data list. The new residents were then guided through a systematic approach to reading the scans while sketching the injuries identified. The authors then performed a survey to establish if the new method was helpful to early learners prior to and after adoption of the method. The survey consisted of five questions regarding the utility of the method for analysis of reading maxillofacial CT. RESULTS In total, seven residents were surveyed; 100% thought the technique made reading facial CT easier, 100% thought this method was easy to teach to junior residents and 86% found the analysis of facial CT easier and helped their surgical decision making. CONCLUSION We present a systematic method for surgeons to evaluate facial CT scans. This is the first published account of methodology for maxillofacial CT analysis for surgeons.
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Affiliation(s)
- Brad David Denney
- Department of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter R Ray
- Department of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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36
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Aboelatta YA, Elbarbary AS, Abdelazeem S, Massoud KS, Safe II. Minimizing the Submandibular Incision in Endoscopic Subcondylar Fracture Repair. Craniomaxillofac Trauma Reconstr 2015; 8:315-20. [PMID: 26576236 DOI: 10.1055/s-0035-1549010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 12/27/2014] [Indexed: 10/23/2022] Open
Abstract
Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique of this controversial subject. The approach is performed through an intraoral and additional submandibular incision. This study presents a technique for minimizing the length of the optional submandibular incision. Ten patients with displaced subcondylar fractures and malocclusion underwent endoscope-assisted open reduction and internal fixation (ORIF). A limited (<1 cm) submandibular incision (dissected under endoscopic guidance from within) was needed in eight patients to complement the intraoral incision and facilitate the reduction in the fractures. Satisfactory small scar could be obtained in all patients with neither wound complications nor facial nerve injuries. Our technique depends on dissection first then incision. Performing the external incision after complete intraoral dissection is safe for the facial nerve and minimizes scarring markedly. This very limited submandibular incision facilitates reduction in relatively difficult cases and enables clear visualization of posterior border of the mandible to confirm adequate fracture reduction.
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Affiliation(s)
| | - Amir S Elbarbary
- Department of Plastic & Reconstructive Surgery, Ain-Shams University, Cairo, Egypt
| | - Sarah Abdelazeem
- Department of Plastic & Reconstructive Surgery, Ain-Shams University, Cairo, Egypt
| | - Karim S Massoud
- Department of Plastic & Reconstructive Surgery, Ain-Shams University, Cairo, Egypt
| | - Ikram I Safe
- Department of Plastic & Reconstructive Surgery, Ain-Shams University, Cairo, Egypt
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Mukherjee S, Abhinav K, Revington PJ. A review of cervical spine injury associated with maxillofacial trauma at a UK tertiary referral centre. Ann R Coll Surg Engl 2015; 97:66-72. [PMID: 25519271 PMCID: PMC4473904 DOI: 10.1308/003588414x14055925059633] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the incidence and patterns of cervical spine injury (CSI) associated with maxillofacial fractures at a UK trauma centre. METHODS A retrospective analysis was conducted of 714 maxillofacial fracture patients presenting to a single trauma centre between 2006 and 2012. RESULTS Of the 714 maxillofacial fracture patients, 2.2% had associated CSI including a fracture, cord contusion or disc herniation. In comparison, 1.0% of patients without maxillofacial trauma sustained a CSI (odds ratio: 2.2, p=0.01). The majority (88%) of CSI cases of were caused by a road traffic accident (RTA) with the remainder due to falls. While 8.8% of RTA related maxillofacial trauma patients sustained a CSI, only 2.0% of fall related patients did (p=0.03, not significant). Most (70%) of the CSIs occurred at C1/C2 or C6/C7 levels. Overall, 455, 220 and 39 patients suffered non-mandibular, isolated mandibular and mixed mandibular/non-mandibular fractures respectively. Their respective incidences of CSI were 1.5%, 1.8% and 12.8% (p=0.005, significant). Twelve patients with concomitant CSI had their maxillofacial fractures treated within twenty-four hours and all were treated within four days. CONCLUSIONS The presence of maxillofacial trauma mandates exclusion and prompt management of cervical spine injury, particularly in RTA and trauma cases involving combined facial fracture patterns. This approach will facilitate management of maxillofacial fractures within an optimum time period.
