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Manodh P, Prabhu Shankar D, Pradeep D, Santhosh R, Murugan A. Incidence and patterns of maxillofacial trauma-a retrospective analysis of 3611 patients-an update. Oral Maxillofac Surg 2016; 20:377-383. [PMID: 27663240 DOI: 10.1007/s10006-016-0576-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 03/16/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Maxillofacial fractures occur in a significant proportion worldwide and can occur as an isolated injury or in combination with other severe injuries including cranial, spinal, and upper and lower body injuries requiring prompt diagnosis with possible emergency interventions. The epidemiology of facial fractures varies with regard to injury type, severity, and cause and depends on the population studied. Hence, understanding of these factors can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries. MATERIALS AND METHODS In this present retrospective study, we provide a comprehensive overview regarding cranio-maxillofacial trauma on 3611 patients to assist the clinician in assessment and management of this unique highly specialized area of traumatology. A preformed pro forma was used to analyze the medical records of patients treated for facial trauma in The Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai. The distribution according to age, gender, etiology, type of injury, time interval between accident and treatment, loss of consciousness, facial bones involved, pattern of fracture lines, treatment offered, and postoperative complications were recorded and evaluated. RESULTS We inferred male patients sustained more injuries mostly in the third decade of age. Road traffic accidents were the most common cause of injury. Mandible was the most commonly fractured bone in the facial skeleton. Soft tissue injuries occurred more in road traffic accidents and upper lip was the commonest site of injury. CONCLUSION Our study provides insights into the epidemiology of facial injuries and associated factors and can be useful not only in developing prevention strategies but also for grading the existing legal regulations and also for framing a more effective treatment protocol.
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Affiliation(s)
- P Manodh
- OMFS, Meenakhi Ammal Dental College, Alapakkam Road, Chennai, Tamil Nadu, 600095, India
| | - D Prabhu Shankar
- OMFS, Meenakhi Ammal Dental College, Alapakkam Road, Chennai, Tamil Nadu, 600095, India
| | - Devadoss Pradeep
- OMFS, Meenakhi Ammal Dental College, Alapakkam Road, Chennai, Tamil Nadu, 600095, India
| | - Rajan Santhosh
- OMFS, Meenakhi Ammal Dental College, Alapakkam Road, Chennai, Tamil Nadu, 600095, India
| | - Aparna Murugan
- OMFS, Meenakhi Ammal Dental College, Alapakkam Road, Chennai, Tamil Nadu, 600095, India.
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Abstract
The changing complexity of maxillofacial fractures in recent years has created a situation where classical systems of classification of maxillofacial injuries fall short of defining trauma particularly that observed with high-velocity collisions where more than one region of the maxillofacial skeleton is affected. Trauma scoring systems designed specifically for the maxillofacial region are aimed to provide a more accurate assessment of the injury, its prognosis, the possible treatment outcomes, economics, length of hospital stay, and triage. The evolution and logic of such systems along with their merits and demerits are discussed. The author also proposes a new system to aid users in quickly and methodically choosing the system best suited to their needs without having to study a plethora of literature available in order to isolate their choice.
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Affiliation(s)
- Vaibhav Sahni
- Maharishi Markandeshwar College of Dental Sciences & Research, Mullana, Ambala, Haryana 133203, India.
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Abstract
Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, with the ultimate outcome dependent on each other, makes the prediction of wounding potential difficult to assess. As the facial features are the component of the body most involved in a patient's personality and interaction with society, preservation of form, cosmesis, and functional outcome should remain the primary goals in the management of ballistic injury. A logical, sequential analysis of the injury patterns to the facial complex is an absolutely necessary component for the treatment of craniomaxillofacial ballistic injuries. Fortunately, these skill sets should be well honed in all craniomaxillofacial surgeons through their exposure to generalized trauma, orthognathic, oncologic, and cosmetic surgery patients. Identification of injured tissues, understanding the functional limitations of these injuries, and preservation of both hard and soft tissues minimizing the need for tissue replacement are paramount.
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Affiliation(s)
- David B Powers
- Duke Craniomaxillofacial Trauma Program, Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, DUMC Box 2955, Durham, NC 27710, USA.
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Júnior SML, Santos SE, Kluppel LE, Asprino L, Moreira RWF, de Moraes M. A comparison of motorcycle and bicycle accidents in oral and maxillofacial trauma. J Oral Maxillofac Surg 2011; 70:577-83. [PMID: 21665346 DOI: 10.1016/j.joms.2011.03.035] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 03/02/2011] [Accepted: 03/30/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to present a large series of motorcycle- and bicycle-related traumas to the face in an attempt to identify the injury pattern in motorcyclists and bicyclists. PATIENTS AND METHODS Data were collected from patients during a 10-year period (1999 through 2009), which included demographic data, diagnosis of facial fractures, use of protective devices, dentoalveolar trauma, and facial soft tissue injuries. RESULTS There were 556 patients with bicycle accidents and 367 with motorcycle accidents. Men were involved in 79% (436) of bicycles accidents and 82% (299) of motorcycle accidents. Young male patients were more frequent in bicycle and motorcycle accidents. Two hundred fifty bicyclists showed 311 maxillofacial fractures. Two hundred twenty-one motorcyclists showed 338 maxillofacial fractures. Motorcycle accidents caused multiple fractures in more patients. Seventy-six percent of motorcyclists were using helmets at the time of the accidents, whereas 6% of cyclists were using helmets. Motorcyclists showed a larger number of lacerations, whereas bicyclists showed a larger number of abrasions. Avulsion was the most common dentoalveolar injury for these accident types. Hospital stays were 3.8 days for motorcyclists and 1.3 days for bicyclists. CONCLUSIONS The high-impact collisions typically observed in motorcycle accidents is directly related to larger percentages of soft tissue lacerations and facial fractures. The low-impact trauma that is observed in bicycle accidents is more commonly associated with soft tissue abrasion, hematoma, and dentoalveolar fractures. This stresses the need for compulsory legislation for helmet use with face-guards for cyclists and motorcyclists. It is important to take measures to alert the public regarding the severity of injuries likely to occur in bicycle- and motorcycle-related accidents and ways to prevent them.
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Affiliation(s)
- Sergio Monteiro Lima Júnior
- Department of Oral Diagnosis, Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas - UNICAMP, Piracicaba, SP, Brazil
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Bassey GO, Anyanechi CE, Chukwuneke FN. Maxillofacial injuries in Calabar south-south, Nigeria: a 5 year study of jawbone fractures. Niger J Med 2011; 20:245-249. [PMID: 21970237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES The aim of this study is to highlight the overall uniqueness of the pattern of presentation of maxillofacial injuries seen at the Department of Oral and Maxillofacial Surgery of the University of Calabar Teaching Hospital, Calabar south-south Nigeria between January 2000 and December 2004 and to share our experience in terms of occurrence, seasonal fluctuations and the adequacy of treatment methods in our environment. MATERIALS AND METHODS Case notes of all. the 200 maxillofacial trauma patients were retrieved, examined and analyzed with regards to age, gender and cause of injury, socio-demographic data, diagnosis, pattern of presentation, distribution and treatment. RESULTS A male-to-female ratio of 3.65:1 was obtained. Out of the 200 patients the highest incidence of injury was in the 20-30 year age group 85 (n=85; 42.5%). The major causes of injuries were motorcycle (n=74; 37%), vehicle (n=62; 31.5%) and assault (n=40; 20%). Six (3%) river-related or boat accidents were recorded. Industrial and sports related accidents contributed the least (n=5; 2.5%). CONCLUSION Road traffic accident had the highest proportion of the entire maxillofacial injuries with more males affected than females. Seasonal distribution showed a bimodal peak variation of May-June and September-January. This paper calls for the reinforcement of measures for the prevention of automobile accident and the establishment of more maxillofacial specialist centers with modern equipment for effective management of maxillofacial injuries.
