Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil

Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

Maxillofacial fractures at Waikato Hospital, New Zealand: 2004 to 2013

Injury to the maxillofacial region continues to place a burden on hospital care in New Zealand, with maxillofacial fractures often being associated with both a significant social cost and personal morbidity. This article describes the characteristics, aetiology and treatment patterns in a tertiary maxillofacial centre in New Zealand during a 10-year period. Over the observation period, a total of 1,975 cases were treated, with a male-to-female ratio of 4:1. The highest incidence was in the 20-29-year-age group. Interpersonal violence (IPV) was the most common aetiology, observed in 54.5% overall, and more common among males than females (58% and 38% respectively; P<0.001). Falls were the most common cause of injury among older females (those aged 50+). Comparison to an earlier analysis shows that IPV-related maxillofacial trauma has increased significantly at this tertiary centre, increasing from 36.2% of cases in 1989-2000, to 54.5% in 2004-2013. There remains an urgent need for appropriate health promotion to reduce interpersonal violence, as well as an increase in the staffing numbers of maxillofacial units in New Zealand.

[A retrospective study of 1 009 patients with oral and maxillofacial fresh trauma]

OBJECTIVE

To analyze the epidemiological characters of fresh maxillofacial fractures in hospitalized patients by the retrospective study.

METHODS

From Jan. 2008 to Dec. 2013, a total of 1 009 patients with fresh maxillofacial fractures treated at Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were investigated. The data were statistically analyzed by SPSS 21.0.

RESULTS

The male and female ratio was 2.94:1 and 33.5% of the patients aged from 20 to 30 years. The most common cause of the fresh fracture was road traffic accidents (424 cases, 42.0%), followed by tumblings (250 cases, 24.8%) and violence (128 cases, 12.7%). The number of new fracture was increasing gradually in recent years. The patients were at peak of 20-29 years old. The mandibular fracture was the most frequently seen (536 cases, 53.1%), followed by zygomatic complex fractures (233 cases, 23.1%). The simple maxillary fracture was rare and usually combined with other fractures. Infraorbital nerve injury was the most common one in nerve injuries (144 cases). The most common associated injury was extremity injuries (77 cases), followed by thoracic injury (65 cases) and craniocerebral injury (57 cases). Associated injuries were mostly caused by car accidents (127 sites), followed by fall (32 sites). Logictic regression analysis showed that fall and tumbling were risk factors of mandibular and condylar fracture (OR > 1, P < 0.05), while age was a protective factor (OR > 1, P < 0.05).

CONCLUSIONS

Oral and maxillofacial fresh fractures most commonly occurred in young people, and the most common cause of fractures was road traffic accidents. Infraorbital nerve was involved frequently. The most common associated injuries was extremity injuries.

Control of cerebrospinal fluid otorrhea via C-arm-guided reduction of the zygomatic arch as a part of the temporal bone: interdisciplinary approach to an unusual craniomaxillofacial fracture

Maxillofacial fractures are often associated with blunt head injuries, of which skull base trauma is a common component. However, most oral and maxillofacial surgeons do not provide definitive management of temporal bone fractures involving the skull base and their sequelae. Persistent cerebrospinal fluid (CSF) leakage that is refractory to conservative measures usually requires surgical closure to decrease the risk of meningitis. In general, reduction of the displaced fragment of the skull base in temporal bone fractures is not considered a priority. We describe an unusual case of craniomaxillofacial injury exhibiting CSF otorrhea because of a temporal bone fracture with a fragment that included the zygomatic arch. The persistent traumatic leakage was stopped after C-arm-guided reduction of the depressed zygomatic arch. This technique facilitated minimal and only necessary manipulation, without overcorrection, thereby avoiding additional damage to the surrounding tissues. The present case illustrates the definitive contribution of therapeutic measures based on maxillofacial surgery as part of an interdisciplinary approach to the management of the complications of severe head injuries; more invasive neurosurgery was thus avoided.

Etiology and incidence of zygomatic fracture: a retrospective study related to a series of 642 patients

BACKGROUND AND OBJECTIVES

The aim of this paper is to investigate epidemiological data (age, gender), sites, etiology and surgical approach of zygomatic fracture.

MATERIALS AND METHODS

A 9 years retrospective clinical and epidemiologic study evaluated 642 patients treated for zygomatic fracture. There were 569 men and 77 women. The age range was 2 to 86 years with 205 (31.9%) in the 21 to 30 years age group. A number of parameters, including age, gender, cause of injury, site of injury, treatment modalities were evaluated.