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Abstract
Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.
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Affiliation(s)
- Adrian F DeAngelis
- Maxillofacial Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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39
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Parcells AL, Yueh J, Ciminello F, Granick M. Facial fracture after motorcycle collision. Eplasty 2014; 14:ic37. [PMID: 25328582 PMCID: PMC4194597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alexis L. Parcells
- Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ,Correspondence:
| | - Janet Yueh
- Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Frank Ciminello
- Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Mark Granick
- Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ
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40
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Mundinger GS, Borsuk DE, Okhah Z, Christy MR, Bojovic B, Dorafshar AH, Rodriguez ED. Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice. Craniomaxillofac Trauma Reconstr 2014; 8:64-78. [PMID: 25709755 DOI: 10.1055/s-0034-1378187] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/26/2013] [Indexed: 10/24/2022] Open
Abstract
Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third. Study level of evidence was assessed according to the American Society of Plastic Surgery criteria, and graded practice recommendations were made based on these assessments. Expert opinions were garnered during the Advanced Orbital Surgery Symposium in the form of surveys evaluating senior surgeon clinical antibiotic prescribing practices by time point and facial third. A total of 44 studies addressing antibiotic prophylaxis and facial fracture management were identified. Overall, studies were of poor quality, precluding formal quantitative analysis. Studies supported the use of perioperative antibiotics in all facial thirds, and preoperative antibiotics in comminuted mandible fractures. Postoperative antibiotics were not supported in any facial third. Survey respondents (n = 17) cumulatively reported their antibiotic prescribing practices over 286 practice years and 24,012 facial fracture cases. Percentages of prescribers administering pre-, intra-, and postoperative antibiotics, respectively, by facial third were as follows: upper face 47.1, 94.1, 70.6; midface 47.1, 100, 70.6%; and mandible 68.8, 94.1, 64.7%. Preoperative but not postoperative antibiotic use is recommended for comminuted mandible fractures. Frequent use of pre- and postoperative antibiotics in upper and midface fractures is not supported by literature recommendations, but with low-level evidence. Higher level studies may better guide clinical antibiotic prescribing practices.
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Affiliation(s)
- Gerhard S Mundinger
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Daniel E Borsuk
- Division of Plastic Surgery, University of Montreal, Montreal, Canada
| | - Zachary Okhah
- Division of Plastic and Reconstructive Surgery, Brown University, Providence, Rhode Island
| | - Michael R Christy
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Branko Bojovic
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Amir H Dorafshar
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Eduardo D Rodriguez
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
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Lawrence LA, Svider PF, Raza SN, Zuliani G, Carron MA, Folbe AJ. Hockey-related facial injuries: a population-based analysis. Laryngoscope 2014; 125:589-93. [PMID: 25169755 DOI: 10.1002/lary.24893] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/26/2014] [Accepted: 07/29/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recognition of the potentially severe sequelae arising from inadequate facial protection has facilitated sustained efforts to increase the use of protective visors in recent decades. Our objective was to characterize nationwide trends among patients presenting to emergency departments (ED) for facial injuries sustained while playing ice hockey. METHODS The National Electronic Injury Surveillance System was searched for hockey-related facial injuries, with analysis for incidence; age and gender; and specific injury diagnoses, mechanisms, and facial locations. RESULTS There were an estimated 93,444 ED visits for hockey-related facial injuries from 2003 to 2012. The number of annual ED visits declined by 43.8% from 2003 to 2012. A total of 90.6% of patients were male; and the peak age of injury was 17 years. Lacerations were the most common form of facial injury (81.5% of patients) across all age groups. Contusions/abrasions and fractures followed in frequency, with fractures increasing with advancing age. CONCLUSIONS The overall incidence of ED visits due to facial injuries from ice hockey has significantly decreased over the last decade, concurrent with increased societal use of facial protective equipment. Nonetheless, facial hockey injuries facilitate a significant number of ED visits among both adults and children; thus, the knowledge of demographic-specific trends described in this analysis is relevant for physicians involved in the management of facial trauma. These findings reinforce the need to educate individuals who play hockey about the importance of appropriate facial protection.
