A Study on 3D Deep Learning-Based Automatic Diagnosis of Nasal Fractures

This paper reported a study on the 3-dimensional deep-learning-based automatic diagnosis of nasal fractures. (1) Background: The nasal bone is the most protuberant feature of the face; therefore, it is highly vulnerable to facial trauma and its fractures are known as the most common facial fractures worldwide. In addition, its adhesion causes rapid deformation, so a clear diagnosis is needed early after fracture onset. (2) Methods: The collected computed tomography images were reconstructed to isotropic voxel data including the whole region of the nasal bone, which are represented in a fixed cubic volume. The configured 3-dimensional input data were then automatically classified by the deep learning of residual neural networks (3D-ResNet34 and ResNet50) with the spatial context information using a single network, whose performance was evaluated by 5-fold cross-validation. (3) Results: The classification of nasal fractures with simple 3D-ResNet34 and ResNet50 networks achieved areas under the receiver operating characteristic curve of 94.5% and 93.4% for binary classification, respectively, both indicating unprecedented high performance in the task. (4) Conclusions: In this paper, it is presented the possibility of automatic nasal bone fracture diagnosis using a 3-dimensional Resnet-based single classification network and it will improve the diagnostic environment with future research.

National Analysis of Risk Factors for Nasal Fractures and Associated Injuries in Trauma

Nasal fractures account for up to 58% of facial fractures. However, the literature characterizing associated injuries and risk factors for nasal fractures is sparse and is mostly composed of single-center experiences. This study sought to provide a large descriptive analysis and identify associated injuries and risk factors for nasal fractures in trauma using a national database. A retrospective analysis of the National Trauma Data Bank (NTDB) from 2007 to 2015 was performed. Patients ≥18 years of age with nasal fractures were included. A multivariable logistic regression model was used to identify predictors for nasal fracture in trauma. Of 5,494,609 trauma patients in the NTDB, 255,533 (4.6%) had a nasal fracture. Most were male (74.8%) with a mean age of 45.6 years. Blunt trauma accounted for 90.5% of fractures, with motor vehicle accident being the most common mechanism (27.5%). Closed fractures occurred in 93.0% of patients. Concomitant injuries included traumatic brain injury (TBI; 56.9%), malar/maxillary fracture (27.9%), and open wound of the face (38.6%) and nose (9.5%). Of all patients, 10.1% underwent closed or open reductions at index hospitalization. The strongest associated injuries with nasal fracture included open wound of the nose (odds ratio [OR]: 8.71, 95% confidence interval [CI]: 8.49-8.94, p  < 0.001), epistaxis (OR: 5.26, 95% CI: 4.59-6.02, p  < 0.001), malar/maxillary fracture (OR: 4.38, 95% CI: 4.30-4.45, p  < 0.001), and orbital fracture (OR: 3.99, 95% CI: 3.91-4.06, p  < 0.001). Nasal fractures are common traumatic injuries with more than 90% occurring by blunt mechanism and over half suffering from a concomitant TBI. The strongest associated injury with nasal fracture is an open wound of the nose.

Midface Fractures I

Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of evaluation, assessment, management, and prevention of further injury when dealing with these fractures is vital. This two-part series detailing the management of midface fractures serves as a guide for the appropriate workup and management of the wide variety of fracture patterns that are commonly encountered.

Prevalence of different kinds of maxillofacial fractures and their associated factors are surveyed in patients

INTRODUCTION

Nowadays maxillofacial fractures have increased. In this study prevalence of different kinds of maxillofacial fractures and their associated factors are surveyed in patients referred to Imam Khomeini Hospital, Urmia in 2011.

METHODS

The study was across-sectional observational study. 637 cases of patients with a confirmed diagnosis of maxillofacial fractures in 2011 referred to Imam Khomeini Hospital, Urmia and their data records were analyzed using SPSS software and chi-square tests.

RESULTS

In this study, 457 patients were male and 178 were female and the mean age was 14.47 ± 26.68 years. Falling was the most common cause of fractures after accidents and assaults were the most common causes. The most common site of nasal fractures was about 66.4% and then fractures in several places about 14.9% and mandibular 7.1%.

CONCLUSION

Based on the results obtained in the present study with other studies in this area it is concluded that maxillofacial fractures in males and in 20 to 30 years of age is prevalent and is mostly due to falling and road accidents and are further seen in nasal bone and mandible.

External fixation of unstable, "flail" nasal fractures

Nasal bone fractures are the most common among facial fractures. Usually these are adequately treated with closed reduction and internal and/or external stabilization with splints. However, there are clinical situations where the nasal bones are severely displaced, the nasal septum fractured and displaced, or there are external drape lacerations which preclude the use of nasal splints. If the nasal bones are reducible but unstable we consider them "flail" and in this case transmucosal, endonasal Kirschner wires are used for dorsal support until sufficient healing occurs. The technique is simple, quick, and predictable and causes minimal discomfort to the patients.