RESULTS

There were 552 (86%) zygoma fractures and 90 (14%) zygomatic arch fractures. The left zygoma was involved in 309 cases (56%); the right zygoma was involved in 243 cases (44%). Concerning the zygomatic arch, the left side was involved in 43 cases (48%) and the right side in 47 cases (52%). 7% of the patients were younger than 9 years old, about 70% between 10 and 39 years, and 18% between 40 and 59 years, while 4% were older than 60 years. Causes of zygoma fracture were traffic accidents in 151 (26%), assault in 117 (20%), accidental falls in 105 (19%), sports injuries in 56 (10%), home injuries in 45 (8%), work accidents in 34 (6%). Causes of zygomatic arch fractures 28 (29.1%) were assaults in 28 (29.1%), traffic accidents in 20 (21.5%), sports injuries in 14 (15.8%), accidental falls in 11 (14%), domestic accidents in 8 (8.8%) and work accidents in 4 (5%). The access to the fronto-zygomatic suture (74.6%) and the maxillary vestibular approaches (66.8%) were the commonest method of reduction of zygomatic fracture. About arch fractures, the Gillies temporal approach was the most used method of reduction (94.4%).

CONCLUSIONS

The findings, compared with similar studies reported in the literature, support the view that the highest prevalence is in young male patients and, concerning cause, traffic accidents and assault are the most frequent.

The clinical presentation and management of zygomatic complex fractures in a Nigeria Teaching Hospital

BACKGROUND

Fractures of the zygomatic complex occur worldwide and are a component part of injuries that can be sustained in the maxillofacial region. The objective was to analyze the clinical presentation and management ofzygomatic complex fractures.

METHODS

This was a prospective study carried out over a period of five years at the University of Calabar Teaching Hospital, Nigeria. Data documented were patients' age, gender, time of presentation, cause and type of fracture, associated head and maxillofacial injuries, clinical features, types of plain radiographs, treatment methods, duration of follow-up and complications.

RESULTS

Majority of the patients (n = 81, 63.3%) were in their third and fourth decades of life while the male to female ratio was 20.3:1. Road traffic accident (n = 111, 86.7%) was the most common cause of fracture. Fractures of the zygomatic complex alone (n = 105, 82.0%) were more common than isolated fractures of the arch (n = 13, 10.2%) and combined fractures of the zygomatic complex and arch (n = 10, 7.8%).

CONCLUSION

While multi-disciplinary approach to treatment is important, majority of the fractures were treated by simple elevation and transosseous wire osteosynthesis. Delay in presentation, associated injuries and non-availability of mini-plating technique contributed to the development of complications.

Paradigm in aetiology and management of zygomatic complex fractures in Pakistan

OBJECTIVE

The purpose of this study was to compare the outcome of wire osteosynthesis with bone plating in the management of zygomatic complex (ZMC) fractures. The rationale was to enable the oral and maxillofacial surgeon to select either of the treatment procedure with confidence.

METHODS

In this quasi experimental study, Sixty five patients of ZMC fractures were randomly allocated in groups of bone plating and wire osteosynthesis. This was done through envelope draw method. Three points fixation with either of the treatment modality was undertaken. Titanium bone plating or stain less steel wire osteosynthesis was carried out at frontozygomatic suture, infra orbital rim and at zygomaticomaxillary buttress.

RESULTS

In this quasi experimental study, three patients failed to follow up. There were 31 patients in each group. Infra orbital step defect was observed in one patient of wire osteosynthesis and two patients of bone plating. Mild facial deformity was observed in two patients of wire osteosynthesis while none in that of bone plating.

CONCLUSION

There is insignificant difference of proportion of infra orbital step defect and facial deformity between wire osteosynthesis and bone plating.

[Retrospective analysis of 2461 patients with maxillofacial fractures]

OBJECTIVE

To review the 2461 cases of maxillofacial fractures.

METHODS

From 2003 to 2009, 2461 maxillofacial fracture cases were treated in Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine. Data regarding sex, age, cause of injury, occupation, geographic distribution, blood type, fracture site, multiple associated injuries, injury severity, the patient's first admitted department, treatment results were reviewed.

RESULTS

The male and female ratio was 4.28:1, 1424(57.86 %) patients were between 20 and 40 years of age. The most common cause of injury was road traffic accident (938 cases, 40.98%). People in tertiary industry (900 cases, 78.53%) were most vulnerable to injuries. The zygomatic complex (22.08%), nasal bone (20.67%) and mandible (16.35%) were the most frequent fracture sites, which were often associated with skull (21.74%), brain (38.36%) and soft tissue contusion injury (48.84%). 85.98% (2116/2461 cases), of patients' AIS score was less than 2. Orthopaedics (939/2461 cases, 38.16%) was the first admitted department.