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Affiliation(s)
- Lauren A Lawrence
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
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Lee TS, Kellman R, Darling A. Crumple zone effect of nasal cavity and paranasal sinuses on posterior cranial fossa. Laryngoscope 2014; 124:2241-6. [PMID: 24515980 DOI: 10.1002/lary.24644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/21/2014] [Accepted: 02/03/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Examine a protective crumple zone effect of paranasal sinuses and nasal cavity on skull base fractures. STUDY DESIGN Randomized-control, cadaveric study. METHODS In the experimental group (n = 4), the nasal cavity and bilateral sinuses of cadavers were obliterated with bone cement, whereas the control group (n = 4) had native sinus architecture. Increasing frontal, glabellar impacts were introduced. Each impact event was examined with a high-speed video camera and sphenoid sinus pressure sensor. After each impact, computed tomography scans were performed and fracture sites were analyzed. RESULTS The control group with intact sinuses showed statistically longer time duration, during which kinetic energy transfer occurred, and longer sphenoid wall pressure equilibrium time after an impact (P < 0.05). In the experimental group, there were statistically higher fracture incidences of clivus, petrous portion of internal carotid, occipital bone, and foramen magnum (P < 0.05). The type A pattern (n = 6) had anterior skull base failure occurring before posterior skull base failure. Type B pattern (n = 2), seen only in two experimental specimens, is marked by premature posterior skull base collapse occurring before anterior skull base failure with grossly disrupted posterior cranial fossa structures. CONCLUSION The presence of nasal cavity and paranasal sinuses behaves as a crumple zone to protect the cranial structures, preferentially posterior cranial fossa. Obliteration of the nasal cavity and paranasal sinuses with bone cement significantly increased structural tolerance of the anterior cranial vault to frontal, glabellar impacts at the cost of premature, posterior cranial fossa failure.
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Affiliation(s)
- Thomas S Lee
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
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Strong EB, Fuller SC, Wiley DF, Zumbansen J, Wilson MD, Metzger MC. Preformed vs intraoperative bending of titanium mesh for orbital reconstruction. Otolaryngol Head Neck Surg 2013; 149:60-6. [PMID: 23482478 DOI: 10.1177/0194599813481430] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The most accurate orbital reconstructions result from an anatomic repair of the premorbid orbital architecture. Many different techniques and materials have been used; unfortunately, there is currently no optimal method. This study compares the use of preformed vs intraoperative bending of titanium mesh for orbital reconstruction in 2-wall orbital fractures. STUDY DESIGN Cadaver-based study. SETTING University hospital. SUBJECTS AND METHODS Preinjury computed tomography scans were obtained in 15 cadaveric heads (30 orbits). Stereolithographic (STL) models were fabricated for 5 of the specimens (10 orbits). Two wall fractures (lamina papyracea and floor) were then generated in all orbits. Surgical reconstruction was performed in all orbits using 1 of 3 techniques (10 orbits each): (1) patient-specific implant molded from the preinjury STL model, (2) titanium mesh sheet bent freehand, and (3) preformed titanium mesh. Each technique was evaluated for orbital volume correction, contour accuracy, ease of use, and cost. RESULTS No difference in volume restoration was found between the 3 techniques. Patient-specific implants had the greatest contour accuracy, poor ease of use, and highest cost. Freehand bending implants had the poorest contour accuracy, acceptable ease of use, and lowest cost. Preformed mesh implants had intermediate contour accuracy, excellent ease of use, and low cost. CONCLUSION All 3 techniques provide equivalent orbital volume correction. However, preformed mesh implants have many advantages based on contour accuracy, ease of use, and relative cost.
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Affiliation(s)
- E Bradley Strong
- Department of Otolaryngology, University of California, Davis, California 95817, USA.