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Affiliation(s)
- G O Bassey
- Dept. of Oral and Maxillofacial Surgery, University of Calabar Teaching Hospital, Calabar
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Lee KH, Snape L. Role of alcohol in maxillofacial fractures. N Z Med J 2008; 121:15-23. [PMID: 18392058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Excessive consumption of alcohol results in impaired judgement and inappropriate behaviour, and is often a major contributor to interpersonal violence and motor vehicle accidents. This study examines the experience of a tertiary centre in alcohol-related facial fractures. METHODS A retrospective database of patients presenting to the Oral and Maxillofacial Surgery Service at Christchurch Hospital (New Zealand) during an 11-year period was reviewed. Variables examined include demographics, type of fractures, mode of injury, and treatment delivered. RESULTS 2581 patients presented with facial fractures during the study period, 49% of these being alcohol-related. Males accounted for 88% of alcohol-related fractures and 59% were males in the 15 to 29 year age group; 78% of alcohol-related fractures were due to interpersonal violence and 13% to motor vehicle accidents; 65% required hospital admission and 58% underwent surgery. CONCLUSION The majority of alcohol-related facial fractures were due to interpersonal violence, with young men in the 15 to 29 year age group being predominantly affected. Alcohol-related fractures were associated with an increase in the incidence of hospitalisation and surgery. The high prevalence of alcohol as a contributing factor to facial fractures indicates a need to push for community awareness and public education on the harmful effects of alcohol.
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Affiliation(s)
- Kai H Lee
- Oral and Maxillofacial Surgery Unit, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
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Holmgren EP, Bagheri S, Bell RB, Bobek S, Dierks EJ. Utilization of tracheostomy in craniomaxillofacial trauma at a level-1 trauma center. J Oral Maxillofac Surg 2007; 65:2005-10. [PMID: 17884529 DOI: 10.1016/j.joms.2007.05.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 04/10/2007] [Accepted: 05/08/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE The decision to perform a tracheostomy on patients with maxillofacial trauma is complex. There is little data exploring the role of tracheostomy in facial fracture management. We sought to profile the utilization of tracheostomy in the context of maxillofacial trauma at our institution by comparing patients who required tracheostomy with and without facial fractures versus those with facial fractures not requiring tracheostomy. MATERIALS AND METHODS All patients admitted to the Trauma Service at Legacy Emanuel Hospital and Health Center (LEHHC), Portland, OR, from 1993 to 2003 that sustained facial fractures or underwent tracheostomy were identified and data were retrospectively reviewed using patient charts and the trauma registry. Variables such as age, gender, death, injury severity score (ISS), facial injury severity score (FISS), Glasgow coma score (GCS), intensive care days (ICU), hospital length of stay (LOS), facial fracture profile, and oral and maxillofacial surgery (OMFS) operative intervention were tabulated and analyzed. Data were divided into 3 groups for comparison: group 1 (ffxT) consisted of patients who underwent a tracheostomy procedure and repair of their facial fracture during the SAME operation by the OMFS department (N = 125); group 2 (ffxNT) were those patients who had repair of their facial fractures by OMFS and did not require a tracheostomy (N = 224); and group 3 (NffxT) were patients who did not have facial fractures but received a tracheostomy during their hospitalization (N = 259). Ten-year data were used to analyze the ffxT and 5-year data were used to analyze the ffxNT and NffxT. Analysis of variance and chi2 testing was used for statistical analysis. RESULTS A total of 18,187 patients were admitted to the trauma LEHHC Trauma Service during the study period, of which 1,079 (5.9%) patients sustained facial fractures and 788 (4.3%) required a tracheostomy. One hundred twenty-five patients (0.69% of total; 11.6% of facial fracture) received a tracheostomy at the same time as the facial fracture repair. All patients had their facial fractures successfully managed, regardless of the type of method used to stabilize the airway. There were no known cases of tracheal stenosis, severe bleeding requiring a return to the operating room, airway obstruction, or loss of secured airway. Males were the predominate gender in all 3 groups. The NffxT group (mean, 44.9 years) was much older compared with the ffxT (mean, 36.2 years) and ffxNT (mean, 30.9 years) groups. The incidence of death was higher in the tracheostomy groups compared with 0% with the non-tracheostomy group. The ffxNT group had a statistically significant higher GCS with an average of 12.4 when compared with the tracheostomy groups (ffxT = 6.8; NffxT = 6.7). ISS was nearly the same in the tracheostomy group (ffxT = 28.45; NffxT = 30.04), but higher when compared with the ffxNT (ISS = 17.33). All 3 groups were much different in terms of LOS and ICU days, in which the NffxT group had an average hospital LOS and ICU days of 34.4 and 16.56, respectively. This was higher when compared with the ffxT (LOS = 19.71 days; ICU = 7.21 days) and ffxNT (LOS = 6.82 days; ICU = 1.33 days) groups. The FISS averaged 6.22 in the ffxT group and was higher compared with an FISS of 3.16 in the ffxNT group. Overall, the fracture profile was different between the tracheostomy and non-tracheostomy groups. There was a higher prevalence of mandibular fractures, multiple mandibular fractures, and Le Fort III fractures in the ffxT group compared with the ffxNT group. CONCLUSION Tracheostomy is commonly performed in the context of multisystem trauma and is a safe method for airway stabilization in patients with craniomaxillofacial trauma. Multi-institutional collaboration and a prospective, randomized trial measuring outcome, resource utilization, and length of ICU stay is necessary to determine if tracheostomy is indeed of measurable benefit to patients with complex injuries.
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Affiliation(s)
- Eric P Holmgren
- Department of Oral and Maxillofacial Surgery, Oregon Health & Science University, Portland, OR, USA
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Khan SU, Khan M, Khan AA, Murtaza B, Maqsood A, Ibrahim W, Ahmed W. Etiology and pattern of maxillofacial injuries in the Armed Forces of Pakistan. J Coll Physicians Surg Pak 2007; 17:94-7. [PMID: 17288855 DOI: 02.2007/jcpsp.9497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 01/08/2006] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine the etiology and pattern of maxillofacial injuries in the Armed Forces of Pakistan in terms of anatomical distribution of injuries. DESIGN A descriptive study. PLACE AND DURATION OF STUDY January 2001 to Jan 2004 at the Oral and Maxillofacial Surgery Department, AFID, Rawalpindi. PATIENTS AND METHODS Three hundred consecutive patients of Armed Forces of Pakistan with maxillofacial injuries reporting to AFID and admitted to the hospital or treated as out-patients in the oral surgery clinic, were included in this study. Isolated nasal bone and frontal sinus fractures were excluded from the study. Anatomical distribution, frequency and etiology of fractures, rank at job and occupational as well as personal hobbies were recorded. Descriptive analyses were used to determine mean, standard deviation, percentage and range values. RESULTS The most frequent bone fractured was the mandible, which accounted for 159 cases (53%). The zygomatic complex was fractured in 51 cases (17%), the maxilla in 12 cases (4 %), and the alveolar process in 21 cases (7%). The most common cause was road traffic accident (168 cases; 56%), followed by accidental fall (69 cases; 23%), gunshot injuries (27 cases; 9%), sports related injuries (15 cases; 5%), and injury associated with a fight (12 cases; 4%); there were only 9 cases of animals related injuries (3%). CONCLUSION In this series, mandible was the most commonly fractured facial bone, while road traffic accident was the most common etiological factor. Results could be influenced by the personal and working environment.