CONCLUSIONS

The traffic accidents are the main cause of the maxillofacial fractures. Most injuries are found in the young and middle-aged people.

Causes and management of zygomatic bone fractures at Abbasi Shaheed Hospital Karachi (analysis of 82 patients)

OBJECTIVES

To assess the causes and management of Zygomatic bone fractures at Abbasi Shaheed Hospital, Karachi.

METHODS

This study was carried out at Department of Oral & Maxillofacial surgery Abbasi Shaheed Hospital, Karachi. A total of 82 cases were studied. A detailed history was taken, clinical examination was performed and fractures were confirmed by radiography. Management of fractures was done by using different proposed modalities, suitable for every case. A number of factors, like age of patients, causes of trauma and gender were assessed.

RESULTS

The commonest cause of Zygomatic bone fracture was found to be road traffic accident (RTA) 50% (n = 41), followed by assault 23.17% (n = 19), fall 20.73% (n = 17), sports injuries 3.65% (n = 3), and others 2.43% (n = 2) respectively. Right side (55%) was involved a little more than the left side (45%). Zygomatic bone fracture was more prevalent in age group between 21-30 years, while male to female ratio was 5.30:1. Remote reduction using Gillie's Temporal Approach with and without fixation using bone plates were the commonest management modalities used in this center.

CONCLUSION

The commonest cause of Zygomatic bone fracture was found to be road traffic accident, with the right side fractures being more common. It reveals poor road traffic sense in road users, lack of road safety measures and legislation in our population.

[The finite element study on zygomatic injury by impact in child]

OBJECTIVE

The purpose of this study was to establish the constructive of craniofacial suture in the three-dimensional finite element model of craniofacial complex in child, to analyse the response procedure of the zygomatic impact, to explore the biomechanics characteristic of the children craniofacial trauma.

METHODS

A 7-year-old female was adopted for study The complex cranial geometry was measured from a series of two-dimensional CT images. The multi-lay spiral CT scans were transformed with a self-developed preprocessor into a finite element mesh. The craniofacial sutures were constructed through the MSC Patran program. Identical impact and boundary conditions were used for the zygomatic impact simulations.

RESULTS

It has been shown that the finite element model (FEM) exhibited fine morphological and mechanical comparability. The higher stress was showed in the zygomatic regions and atlas occipital articular in 3d FEM. The maximum von Mises stress was found at the zygomatic regions and atlas occipital articular.

CONCLUSION

The concentrations of shear stress and tension stress in the suture and articular would increase the risk of injury in this area. But the conduction of the stress might be weakening in the suture of child skull.

[Diagnosis and management of zygomaticomaxillary complex fractures]

The zygornaticomaxillarx complex (ZMC) plays an important role in maintaining the structure and function of the face. The prominent convex shape of the ZMC makes it particularly vulnerable to trauma, resulting in a tetrapod fracture involving all four buttresses. ZMC fracture usually leads to local depressed deformities, even dysfunction such as limited mouth opening and diplopia. This article lescribes the etiology, clinical features, surgical approaches and postoperative complications of ZMC fractures based on our own clinical experiences and literature review. It is believed that lateral brow incision combined with intraoral incision can provide better access to ZMC fractures and avoid the disadvantages caused by coronal incision. This surgical approach leaves minimal scar and injury to the facial nerve, with better esthetic and functional outcomes. Supported by Shanghai Leading Academic Discipline Project (Grant No. Y0203).

A Retrospective Analysis of 101 Zygomatico-Orbital Fractures

A 5-year review of 101 cases of zygomatico-orbital fractures is presented. The epidemiology, fracture patterns, treatment modalities, and complications were evaluated in this retrospective study. A majority of fractures were sustained by males and resulted from trauma inflicted during altercations and traffic accidents. The most common fracture pattern was tripod fracture and the most common associated facial fractures were mandibular fractures. Open reduction and rigid fixation was the most frequently employed treatment modality. Depending on the stability of reduced zygoma, one, two and three-point fixations were applied. Orbital floor exploration was performed in 41 cases. Ten out of 16 orbital floor bone defects required reconstruction. In these cases orbital floor was reconstructed with 1.5-mm porous polyethylene implant. Although we encountered a few complications related to the incisions for open reduction, the rate of complication in which correction was difficult (e.g. facial asymmetry) was lower with this approach when compared with the literature.