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Abstract
Over the past 20 years, there have been many advances in the development of bone fixation systems used in the practice of craniomaxillofacial surgery. As surgical practices have evolved, the complications of each technologic advance have changed accordingly. Interfragmentary instability of interosseous wiring has been replaced by the risk of exposure, infection, and palpability of plate and screw fixation systems. The improved rigidity of plate fixation requires anatomic alignment of fracture fragments. Failure to obtain proper alignment has led to the phenomenon known as "open internal fixation" of fracture fragments without proper reduction. The size of the plates has decreased to minimize palpability and exposure. However limitations in their application have been encountered due to the physiologic forces of the muscles of mastication and bone healing. In the pediatric population, the long-standing presence of plates in the cranial vault resulted in reports of transcranial migration and growth restriction. These findings led to the development of resorbable plating systems, which are associated with self-limited plate palpability and soft tissue inflammatory reactions. Any rigid system including these produces growth restriction in varying amounts. In this discussion, we review the reported complication rates of miniplating and microplating systems as well as absorptive plating systems in elective and traumatic craniofacial surgery.
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Affiliation(s)
- Chris A Campbell
- Department of Plastic Surgery, University of Virginia Health System, Charlottesville, Virginia
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Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. Characteristics of associated craniofacial trauma in patients with head injuries: An experience with 100 cases. J Emerg Trauma Shock 2011; 2:89-94. [PMID: 19561967 PMCID: PMC2700599 DOI: 10.4103/0974-2700.50742] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 12/06/2008] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Facial fractures and concomitant cranial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults. AIMS AND OBJECTIVES To analyze the characteristics of head injuries and associated facial injuries, the management options and outcome following cranio-facial trauma. METHODS This retrospective review was performed at Justice K. S. Hegde Charitable Hospital, and associated A. B. Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore. Following Ethical Committee approval, hospital charts and radiographs of 100 consecutive patients of cranio-facial trauma managed at the Department of Oral and Maxillofacial Surgery and Neurosurgery between January 2004 and December 2004 were reviewed. RESULTS Majority of the patients were in the 2nd to 4th decade (79%) with a male to female ratio of -8.09:1. Road traffic accidents were the common cause of craniofacial trauma in present study (54%) followed by fall from height (30%). Loss of consciousness was the most common clinical symptom (62%) followed by headache (33%). Zygoma was the most commonly fractured facial bone 48.2% (alone 21.2%, in combination 27.2%). Majority of patients had mild head injury and managed conservatively in present series. Causes of surgical intervention for intracranial lesions were compound depressed fracture, contusion and intracranial hematoma. Operative indications for facial fractures were displaced facial bone fractures. Major causes of mortality were associated systemic injuries. CONCLUSION Adult males are the most common victims in craniofacial trauma, and road traffic accidents were responsible for the majority. Most of the patients sustained mild head injuries and were managed conservatively. Open reduction and internal fixation with miniplates was used for displaced facial bone fractures.
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Affiliation(s)
- Prasad B Rajendra
- Department of Neurosurgery, K.S.Hegde Medical Academy, Deralakatte-575018, Mangalore, Karnataka, India
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Abstract
Blindness is an uncommon, yet documented complication of facial trauma. Numerous case studies, series, and retrospective analyses have been published, with a reported incidence around 3%. Hippocrates first noted the association between maxillofacial trauma and blindness; millennia later, this was expounded upon by Berlin, who discovered such trauma may directly lead to fracturing of the optic canal. As diagnostic modalities such as computed tomographic scanning evolved, particularly over the past few decades, more specific, in-depth reports analyzing maxillofacial trauma and subsequent sequelae have emerged. It is the goal of this article to examine the current literature for those publications that have addressed the issue of blindness following facial trauma (including operative interventions) and create a concise review for maxillofacial surgeons.
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Affiliation(s)
| | - John A. Girotto
- Department of Surgery, University of Rochester, Rochester, New York
- Cleft and Craniofacial Anomalies Center, University of Rochester, Rochester, New York
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