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Al-Khateeb T, Abdullah FM. Craniomaxillofacial Injuries in the United Arab Emirates: A Retrospective Study. J Oral Maxillofac Surg 2007; 65:1094-101. [PMID: 17517291 DOI: 10.1016/j.joms.2006.09.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 07/25/2006] [Accepted: 09/27/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE To analyze craniomaxillofacial injuries in selected hospitals in the United Arab Emirates (UAE). PATIENTS AND METHODS This is a retrospective study of craniomaxillofacial injuries treated in 3 major hospitals in the UAE. Patient files were retrieved, reviewed, and analyzed. The main analysis outcome measures were the patients' name, age, and gender and the injuries' time, site, type, treatment and outcome. RESULTS A total of 288 patients sustained 475 craniomaxillofacial injuries; road traffic accidents caused the majority of injuries. The patients ranged in age from 2 to 82 years (mean, 27.3 years), and the male-to-female ratio was 7:1. The yearly distribution of fractures peaked during 2001, and the monthly distribution peaked in January. The greatest number (41%) of patients were UAE nationals. Most patients (70.5%) had mandibular fractures, and the most common site was the body. There were 139 patients (48.3%) with a total of 171 midface fractures (36%); the most common fracture site was the zygomatic complex (29.8%). The most common treatment for jaw fractures was plating plus intermaxillary fixation. Stable zygomatic complex fractures were closely reduced (elevated), and unstable ones were treated by internal fixation. About 25% of the cases had 1 or more postoperative complication. CONCLUSIONS Craniomaxillofacial injuries in the UAE included in this study are somewhat similar to those reported in other countries. Differences from other countries are probably related to factors peculiar to the UAE, such as climate, social trends, and the cosmopolitan population.
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Affiliation(s)
- Taiseer Al-Khateeb
- Oral and Maxillofacial Surgery, Jordan University of Science and Technology, Irbid, Jordan.
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Bagheri SC, Dierks EJ, Kademani D, Holmgren E, Bell RB, Hommer L, Potter BE. Application of a Facial Injury Severity Scale in Craniomaxillofacial Trauma. J Oral Maxillofac Surg 2006; 64:408-14. [PMID: 16487802 DOI: 10.1016/j.joms.2005.11.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2004] [Indexed: 11/21/2022]
Abstract
PURPOSE To establish a Facial Injury Severity Scale (FISS) that correlates with patient outcome and provides a practical tool for communication between clinicians and healthcare personnel for management of facial trauma. PATIENTS AND METHODS All patients presenting to the Emergency Department (ED) at Legacy Emanuel Hospital (Level One Trauma Center) in Portland, Oregon between 01/1993 and 6/2003 with facial fractures with or without concomitant non-facial injuries where identified retrospectively. The diagnosis and treatment of all facial fractures were conducted by the Oral and Maxillofacial Surgery (OMFS) service. The following data were collected; age, gender, mechanism of injury, detailed diagnosis of facial fractures, disposition, and the length of hospital stay (LOS). The hospital operating room charges (ORC) for the treatment of each patient's facial fractures were also obtained. We designed the FISS to be a numeric value composed of the sum of the individual fractures and fracture patterns in a patient. Not all fractures of the face are weighted equally in the FISS because not all fracture patterns are equal in severity. Individual fracture points within the scale were optimized to result in the highest correlation. RESULTS A total of 1,115 patient admissions to the ED with blunt or penetrating maxillofacial injuries were identified and reviewed. Full information on operating room charges (ORC) was available for 247 patients (average age: 32, SD +/- 17; range, 2 to 84; male:female, 3:1; blunt:penetrating, 232:15). The FISS scores were calculated for each patient (average FISS: 4.4, SD +/- 2.7; range, 1 to 13). Hospital ORC for the treatment of each patient's maxillofacial injuries were obtained from the hospital financial services (average ORC: 4,135 dollars, SD +/- 2,832 dollars; range, 845 dollars to 18,974 dollars). A significant correlation was identified between the FISS and the ORC (R value = .82). The length of stay was significantly associated with the FISS (t = 4.7, 245 degrees of freedom, P = .000004). Although the association was statistically significant, FISS is not a very good predictor of length of stay. The correlation between the predicted and observed values was 0.38. There were 3 deaths among the 247 entries. Those 3 deaths had higher than average FISS scores, but the difference between the scores of survivors and non-survivors was not significant (P = .08). The number of deaths was small and a larger study would be required to resolve this question. CONCLUSIONS We introduce a FISS that is easily calculated and reliably predicts the severity of maxillofacial injuries as measured by the operating room charges required to treat the facial injury. The scale is also an indicator of hospital length of stay. We anticipate this to be a valuable tool for assessment and management of maxillofacial trauma.
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Affiliation(s)
- Shahrokh C Bagheri
- Craniomaxillofacial Trauma/Cosmetic Surgery, Head and Neck Surgical Associates, Atlanta, GA, USA.
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Hussain OT, Nayyar MS, Brady FA, Beirne JC, Stassen LFA. Speeding and maxillofacial injuries: Impact of the introduction of penalty points for speeding offences. Br J Oral Maxillofac Surg 2006; 44:15-9. [PMID: 16162375 DOI: 10.1016/j.bjoms.2005.07.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 07/31/2005] [Indexed: 10/25/2022]
Abstract
On 31 October 2002 the Irish Government introduced a point demerit scheme for road speeding offences. To evaluate the impact of the scheme, we made a comparative assessment of the number of maxillofacial operations necessitated by road crashes at two tertiary surgical centres in the year before and the year after the introduction of penalty points. There were no significant differences in the composition of the groups between the two study periods. There were 57 operations in the year before and 22 in the year after for injuries caused by collisions (a 61% reduction). No changes were seen in the distribution or severity of maxillofacial injuries or in the pattern or severity of other injuries. Severity was assessed using the Abbreviated Injury Scale (AIS) and Maximum Abbreviated Injury Severity Scale (MAIS), and bodily injuries by the Injury Severity Scale (ISS). The number of patients requiring intensive care and the duration of admission to the unit were unchanged, as was the total duration of hospital admission. There were no differences in the requirement for other specialist management.
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Affiliation(s)
- O T Hussain
- National Maxillofacial Unit, St. James's Hospital, James's Street, Dublin 8, Ireland.
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Zhang J, Zhang Y, El-Maaytah M, Ma L, Liu L, Zhou LD. Maxillofacial Injury Severity Score: proposal of a new scoring system. Int J Oral Maxillofac Surg 2006; 35:109-14. [PMID: 16188427 DOI: 10.1016/j.ijom.2005.06.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 04/08/2005] [Accepted: 06/29/2005] [Indexed: 11/22/2022]
Abstract
In this study a new injury severity score system, the Maxillofacial Injury Severity Score (MFISS), was developed to evaluate the characteristics of injury from maxillofacial trauma. Nine hundred and two cases of maxillofacial trauma were included in this study to evaluate injury severity using the MFISS, which was designed on the basis of Abbreviated Injury Scale, 1990 revision (AIS-90), and defined as the product of the sum of the three highest maxillofacial AIS scores and the sum of the injury severity scores for three maxillofacial functional parameters, malocclusion (MO), limited mouth opening (LMO), and facial deformity (FD). The correlation analysis was undertaken with the dependent factor of cost and number of days of stay in hospital. The results demonstrated a significant difference (P < 0.01) between bone and soft-tissue injuries and among various regional fractures. There was correlation (P < 0.01) between the MFISS and the cost of treatment and days of stay in hospital. The newly established MFISS thus characterizes maxillofacial injury severity while reflecting the management costs and treatment complexity.