Unknown Posttraumatic Foreign Body in Facial Region

This study emphasizes the importance of scrupulous diagnostic first aid procedures to avoid the consequences of trauma due to a foreign body. Two patients were examined, both with facial trauma showing nonspecific symptoms. Through objective internal and external oral examination complete with clinical and radiographic examinations Three dimensional computed tomography (TC3D), foreign bodies unknown at the time of the trauma were identified. When the foreign bodies had been removed, the ache symptoms disappeared, restoring functionality and the patient's facial appearance. This study shows the need for detailed early diagnosis to achieve correct monitoring and therefore proper treatment for these patients.

Predicting zygoma fractures from baseball impact

The purpose of this study is to develop injury risk functions that predict zygoma fracture based on baseball type and impact velocity. Zygoma fracture strength data from published experiments were mapped with the force exerted by a baseball on the orbit as a function of ball velocity. Using a normal distribution, zygoma fracture risk functions were developed. Experimental evaluation of these risk functions was performed using six human cadaver tests and two baseballs of different stiffness values. High speed video measured the baseball impact velocity. Post test analysis of the cadaver skulls was performed using CT imaging including three-dimensional reconstruction as well as autopsy. The developed injury risk functions accurately identify the risk of zygoma fracture as a result of baseball impact. The experimental results validated the zygoma risk functions at the lower and upper levels. The injuries observed in the post test analysis included fractures of the zygomatic arch, frontal process and the maxilla, zygoma suture, with combinations of these creating comminuted, tripod fractures of the zygoma. Tests with a softer baseball did result in injury but these had fewer resulting zygoma bone fragments and occurred at velocities 50% higher than the major league ball.

Etiology of zygomatic fractures

We report on the etiology of zygomatic fractures in an Irish population. More than half of these injuries are related to interpersonal assault. Treatment of these injuries places a considerable burden on the health service.

Zygomatic complex fractures in a suburban Nigerian population

A retrospective analysis of 128 zygomatic complex fractures was undertaken. There were 109 males (85.2%) and 19 females (14.8%), aged 3-74 years (mean +/- SD, 33 +/- 12.6 years). Patients in the third decade of life (38.3%) recorded the highest incidence. Road traffic accidents (74.2%) mainly from automobile (61.7%) and motorcycle (9.4%) involvement were the predominant etiology. While 38.8% of them presented within the first 24 h, males were relatively earlier than their female counterparts, although this was not statistically significant (P > 0.05). Class 3 fractures were the commonest (50%), followed by classes 2 (zygomatic arch) and 4, respectively. Most class 6 fractures (6.3%) resulted from gunshot injuries. There were 116 unilateral (left 63, right 53) and 12 bilateral fractures with the right side of the face recording more zygomatic arch fractures. In addition, statistical significance was observed between etiology, class and type of fracture (P < 0.05). One hundred and twenty-four (136 fractures) patients were available for treatment as four declined. Twelve cases did not require treatment while others were managed by either closed or open reduction under general anesthesia. Gillies' temporal approach was the commonest (57.1%) surgical technique employed. However the unstable nature of the fractures necessitated open reduction and transosseous wiring in 33 cases. The high prevalence of zygomatic complex fractures arising from vehicular accidents reflects the poor status of the road network in rural and suburban Nigerian communities. Hence government should improve on existing infrastructures, decongest the highways and enforce traffic laws amongst road users. In addition, the need to encourage massive investments in safer alternative transport systems is emphasized.

Etiology and pattern of zygomatic complex fractures: a retrospective study

PURPOSE

To document the etiology and clinical data of patients with fractures of the zygomatic complex seen in two university teaching hospitals in Nigeria and to compare the findings with other studies in the literature.

PATIENTS AND METHODS

A six-year retrospective study involving 134 patients with zygomatic complex fractures. These patients were selected from a pool of 960 patients who sustained maxillofacial fractures during the period under review. Recorded were demographic, etiologic and clinical data as well as radiologic findings, treatment and postoperative complications. The Chi-squared test was used to test for significance and p values < 0.05 were regarded as significant.

RESULTS

76.1% were males and 23.9% females. Most (46.3%) patients were aged 21-30 years and road traffic accidents (82.1%) caused the most injuries (p < 0.05). Regarding the site of fracture, 88.8% of the patients had fractures of the zygomatic bone, 8.2% had fractures of the arch, and 3.0% had fractures of both the zygomatic bone and arch. The most frequently associated maxillofacial fracture was mandibular (21.0%). The commonest clinical feature was subconjunctival ecchymosis (63.4%), while the commonest radiologic findings were fractures at the zygomatico-frontal and zygomatico-maxillary sutures (38.8%). The Gillies approach (23.4%) was the commonest method of reduction.