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Affiliation(s)
- J Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, PR China.
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Bagheri SC, Holmgren E, Kademani D, Hommer L, Bell RB, Potter BE, Dierks EJ. Comparison of the severity of bilateral Le Fort injuries in isolated midface trauma. J Oral Maxillofac Surg 2005; 63:1123-9. [PMID: 16094579 DOI: 10.1016/j.joms.2005.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The Le Fort classification pattern established in 1901 by the French surgeon Rene Le Fort is commonly used in describing midface fractures. This frequently used classification system is based on predictable patterns of midface fractures initially described for blunt trauma. The purpose of this study was to compare the profile and outcome of patients with isolated bilateral Le Fort I, II, and III fractures. PATIENTS AND METHODS All patients presenting to the emergency department (ED) at Legacy Emanuel Hospital (Level I trauma center) in Portland, OR, between December 1990 and December 2003 with isolated bilateral Le Fort I, II, or III fractures with or without concomitant nonfacial injuries were identified retrospectively using the Hospital Trauma Registry. Patients were classified into study groups I (n = 22), II (n = 22), or III (n = 23) corresponding to the Le Fort classification, respectively. RESULTS Sixty-seven patients had a diagnosis of isolated bilateral Le Fort I, II, or III fracture. The average Injury Severity Score (ISS) and hospital length of stay were 18.8 +/- 8.9 and 9.5 +/- 11.9 days, respectively. Blood alcohol was detected in 19 patients. Sixty-four injuries (95.5%) were secondary to blunt trauma, and the remaining 3 (4.5%), penetrating injuries. More than half of the patients (n = 35, 52.2%) were admitted to the intensive care unit (ICU), 18 patients (26.8%) were transferred to the hospital trauma ward from the ED, and 14 patients (20.9%) were taken directly to the operating room. Fifteen (22.4%) patients required a tracheostomy secondary to their maxillofacial injuries. A statistically significant difference in the ISS was detected between patients with Le Fort I versus those with II or III injuries ( P < .0001). Patients with Le Fort II or III fractures had a significantly higher probability of ICU admission or immediate operative intervention. Ten patients (43.5%) with Le Fort III injuries required tracheostomy versus 3 patients (13.6%) with Le Fort I, and 2 patients (9.1%) with Le Fort II injuries. This was statistically significant. None of the patients with Le Fort I injuries had a negative outcome (death); however, 1 patient with Le Fort II injuries (4.5%) and 2 with Le Fort III injuries (8.7%) had a negative outcome. No statistically significant differences or emerging trends were observed among the 3 groups for age, gender, length of stay, number of operations, and number of associated injuries. CONCLUSIONS Patients with higher Le Fort injuries are characterized by an overall greater severity of injuries as measured by the ISS and the more frequent need for a surgical airway. Patients with Le Fort III injuries have a higher chance of requiring neurosurgical intervention or of experiencing vision-threatening ocular trauma. Immediate operative intervention and/or ICU care is more frequently indicated in these patients.
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Affiliation(s)
- Shahrokh C Bagheri
- Department of Oral and Maxillofacial Surgery, Legacy Emanuel Hospital, Portland, OR, USA.
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Buchanan J, Colquhoun A, Friedlander L, Evans S, Whitley B, Thomson M. Maxillofacial fractures at Waikato Hospital, New Zealand: 1989 to 2000. N Z Med J 2005; 118:U1529. [PMID: 15980903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
AIM To describe the patterns of facial fractures presenting to a tertiary referral centre in New Zealand, and to identify risk indicators for maxillofacial trauma. METHOD Clinical records of 2527 patients referred to a tertiary base hospital for the treatment of maxillofacial fractures from 1989 to 2000 were retrospectively analysed. Age, sex, ethnicity, cause of injury, anatomic location of facial fractures, alcohol involvement, and treatment received were recorded. RESULTS The number of facial fractures treated by the Maxillofacial Unit at Waikato Hospital annually almost doubled over the 12-year study period (1989 to 2000). Eighty percent of those presenting with maxillofacial injuries were male, and 40% were aged between 15 and 24 years. Interpersonal violence and road traffic accidents were the most frequent causes of facial fractures. Alcohol consumption was associated with just over one-third of all cases, and was strongly associated with interpersonal violence. CONCLUSION Presentation of patients with facial fractures at the Maxillofacial and Oral Surgery Unit at Waikato Hospital almost doubled over the 12 years. Risk indicators for presentation with a maxillofacial fracture included male gender, alcohol consumption, and interpersonal violence. There is an urgent need for appropriate health promotion to reduce interpersonal violence.
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Affiliation(s)
- Jessica Buchanan
- Department of Maxillofacial and Oral Surgery, Waikato Hospital, Hamilton, New Zealand.
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15
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Zhang J, Zhang Y, Zhou L, Liu L, Zou LD, Liu XH. [Preliminary proposal of the severity score system for maxillofacial injuries]. Zhonghua Kou Qiang Yi Xue Za Zhi 2004; 39:367-9. [PMID: 15498338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE A new injury severity score system was proposed in this study to evaluate maxillofacial injuries. METHODS Based on AIS-90, all clinical samples were given diagnosis. Their month opening limitation, malocclusion and facial deformity were recorded as indices in scoring system. Severity injury scores for different groups and types were statistically. analyzed. RESULTS It was demonstrated that there was a significant difference in scores between injuries of soft tissue and bone tissue and between different fracture groups. CONCLUSIONS The proposed scoring was system useful to predict the cost of medical care and the days of in-patient, reliable, sensitive and specific in evaluation the maxillofacial injury severity.
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Affiliation(s)
- Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing 100081, China
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16
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Abstract
The aim of this research was to evaluate maxillofacial weapon-related injuries from the epidemiological, clinical, and forensic points of view. Analysis of medical records of 183 patients treated for weapon-related injuries in Belgrade maxillofacial surgery clinics in the period 1988 through 2002 has been carried out. Most treated patients were male, 21 to 50 years of age, and injured during the war in the territory of the former Yugoslavia. Injuries involving the mandible were the most frequent (40%); firearm (85%) and perforating (70%) wounds occurred more frequently than explosive (25%) and penetrating (30%) wounds; in certain cases, medical records were incomplete and thus useless for forensic court expertise and evidence. A rapid increase in maxillofacial weapon-related injuries was recorded in the period from 1991 to 1995 as a result of war injuries; high-velocity projectiles caused most of the injuries. It is necessary to keep adequate medical records for successful forensic and court expertise and evidence.
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Affiliation(s)
- Dragana Puzović
- Institute of Forensic Medicine and Clinic of Maxillofacial Surgery, Faculty of Stomatology, University of Belgrade, Belgrade, Serbia
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17
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Affiliation(s)
- Nicholas J Moncrieff
- Department of Plastic Surgery and Maxillofacial Surgery, Liverpool Hospital, Liverpool, Sydney, Australia.