CONCLUSION

This study has shown that road traffic accidents are responsible for most zygomatic complex fractures in our environment. Urgent enforcement of road traffic legislation is therefore necessary to minimize zygomatic complex fractures due to road traffic accidents. It also showed a low utilization of technological advances in the imaging and treatment of these fractures. These may play a role in the frequency of postoperative complications.

Quantitative Comparison of Open Reduction and Internal Fixation versus the Gillies Method in the Treatment of Orbitozygomatic Complex Fractures

BACKGROUND

Precise repair of orbitozygomatic complex fractures is essential for proper re-establishment of facial symmetry, ocular globe position, and infraorbital nerve function. Controversy regarding the optimal treatment method remains.

METHODS

To compare uniform study groups, only patients without previous craniofacial injuries or operations who had sustained moderate-energy orbitozygomatic complex fractures, based on preoperative computed tomography scans, and who were treated using the Gillies repair or open reduction and internal fixation were selected. Quantifiable end-points, including orbitozygomatic complex position, ocular globe projection, and infraorbital nerve function, were measured to objectively compare the accuracy of repair produced by the Gillies procedure and open reduction and internal fixation. Negative sequelae resulting from cutaneous access were tabulated.

RESULTS

Overall, 12 patients treated using the Gillies repair and 12 treated with open reduction and internal fixation were examined. The results demonstrated that the open reduction and internal fixation technique produces superior realignment of the orbitozygomatic complex, that is, a smaller difference in the position of the orbitozygomatic complex between the injured and noninjured sides of the face. The differences in orbitozygomatic complex projection, height, and lateral position were 1.4 mm, 1.4 mm, and 1.6 mm, respectively, in the open reduction and internal fixation group and 7.5 mm, 5.6 mm, and 4.1 mm in the Gillies group. The p values were 0.0003, 0.01, and 0.06, respectively. Visible cutaneous scarring was present in four patients and lower lid shortening was seen in three patients treated using open reduction and internal fixation.

CONCLUSIONS

To the authors' knowledge, this is the first study to objectively show that the open reduction and internal fixation technique results in superior positioning of the orbitozygomatic complex in moderate-energy orbitozygomatic complex fractures compared with the Gillies repair. Although negative sequelae from surgical access were substantial, recently introduced transconjunctival and upper lid blepharoplasty incisions will minimize these drawbacks.

Zygomatic bone fracture

OBJECTIVE

To find out the number and etiology of fractures of zygomatic bone.

DESIGN

Observational study.

PLACE AND DURATION OF STUDY

This study was carried out at the Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore from January 2001 to December 2002.

PATIENTS AND METHODS

A total of 209 cases were treated during a period of two years. A detailed history and examination was done and findings were confirmed radiologically.

RESULTS

There were 184 (88.04%) male and 25 (11.96%) female patients. In 117 (56 %) cases only the zygomatic bone was involved while in the rest of the 92 (44 %) cases, fracture occurred in combination with fracture of other facial bones. The youngest patient in the series was 9 years of age and the oldest of 80 years. Most of the patients were in the third decade of life (35%). Most common etiology was road traffic accidents, followed by interpersonal violence. In half of the road traffic accidents, motorcyclists were involved.

CONCLUSION

Most common etiology of the fractured zygomatic bone was road traffic accidents. Measures, like various awareness campaigns, raising the traffic sense in public, wearing helmets while driving the motorcycle, can minimize number of these cases.

Causes and effects of zygomatico-orbital and zygomatico-maxillo-orbital fractures managed by open reduction and rigid internal fixation

Progressive violence, the quickening pace of life and transport facilities' development have as a consequence an increased number of traumas. Midface fractures involving zygomatic bone fractures take one of the leading positions in the total number of traumas. It seems appropriate to study the causes and the effects of zygomatico-orbital and zygomatico-maxillo-orbital fractures managed by open reduction and rigid internal fixation at the present time of the medical service being reformed and economic rules being included in the treatment. The analysis of the economic consequences of midface traumas and their causes as well as the search for the influence of social and cultural changes on fracture management was the aim of the study. Histories of 61 injured patients treated by open reduction and rigid internal fixation in 1st Department of Maxillofacial Surgery of the Silesian Medical University in Zabrze between 1996 and 2001 were studied. Patients' sex, the most frequent trauma causes and their disposition in different age groups were taken into consideration. It was observed that certain symptoms of the fracture tend to coexist with high energy traumas (traffic accidents, violent assaults). The influence of injury's extension on the prolongation of hospitalization time was emphasized. It was concluded that assaults and traffic accidents are the most frequent and devastating causes of zygomatico-orbital and zygomatico-maxillo-orbital fractures. The fractures usually involve men aged from 21 to 40 years. The rapid growth of violence and the pace of life have in recent times necessitated the general use of advanced and expensive operating techniques in injured patients recently. The break in social and professional activity of injured individuals and the scale of the problem indicate the necessity of change in medical service financing.

Trends in the characteristics of maxillofacial fractures in Nigeria

PURPOSE

The study purpose was to assess the changes in the pattern of maxillofacial fractures in 2 different study periods.

PATIENTS AND METHODS

We conducted retrospective study of 341 patients treated for maxillofacial fractures between January 1978 and December 1982 and a prospective study of 483 patients treated between January 1995 and December 1999 at the Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria. Data were collected on age, gender, etiologic factor, and site of injury.

RESULTS

The male-to-female ratio reduced in the second period by a factor of 2.0. Patients in the age groups of 21 to 30 years and older than 60 years increased by a factor of 1.8 and 2.9, respectively, in the second period. Assaults, falls, sporting injuries, and industrial accidents in the second period increased by a factor of 1.4, 1.5, 3.5, and 1.5, respectively. The ratio between road traffic accidents and other causes changed from 3.4:1 to 2.2:1 in the second period. Mandibular fractures increased by 2% in the second study period.

CONCLUSION

The data confirmed that although other etiologic factors are increasing in number, road traffic accidents remains the major etiologic factor of maxillofacial fractures in Nigeria. There is a need to enforce seat belt use, speed limit, and drink driving laws to reduce maxillofacial injuries caused by road traffic accidents; to organize preventive programs to minimize assaults, and to legislate the wearing of headgear by industrial workers.

Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions

Orbital skeletal injuries are frequently associated with other significant injuries and require a substantial surgical effort to correct. The use of a unified classification of orbital injury may better predict the surgical effort required to correct such injuries and help with future comparisons of results. In an attempt to summarize the principles of reconstruction of the orbital skeleton following trauma and introduce a unified classification system for orbital injuries, a retrospective review of all consecutive orbital reconstructions in a tertiary care teaching hospital was conducted. The nasoethmoidal region was involved in 32%, the zygomatic complex in 50%, and the frontal region in 28% of orbital fractures. Of the orbital walls, four walls were involved in 5%, three walls in 17%, two walls in 30%, and one wall in 53%. Associated ocular and neurologic injury was encountered in 33% and 57% of patients, respectively. Regions of fixation ranged from one to eight. Bone grafts were used in 20% and titanium mesh in 34% of the orbits. In general, the authors recommend an aggressive approach to orbital injuries, addressing all associated injuries simultaneously.

Paediatric maxillofacial fractures: their aetiological characters and fracture patterns

OBJECTIVE

Paediatric maxillofacial fractures are not common and carry different clinical features when compared with adults. To clarify the differences of aetiology and patterns of fractures in paediatric patients, a clinical retrospective analysis was performed.

PATIENTS

One hundred seventy-four paediatric patients younger than 16 years of age treated in the First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital during a 15-year period were analysed.

STUDY DESIGN

Age, sex, fracture patterns, incidence, common locations of the mandibular fractures and treatment were studied according to the patients' charts and radiographs.

RESULTS

The ratio of boys to girls was 2:1 and the largest age subgroup was 15-years old. The most common cause of injury was bicycle accidents (26%), followed by falls (25%). The distribution of causes and ages revealed that the incidence of the fall-related injuries decreased in patients older than 10 years, and assaults became a common cause in patients older than 12 years. The yearly distribution showed a decrease of the group between 6 and 10 years and of bicycle-related accidents in the last 5-year period (1992-1996). Mandibular fractures were most common (56%), followed by fractures of the alveolar process (31%). Condylar fracture was common in children younger than 14 years, especially in those below 6 years. Fractures of the mandibular angle were the most common in those above 13 years.

CONCLUSION

These results document that the aetiological characters and patterns of paediatric maxillofacial fractures gradually shifted towards those found in adolescents.

The causes and consequences of maxillofacial injuries in elderly people

OBJECTIVE

The occurrence of trauma in older people is well-documented; however the incidence of maxillofacial trauma is scarcely reported. Therefore, the objective of this study is to determine the causes and consequences of maxillofacial trauma in older people.

DESIGN

A five-year (March 95 - March 2000) retrospective study was carried out of all patients over the age of 65 years with facial trauma presenting to Accident and Emergency Department (A&E). The information was collected using the medical notes and discharge summaries.

SETTING

The Departments of A&E and Maxillofacial Surgery.

SUBJECTS

A total of 42 patients' records were examined for study related data.