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18
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Cox D, Vincent DG, McGwin G, MacLennan PA, Holmes JD, Rue LW. Effect of restraint systems on maxillofacial injury in frontal motor vehicle collisions. J Oral Maxillofac Surg 2004; 62:571-5. [PMID: 15122562 DOI: 10.1016/j.joms.2003.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Motor vehicle collisions (MVCs) are the leading cause of maxillofacial fractures. Additionally, maxillofacial injuries are the most common injury related to air bag deployment. We sought to characterize the occupant restraint system (seat belt and air bag) and collision characteristics associated with MVC-related maxillofacial injuries. MATERIALS AND METHODS The 1991-2000 National (United States) Automotive Sampling System Crashworthiness Data System (CDS) data files were used. The CDS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Analysis was limited to front seat occupants involved in frontal collisions of delta-V (estimated change in velocity) of greater than 15 km/hr. The risk of facial injury was calculated according to occupants' restraint use (unrestrained, seat belt only, air bag only, and seat belt and air bag combined) and compared using risk ratios (RRs) and associated 95% confidence intervals (CIs). RESULTS Occupants restrained with a seat belt only (RR, 0.48; 95% CI, 0.40 to 0.57) or a seat belt and an air bag (RR, 0.83; 95% CI, 0.73 to 0.94) had a significantly reduced risk of any facial injury compared with completely unrestrained occupants. There was no association for those restrained with an air bag only (RR, 1.19; 95% CI, 0.82 to 1.73). A similar pattern of results was observed for moderate to severe facial injuries and for facial fractures. CONCLUSION Seat belt use significantly reduces the risk of facial injury in frontal MVCs. Air bag use was not associated with the risk of facial injury.
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Affiliation(s)
- Daniel Cox
- Center for Injury Sciences, University of Alabama at Birmingham, 35294-0009, USA
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19
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Gu XM. [Advances in theory and practice of oral and maxillofacial trauma surgery in the past three years]. Zhonghua Kou Qiang Yi Xue Za Zhi 2004; 39:19-21. [PMID: 14989861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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20
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Rózyło-Kalinowska I. The influence of application of 3D CT reconstructions on classification of maxillofacial fractures. Ann Univ Mariae Curie Sklodowska Med 2003; 57:549-55. [PMID: 12898894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The aim of the paper was to study of the influence of application of three-dimensional CT reconstructions on diagnostics and classification of maxillofacial fractures. The material comprised 97 patients presenting with maxillofacial trauma who underwent CT examination in the 2nd Department of Medical Radiology of the Medical University of Lublin in the years 1995-2001. The CT examinations were performed using the Somatom AR-T machine in coronal and axial slices, 2 and 3 mm thick. Then the 3D CT reconstructions were obtained. All cases of trauma were classified according to Wanyura first on the basis of radiograms and CT examination, next on the basis of 3D CT reconstructions. The results of the two analyses differed in cases of properly diagnosed zygomatico-orbital fractures and orbitonasal dislocations, which were less numerous during the first reviewing. It was found that 3D CT reconstructions were generally useful in classifying the maxillofacial fractures with the exception of isolated orbital floor fractures.
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21
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Abstract
The objective of this study was to determine the influence of positions on the incidence and severity of maxillofacial injuries in vehicular crashes. Two hundred and fifty cases of RTA were seen and studied from October 1999 to May, 2000. They comprised 72.8% males and 27.2% females with a male to female ratio of 2.7:1. The age range was 1 to 80 years with a mean age of 40 years. The most common vehicle involved in RTA was the mini bus, 34.3% followed by motorcycle, 26.5%. Middle seat passengers, drivers and motorcycle passengers and riders sustained more and severe injuries during crashes. The mandible was more frequently fractured at the symphysis (24.6%) than at any other site while the maxilla was frequently fractured at the zygomatic bone and arch (10.8%). More injuries occurred in the age range of 20-30 years and these accounted for 31.8% of the cases. Only 6 occupants of motor vehicles wore seat belts before accident while no motorcycle rider or passenger wore any helmet. In conclusion, drivers, middle seat occupants of a vehicle, motorcycle passenger and riders sustained more and severe injuries than back seat occupants.
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Affiliation(s)
- B D O Saheeb
- Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
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22
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Abstract
The following study focuses on three hundred maxillofacial war casualties that were admitted to the Basra Republic Hospital during the Iraq-Iran War. These three hundred cases were chosen on the basis of them being only oral and maxillofacial injuries. Of these cases, there was no mortality recorded. This was in part due to the rapid evacuation, immediate resuscitation and proper management of the casualties. An appropriately staffed hospital, efficient surgical techniques and the presence of highly skilled specialists working as a team also made this result possible. This analysis categorizes, evaluates and discusses the treatment of the casualties based on the severity of the injury and outlines several techniques used to treat such patients.
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Affiliation(s)
- R S Sadda
- College of Dentistry, Department of Oral and Maxillofacial Surgery, New York University, New York, NY, USA.
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23
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Stitik TP, Foye PM, Nadler SF. Electromyography in craniomaxillofacial trauma. J Craniomaxillofac Trauma 2002; 5:39-46. [PMID: 11951229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE Electromyography is used in conjunction with clinical diagnosis to determine the presence and extent of craniofacial injuries; it is also an aid in prognosis of recovery. This article reviews the neural pathophysiology following trauma and the basic principles of electrodiagnostic testing; such understanding helps to determine indications for electrodiagnostic testing. METHODS AND MATERIALS Electrodiagnostic techniques can detect and differentiate the degree of injury. There are three major categories of nerve injury--neurapraxia, axonotmesis, and neurotmesis. In neuropraxic injuries, stimulation distal to the lesion will continue to elicit a response indefinitely; in more severe injuries, axonal degeneration begins within 3 to 5 days postinjury. RESULTS AND/OR CONCLUSIONS Electromyography may be used as a valuable adjunct to traditional forms of diagnosis and prognosis. The accuracy of electrodiagnostic data reported in the literature ranges from 50% to 67% in some studies and 77% to 90% in others. Studies with larger patient populations and longer follow-up periods are required.
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Affiliation(s)
- T P Stitik
- Department of Physical Medicine and Rehabilitation, UMDNJ (University of Medicine and Dentistry of New Jersey), Newark, New Jersey, USA
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24
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Goldman JL, Ganzel TM, Ewing JE. Priorities in the management of penetrating maxillofacial trauma in the pediatric patient. J Craniomaxillofac Trauma 2002; 2:52-5. [PMID: 11951474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Penetrating facial trauma is uncommon in children; a large series published by Cooper et al revealed that only 1% to 2% of the total population of infants and children admitted for trauma during their study period had a diagnosis of penetrating trauma to the head or neck. Little has been published specifically addressing these injuries in the pediatric population. The records of 20 patients treated for penetrating facial injuries at Kosair-Children's Hospital in Louisville, Kentucky from January 1991 through December 1994 were reviewed. The location, mechanism and extent of injury, as well as the diagnostic and management practices used in patient treatment, were collected. Categorizing the injuries relative to the involvement of one or more facial zones helped guide diagnostic studies and therapeutic intervention and predict associated injuries. This article evaluates the authors' method of management and any differences in management between pediatric and similarly injured adult patients.