RESULTS

A total of 42 patients were seen during the study period. Thirty-six gave a history of a fall, of which 15 had tripped, 5 had slipped, 3 resulted from a Transient Ischaemic Attack (TIA), 1 as a result of alcohol abuse, in 1 a prosthetic knee gave way and 11 gave no cause for the fall. Of the remaining 6 patients, 5 were assaulted and 1 had a wardrobe fall on top of him. The majority of the falls occurred during the winter months. Maxillofacial injuries were noted in 27 of the 42 patients. Sixteen patients had cheekbone fractures, 8 mandibular fractures, 2 midface and 1 orbital complex fracture. Twenty-five percent of cheekbone fractures and 50% of mandibular fractures were treated surgically. Medical history was noted in 27 patients.

CONCLUSIONS

This study clearly demonstrates the majority of the facial trauma in the older people can be treated conservatively unless the patients complain of functional problems.

Application of endoscope in zygomatic fracture repair

The endoscope has been used to visualise the upper face and brow in aesthetic facial surgery which is performed without a coronal incision. We applied these principles to repair zygomatic fractures with the aid of a 4 mm, 30 degree telescope inserted through a small temporal incision. Fracture sites at the zygomatic arch and the zygomaticofrontal suture were exposed and fixed with miniplates under endoscopic control. This technique was used in 15 consecutive patients including 2 with isolated zygomatic arch comminuted fractures and 13 having displaced zygomatic fractures with segmental, displaced zygomatic arch fractures. Nine patients were men and six patients were women with a mean age of 35 years. Three patients had associated mandibular fractures. The periods of follow-up ranged from 3 to 22 months. Two patients developed transient frontal nerve palsy which recovered within 2 months. One patient had mild temporal hollowing on the side of the facial fracture. All patients achieved the adequate anatomic reduction and satisfactory malar symmetry. There has been no case of chewing problems, cheek numbness or progressive enophthalmos developing postoperatively. Application of the endoscope in zygomatic fracture repair minimises the scalp scar, avoids forehead numbness, provides a comfortable postoperative recovery and shortens hospital stay. Careful preoperative evaluation and proper surgical technique are mandatory for achieving optimal results in selected patients.

[Sports activities and maxillofacial injuries. Current epidemiologic and clinical aspects relating to a series of 379 cases (1982-1998)]

BACKGROUND

The constant improvement in the quality of individual life and growing interest in sporting activities have resulted in an increased use of sport in free time at amateur level. As a result, sports injuries have steadily increased since the late 1980s. The aim of this study was to illustrate our experience in the treatment of injuries in this particular category.

METHODS

The series included patients admitted to the Division of Maxillofacial Surgery at Turin University over a 15-year period. A total of 379 maxillofacial fractures caused by sporting activities were recorded out of a total of 2925 cases. The factors examined included: the type of sport, the age and sex of the patient, the cause of the injury, the site of the lesion and the treatment.

RESULTS

Sports injuries represent 12.9% of total injuries. The mean age of patients was 32.1 years and the male/female ratio was 5.6:1. A range of 36 sports were examined, but football (43.5%), cycling (23.4%) and skiing (13.9%) represented 80.9%. The injuries observed involved different areas of the face with a prevalence of the orbital/zygomatic complex (47.4%) compared to the mandibular region (42%). The most important forms of treatment and preventive therapy were examined and a comparison was made of their incidence.

CONCLUSIONS

The authors conclude by emphasizing the importance of prevention in sports injuries.

Maxillofacial fractures following airbag deployment

Maxillofacial fractures and associated lesions following airbag deployment were studied in six patients who suffered frontal or fronto-lateral car crashes. Installation of airbags in motor vehicles has reduced the morbidity and the mortality following motor vehicle accidents, but the appearance of new types of trauma directly related to airbag deployment raise questions about the potential danger of these devices when used improperly. The results of this limited study suggest that airbag injuries can be aggravated if: (1) seat belts are not worn; and (2) if the driver's chest is too close to the steering wheel as can easily happen with small people (in our study, two women). There needs to be a way of disconnecting the system.

Is there still a role for traditional methods in the management of fractures of the zygomatic complex?

With the introduction of low-profile mini-plating systems, a trend has developed towards open reduction and rigid internal fixation (ORIF) of fractures of the cranio-facial skeleton. The current policy for management of zygomatic fractures in our unit is to attempt primary reduction by traditional methods, and proceed to ORIF in the event of unsatisfactory fracture stability or alignment. Over a one-year period, 109 patients underwent surgical correction of fractures of the zygomatic complex. Standard Gilles' elevation was performed in 71 cases, percutaneous elevation in three cases, and ORIF was performed in 35 cases. Mean follow-up was 190 days. One case of persistent infraorbital step and three cases of residual malar flattening were documented in patients who underwent Gilles or percutaneous elevation. Morbidity associated with ORIF was minimal. We conclude that while ORIF of zygomatic fractures may offer better results than traditional methods in the management of complex fractures, traditional methods still have a role to play in less complex fractures.