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MESH Headings
- Adolescent
- Adult
- Angiography
- Child
- Child, Preschool
- Female
- Fractures, Comminuted/surgery
- Humans
- Male
- Mandibular Condyle/injuries
- Mandibular Condyle/surgery
- Mandibular Fractures/surgery
- Maxillary Fractures/surgery
- Maxillofacial Injuries/classification
- Maxillofacial Injuries/diagnosis
- Maxillofacial Injuries/etiology
- Maxillofacial Injuries/surgery
- Palate, Soft/injuries
- Retrospective Studies
- Tomography, X-Ray Computed
- Wounds, Gunshot/classification
- Wounds, Gunshot/diagnosis
- Wounds, Gunshot/surgery
- Wounds, Penetrating/classification
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/etiology
- Wounds, Penetrating/surgery
- Wounds, Stab/classification
- Wounds, Stab/diagnosis
- Wounds, Stab/surgery
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Affiliation(s)
- J L Goldman
- Department of Surgery, Division of Otolaryngology, Myers Hall, University of Louisville, Louisville, Kentucky 40292, USA
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25
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Abstract
PURPOSE Facial gunshot wounds can result in devastating functional and aesthetic consequences for patients. In an attempt to evaluate the management and outcome in these patients, a 4-year retrospective review was undertaken of all patients presenting with facial gunshot wounds at a level I trauma center. PATIENTS AND METHODS A total of 121 patients were identified. Medical documentation could be obtained on 84 of those patients. The patients' maxillofacial injuries were treated by the 3 participating services: plastic surgery, oral and maxillofacial surgery, and otorhinolaryngology. The patients ranged in age from 6 to 64 years, with a mean age of 27 years. RESULTS The gunshot wounds were single in 64% of the cases and multiple in 36% of the cases. Overall mortality in the series was 11%. Sixty-seven percent (56/84) of the patients suffered an injury to the underlying craniofacial skeleton. Seventy-five percent of these patients required surgical intervention. Twenty-one percent of the patients (16/75) required tracheostomy emergently for management of the airway. Eighteen percent (15/84) of these patients had an intracranial injury, with 50% of these patients requiring surgery. Fourteen percent of the patients in the series (12/84) had great vessel injuries diagnosed at the time of angiography, with 50% of these patients requiring surgery for treatment. CONCLUSION Contrary to much of the published literature, most patients in this series required surgical intervention for treatment of their facial gunshot wounds. Reconstructive procedures were performed early in the patient's course and, when possible, addressed both the soft tissue and underlying bony injury in a minimum number of stages.
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Affiliation(s)
- L Hollier
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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26
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Dummett CO. Dental management of traumatic injuries to the primary dentition. J Calif Dent Assoc 2000; 28:838-45. [PMID: 11811232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
There is considerable information on traumatic injury management of permanent teeth. However, there are no conclusive guidelines for treating traumatized primary teeth. This article will summarize a number of issues relative to primary dentition trauma and provide a system for treatment.
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Affiliation(s)
- C O Dummett
- Department of Pediatric Dentistry, Louisiana State University, School of Dentistry, New Orleans 70119-2799, USA.
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27
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Shand JM, Heggié AA. Maxillofacial injuries at the Royal Children's Hospital of Melbourne: a five year review. Ann R Australas Coll Dent Surg 2000; 15:166-9. [PMID: 11709932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
There are important differences in the incidence and nature of facial injuries between the paediatric and adult population. While some of the aetiological factors and principles of management are similar, important differences exist in the treatment of growing patients. This study reviews maxillofacial trauma managed at the Royal Children's Hospital of Melbourne between 1995 and 2000.
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Affiliation(s)
- J M Shand
- Oral and Maxillofacial Surgery Unit, Royal Children's Hospital of Melbourne, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
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28
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Kassan AH, Lalloo R, Kariem G. A retrospective analysis of gunshot injuries to the maxillo-facial region. SADJ 2000; 55:359-63. [PMID: 12608195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
This study analysed the prevalence, demography, soft- and hard-tissue injury patterns, management and complications of gunshot injuries to the maxillo-facial region in 301 patients treated at Groote Schuur Hospital, Cape Town. The number of patients presenting with maxillo-facial injuries caused by gunshot increased over the 15-year study period. The majority were caused by civilian type low-velocity hand-guns and were purposefully and intentionally inflicted by others. Males in their third decade of life and of low socioeconomic status were most often the victims. The wounding effects of these low-velocity injuries were characteristic--small rounded entrance wounds, causing fragmentation of teeth and comminution of the underlying bone, usually without any exit wounds. A comminuted displaced type of fracture pattern was most frequently observed. Special investigations included plain film radiographs with more sophisticated investigations being requested where indicated. Definitive surgical management was initiated by early soft-tissue debridement. Both the mandibular and maxillary fractures had more open than closed reductions. Bone continuity defects as a result of the initial injury were usually reconstructed secondarily using free autogenous bone grafts. All the patients received anti-tetanus toxoid on admission and the majority received antibiotic treatment. The most common complications were sepsis, ocular and neurological complications and limitation of mouth opening. The postoperative sepsis rate was high (19%). The wounding effects of these low-velocity missile injuries are devastating and pose a treatment challenge to the maxillo-facial surgeon.
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Affiliation(s)
- A H Kassan
- Department of Maxillo-facial and Oral Surgery, WHO Collaborating Centre, University of the Western Cape, Mitchells Plain.
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29
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Abstract
The purpose of this study was to determine the occurrence and type of traumatic dental injuries after maxillofacial injuries as a result of Alpine skiing. During an 8-year period (from January 1991 to December 1998) 7600 patients with facial injuries were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria. Of 784 patients with skiing-related facial injuries (524 males, 260 females) 326 (41.6%) sustained injuries to 639 teeth. The age groups predominantly affected were between 7 and 32 years. Luxation injuries occurred in 338 (53%) teeth, fractures accounted for 270 tooth injuries (42%), and only 35 (5%) were lost at the place of the accident. Of skiers with traumatic dental injuries 58% had concomitant soft tissue injuries, while 23.3% had associated facial bone fractures. The most common causes of injury were falls in 42% (329 patients) and collisions with other persons in 24.1% (189 patients). Being hit by one's own sports equipment (11%) was the third most common cause. Collisions with obstacles accounted for 9% and lift accidents for 5.6% of injuries. The probability of suffering dentoalveolar trauma during skiing varied depending on the injury mechanism. There was a 2-fold risk for dentoalveolar trauma when colliding with objects, a 3.5-fold risk when hit by one's own equipment and a 8.5-fold risk during lift accidents. Dental injuries occurred in about 2% of all injured skiers. Dental health professionals should be aware of the high incidence and the distribution of dental trauma and facial injuries caused by skiing.
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Affiliation(s)
- R Gassner
- Department of Oral and Maxillofacial Surgery, Preventive and Restorative Dentistry, School of Dental Medicine, University of Innsbruck, Austria.
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30
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Stewart C. Maxillofacial trauma. Emerg Med Serv 2000; 29:73-4, 78-83. [PMID: 11067454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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31
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Abstract
A classification system for sinus membrane perforations encountered during a sinus augmentation procedure is presented. Five of the perforations are discussed, as are the therapeutic options for their repair. Class I and Class II perforations are most easily repaired, while Class IV is the most difficult to successfully treat. In addition, the effect of the sinus membrane perforation on the course of proposed therapy is discussed. When classified and managed appropriately, sinus membrane perforations are not an absolute indication for aborting the augmentation procedure which is in progress. This paper provides a system of classification that can be used by clinicians to collect data on membrane perforations and repair results.
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Affiliation(s)
- J M Vlassis
- University Hospital Health Science Center at Syracuse, NY, USA
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32
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Sadrian R, Rappaport NH. An overview of maxillofacial trauma for nurses. Plast Surg Nurs 1999; 18:177-81. [PMID: 10205522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A team approach is necessary in order to maximally evaluate, treat, monitor, and rehabilitate the patient with maxillofacial injuries. An overview of the complexities of the management of patients with significant maxillofacial injuries is presented in a manner that should assist any nurse in the assessment and subsequent management of such patients.
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Affiliation(s)
- R Sadrian
- Baylor College of Medicine, Dallas, TX, USA
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33
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Fleuridas G, Favre E, Meningaud JP, Bertrand JC, Guilbert F. [Gunshot wounds and injuries of the face in civilian practice]. Rev Stomatol Chir Maxillofac 1998; 99:75-9. [PMID: 9690295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Firearm wounds are relatively frequent in civilian practice. Due to the variable power of the weapons involved, a wide range of maxillofacial lesions are encountered and classification is a difficult task. In order to predict the gravity of the lesions, we have drawn a classification scheme from our experience with maxillofacial injuries. The scheme was based on the kind of ammunition which gives a better classification than the type of weapon. Three main categories have been identified.
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Affiliation(s)
- G Fleuridas
- U.F.R. de Stomatologie et de Chirurgie Maxillo-Faciale, C.H.U. Pitié-Salpétrière, Paris
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34
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Abstract
To assess the aetiology and demand for oral and maxillofacial surgery services associated with sports injuries, a prospective study was undertaken. Data were collected from consecutive patients (with maxillofacial injuries associated with sports) attending the accident and emergency department at the Cardiff Royal Infirmary in the UK during a 12-month period and analysed. Data relating to demography, aetiology, site and extent of injury, treatment and outcome were collected. There were 790 attendances (695M:85F) arising principally from injuries related to rugby (n = 206), cycling (n = 189) and football (n = 109) but few from recognized contact sports (n = 26). The principal causes of these injuries were direct bodily contact (n = 260) and falls (n = 219). The commonest injury was soft-tissue laceration (n = 604); 80 patients had dentoalveolar fractures and 64 patients had fractures of the facial skeleton. Injuries were located in the upper- (n = 257), middle- (n = 201) and lower third of the face (n = 124) with 188 lip/intraoral injuries. Repair of lacerations (n = 600) was the commonest treatment; only 46 fractures required interventive treatment. Follow-up was performed for most of these patients at the Department of Oral and Maxillofacial Surgery at the Dental Hospital (n = 404) and general medical/dental practitioners (n = 258). These data highlight the importance of oral and maxillofacial surgery staff in the management of sports injuries in accident and emergency departments. Moreover, they suggest the need for prioritization of rule and legislation changes and the continuing need to improve safety standards to prevent maxillofacial injuries.
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Affiliation(s)
- C M Hill
- Department of Oral and Maxillofacial Surgery, Dental School, UWCM, Cardiff, UK
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35
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Bos RR, Jansma J, Vissink A. [Fractures of the midface]. Ned Tijdschr Tandheelkd 1997; 104:440-3. [PMID: 11924441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Midfacial fractures have a wide variety of appearance. The original classification by Le Fort is still in use. Nasal-orbital-ethmoidal (NOE) fractures deserve special attention. Next to clinical evaluation detailed computer tomography is necessary. Extended open reduction and internal fixation with various mini- and microplate osteosyntheses as well as immediate reconstruction with calvarian bone are essential components of surgical treatment aiming for adequate function and esthetics. Reduction of increased inner intercanthal distances is a substantial part of the treatment of NOE fractures. Surgical repair within 48-72 hours benefits the final result and limits the number and extent of secondary corrections.
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Affiliation(s)
- R R Bos
- Afdeling Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde, Academisch Ziekenhuis Groningen, postbus 30.001, 9700 RB Groningen
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36
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Bamjee Y. Paediatric maxillofacial trauma. J Dent Assoc S Afr 1996; 51:750-753. [PMID: 9462032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- Y Bamjee
- Division of Maxillofacial and Oral Surgery, University of the Witwatersrand, Johannesburg
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37
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King HK. Airway managements of patients with maxillofacial trauma. Acta Anaesthesiol Sin 1996; 34:213-20. [PMID: 9084550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Airway management in patients with maxillofacial trauma (MFT) is usually complicated. This is not only because the trauma directly involves the airway itself, but also the commonly associated injuries and conditions, such as cervical fracture and full stomach, often limit the options in management. The disruption of normal anatomy makes laryngoscopy, endotracheal intubation and even placement of a pharyngeal airway not only technically difficult, but sometimes even hazardous. Additionally, these patients are often in acute respiratory distress. They are often irritable and uncooperative due to underlying hypoxemia, alcohol or drug intoxication. Airway management of MFT victims is certainly challenging, if not difficult. As the clinical condition varies greatly, each patient represents a unique challenge and therefore, no single or uniform method can be adopted. This article will focus on the techniques and instrumentations currently applicable for handling the problems.
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Affiliation(s)
- H K King
- Department of Anesthesiology, King/Drew Medical Center Charles R. Drew University of Medicine and Science, Los Angeles, California 90059, USA
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38
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Abstract
OBJECTIVE To find out the incidence of maxillofacial injuries in South African children aged 18 years or less. DESIGN Retrospective study of casenotes. SETTING Six teaching hospitals affiliated to the University of Witwatersrand, Johannesburg, serving a population of about 5 million people. SUBJECTS All 326 children treated for facial injuries in the maxillofacial and oral departments of the six hospitals between 1 January 1989 and 30 June 1992. MAIN OUTCOME MEASURES Classification of the types of injury, associated injuries, cause of the injury, and methods of diagnosis. RESULTS Of the total of 4192 patients of all ages treated for facial injuries, 326 (8%) were within the age range of the study. The female:male ratio was 1:2.3. Most of the injuries (227, 70%) occurred in the 13-18 age group, and assaults, fights and gunshot wounds accounted for 155 injuries (48%). Of the 326 children, 173 (53%) had single injuries and 153 (47%) had multiple injuries. Mandibular fractures were the most common (64%) followed by maxillomandibular fractures (25%). Violence was the most common cause of injury, as in the USA and Zimbabwe, but unlike the rest of the world in which it is motor vehicle accidents. Soft tissue injuries were the most common associated injuries, and conventional plain radiography was the usual investigation. CONCLUSION The incidence of 8% compares favourably with those in other countries, but far too many injuries are the result of violence.
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Affiliation(s)
- Y Bamjee
- Division of Maxillo-Facial and Oral Surgery, University of the Witwatersrand, Dental Research Institute, Johannesburg, South Africa
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39
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Abstract
Experience in team management of multiply injured patients with maxillofacial injuries is reported. During 1992, out of 169 patients transferred to the Royal London Hospital, UK by the Helicopter Emergency medical Service 38 (22.4%) had injuries to the maxillofacial region, 17 of whom were scored on the Abbreviated Injury Scale (AIS) as having sustained facial AIS > 2. The median Injury Severity Score (ISS) was 22, while the ISS was 17.7 for survivors and 34.5 for those who died (chi 2 = 7.3, 0.05 < P > 0.02). Facial AIS (median 4) and facial AIS contribution to ISS were found to be poor indicators of severity of injury. Revised Trauma Score (RTS) and percentage probability of survival (Ps%) were found to be useful discriminators of severity of overall injuries. RTS compared between survivors and those who died was 0.05 < P > 0.02 (chi 2), while Ps% was 0.01 < P > 0.001 (chi 2). It was concluded that the severity of maxillofacial injuries, and hence their contribution to total injury assessments, tended to be underscored. We propose that refined facial injury assessment methods be tested.
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Affiliation(s)
- H Cannell
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, UK
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40
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Abstract
This new proposed maxillofacial categorization is based on the scoring of two groups: Group I and Group II. The information obtained in Group I permits evaluation of (1) life-threatening injuries; (2) maxillofacial etiological factors producing life-threatening injuries; and (3) other organ or anatomic areas that may also have been injured. This information permits a fast and correct categorization of the patient before hospitalization and helps achieve transportation to an adequate hospital in an adequate amount of time and adequate treatment. Using the score obtained for Group II categorization, the functional and aesthetic severity of soft tissues (skin, mucosa, scalp), skeletal facial areas, and other important tissues (e.g., facial nerve, ocular globe, palpebral tissues) is determined. The final score resulting in Group II categorization is based on three grades of different severity: Grade I (minor), 1 to 6; Grade II (moderate), 7 to 24; and Grade III (grave), greater than 25. By means of Group II categorization the following can be evaluated: (1) type and severity of functional and aesthetic lesions; (2) adequate timing of treatment; (3) convenient treatment; (4) type and severity of functional and aesthetic sequelae; and (5) probability of successful treatment of sequelae.
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Affiliation(s)
- J O Guerrissi
- Service of Plastic Surgery, Hospital Argerich, Buenos Aires, Argentina
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41
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Bakland LK, Andreasen JO. Examination of the dentally traumatized patient. J Calif Dent Assoc 1996; 24:35-7, 40-4. [PMID: 9063188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A thorough examination of the dentally traumatized patient is the first step in arriving at the correct diagnosis and subsequent treatment plan. A medical history and evaluation is part of the initial examination along with an oral exam during which detailed information is recorded.
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Affiliation(s)
- L K Bakland
- Loma Linda University School of Dentistry, USA
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42
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Abstract
Firearms induce severe morphological and structural alterations on both soft and bony tissues of the face. It is therefore essential to restore their previous functionality. In our experience, maxillofacial lesions due to firearm shooting must be divided, from a locational point of view, into those lesions involving the upper third, those involving the medium third, and those involving the lower third of the face. Lesions of soft and bony tissues must be evaluated precisely through instrumental diagnostic examinations and axial and coronal computed tomographic projection, preferably with a three-dimensional construction, to be able to restore the previous functional integrity of the maxillofacial region. At a subsequent surgical time, it may be necessary to plan aesthetic corrections for recovery of the previous facial harmony.
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Affiliation(s)
- R Becelli
- Department of Maxillo-Facial Surgery, University of Rome La Sapienza, Italy
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43
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Carroll SM, Condon KC, O'Connor TP. Facial fractures in Gaelic football and hurling. Ir Med J 1995; 88:159-60. [PMID: 8575903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A one year, retrospective, epidemiological study of all facial fractures, sustained whilst playing the GAA sports of football and hurling, treated in the Cork Regional Hospital was undertaken. The results have been analysed and compared to a similar study performed in this unit in 1975. Of 332 patients treated for facial fractures, 110 (33%) were injured whilst playing sport and 47% of these occurred when playing Gaelic football or hurling (52 injuries in all). Eighty per cent of Gaelic football and hurling patients required operative treatment. All surgery was performed under general anaesthetic. The numbers of hurling fractures have more than halved since 1975-76. This coincides with an increase in the numbers hurling, an increase in the use of protective headgear and vastly improved coaching. This study demonstrates that improved safety can be achieved without diluting sporting enjoyment.
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Affiliation(s)
- S M Carroll
- Plastic Surgery Department, Cork Regional Hospital, Ireland
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44
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Abstract
Helmets are effective in decreasing maxillofacial trauma in motorcycle crashes. The impact, however, of motorcycle crashes on the location and patterns of craniofacial injuries among helmeted versus unhelmeted patients has not been examined. In the present study, 331 injured motorcyclists were evaluated to compare the incidence of craniofacial and spinal injury in 77 (23%) helmeted and 254 (77%) nonhelmeted patients. Nonhelmeted motorcyclists were three times more likely to suffer facial fractures (5.2% vs. 16.1%) than those wearing helmets (p < 0.01). Skull fracture occurred in only one helmeted patient (1.2%), compared with 36 (12.3%) of nonhelmeted patients (p < or = 0.01). The incidence of spinal injury was not significantly different between the two groups. Blood alcohol levels demonstrated that 12% of the helmeted group were legally intoxicated (blood alcohol level > 100 mg/dL), in contrast to 37.9% of the nonhelmeted motorcyclists (p < or = 0.01). Failure to wear a helmet resulted in a significantly higher incidence of craniofacial injury among patients involved in motorcycle crashes, but did not affect spinal injury or mortality. Alcohol usage seemed to correlate with failure to use helmets. Helmet use should be legally mandated on a national level for all motorcyclists.
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Affiliation(s)
- R M Johnson
- Department of Surgery, Southern Illinois University, Springfield
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45
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Metzinger SE, Rigby PL, Simmons MJ, Boyce RG. An epidemiologic study of maxillofacial trauma at University Medical Center in Lafayette, a regional referral center. J La State Med Soc 1994; 146:101-4. [PMID: 7964112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The authors retrospectively reviewed maxillofacial trauma admissions at University Medical Center in Lafayette, Louisiana, a Level II trauma center, over the 2-year period from July 1, 1990 to June 30, 1992. This study encompassed 208 fractures in 166 patients. All patients in this study group required surgical intervention for their maxillofacial injury. Variables examined in this cohort included age, race, gender, seasonal variation, fracture location, mechanism of injury, associated injuries, seatbelt utilization, substance abuse, surgical management, complications, operative duration, hospital stay, hour of presentation, and preoperative imaging modalities. The purpose of our study is to provide an epidemiologic review of maxillofacial trauma in the Acadian community of southwestern Louisiana.
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Affiliation(s)
- S E Metzinger
- Dept of Otorhinolaryngology and Biocommunication, Louisiana State University Medical Center, New Orleans
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46
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Abstract
Although the general principles for evaluation and management of facial fractures in children are the same as for adults, some modification in assessment, timing, and technique must be considered. This article has a double purpose: to re-emphasize acute assessment and medical management so that the pediatrician can function as the coordinator of the maxillofacial trauma team, and to present both established and new techniques for the reduction of simple and complex fractures in children.
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Affiliation(s)
- D M Crockett
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles
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47
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Brown-Stewart P. Maxillofacial trauma: implications for critical care. Crit Care Nurse 1989; 9:44-57. [PMID: 2805753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Maxillofacial trauma is a complex phenomenon that creates challenges for the critical care nurse. Effective management of maxillofacial trauma requires a comprehensive understanding of facial anatomy and function. Physiologic requirements, such as airway management and hemodynamic monitoring are the focus during the acute care phase. Nutritional and self care needs are also priorities. A collaborative approach across health care disciplines is essential to healing, the prevention of further injury, and the development of adaptive processes.
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48
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Bailey BM, Carr RJ, Bermingham DF, Shepherd RG. A comparative study of psychosocial data on patients with maxillofacial injuries in an urban population--a preliminary study. Br J Oral Maxillofac Surg 1988; 26:199-204. [PMID: 3165017 DOI: 10.1016/0266-4356(88)90163-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A retrospective study of 75 patients who had sustained maxillofacial injuries was undertaken. These patients were assigned to one of three equal groups consisting of firstly, patients whose injuries had been inflicted by a person who had an established personal relationship to the victim, secondly, where the assailant was completely unknown to the victim, and thirdly, a group where inter-personal conflict was not involved. Psychological, social and clinical data was collected and analysed. A profile emerged of a patient who is 'at risk' from assault by a person well known to them. Two thirds of the victims were female; the victims were exclusively from social classes IV and V, and half of the victims had a previous record of assault against their person. Psychological indices of neuroticism were also higher in this group. This group of patients should be identified, and special consideration offered, including family support and referral to social workers, in addition to alerting their general medical practitioners.
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Affiliation(s)
- B M Bailey
- Department of Oral and Maxillofacial Surgery, Queen Mary's Hospital, London
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49
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50
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Perczyńska-Partyka W. [Clinical classification of the severity of injuries to the facial skeleton]. Czas Stomatol 1987; 40:555-9. [PMID: 3506508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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