[Clinical and anatomopathologic classification of fractures of the orbit]

One hundred forty-four orbital fractures treated between 1982 and 1987 were examined with special attention to the specific anatomic architecture and biomechanical aspects of the craniofacial skeleton. The following parameters were examined: lesion mechanism, the bony lesion observed at surgery, clinical signs of fracture and morphological, functional and esthetic sequellae. All operated patients had undergone an ophthalmological examination prior to surgery, with special attention on binocular vision and ocular motility. Fractures were classified into pathological groups according to the parameters studied. For each group, clinical signs and accompanying sequellae were described. Seven clinical and pathological groups of orbital fractures were described, each with its specific mechanism of trauma, bony lesions, clinical signs, sequellae and appropriate treatment.

Facial injury: a review of biomechanical studies and test procedures for facial injury assessment

A review of biomechanical studies that have attempted to measure fracture tolerances of facial bones has been carried out. The particular bones of interest were the mandible, the zygoma, the maxilla and the nasal bones. Numerical values have been given for the peak force and pressure fracture tolerances for these bones. A study of these values illustrates just how variable the bone strength of various individuals is. A review of various methods that have attempted to measure and quantify the physical effects of a blow to the face has also been carried out. Three major types of test procedure exist, namely frangible elements, peak force and pressure sensing elements and deformable elements. Frangible and deformable elements generally replace the face of a standard test dummy, fracturing and deforming at appropriate impact force levels, respectively. These surrogate face forms are used for two different reasons; either they are used to measure the damage to the human face for some impact scenario or they are simply used to better simulate the response of the whole head to impact by simulating the compliance of the face. Peak force and pressure sensing elements take the form of piezoelectric sensors and pressure-sensitive, colour 'Fuji film'. Both these methods are complicated and really only suitable for research purposes only. Finally, it is recommended that a mathematical model approach be used to establish the principal injury mechanism and support further development of an acceptable face form test.

Reconstruction of traumatic orbital floor defects using irradiated cartilage homografts

The important role of orbital shape and volume reconstruction has been studied by many investigators. There is, however, no consensus on the material that should be used in the reconstruction of the orbit. Both biologic and alloplastic materials have been used, each with its advantages and disadvantages. Here we report our experience with irradiated costal cartilage homograft in the reconstruction of the orbital floor. Irradiated cartilage grafts were used in 31 patients with significant traumatic defects in the orbital floor. Long-term follow-up in 21 patients up to 48 months revealed no incidence of graft infections, extrusions, or clinically detectable graft distortion or resorption. Irradiated cartilage homograft appears to be an excellent material for reconstruction of the orbital floor.

Aetiology of maxillofacial fracture

The aetiological factors associated with maxillofacial fractures, and the trends in these factors over a 13 year period are reported. The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, managed 695 patients with maxillofacial fractures between 1977 and 1989. The male to female ratio was 3.2:1 and the majority of patients were aged between 10 and 30 years old. Road traffic accidents and accidental falls were the main causes of fractures throughout the 13 year study period. Mandibular fractures occurred in 477 patients (68.6%). A high percentage of patients were treated by closed reduction and maxillo-mandibular fixation, or occlusal splinting.

Self-compression plates for orbital rim fractures

The development and principles of self-compression plating, as well as a series of patients treated with this technique, are described. The use of such plates has specific advantages over other techniques for disorders encountered by the oculoplastic surgeon. The indications for plating were displaced trimalar fracture, displaced trimalar fracture with orbital rim fragment, and comminuted orbital rim fracture. Results were good; no complications have been observed to date. Comparison of compression plating to other methods for repair of orbital fractures is made. Self-compression plating with Vitallium plates is an effective modality for the treatment of a broad spectrum of patients with orbital rim fractures.

A complication of the Dautrey procedure

A case of longstanding recurrent dislocation of both temporomandibular joints treated surgically by the Dautrey procedure is presented. A complication occurred at the time of surgery. The management of this problem and the outcome after a 3-year follow-up period is described.

[Morbidity analysis of 1484 facial bone fractures between 1968 and 1987]

In the years 1968 to 1987 a total of 1484 patients were treated for facial bone fractures at the Hospital for Stomatology and Maxillofacial Surgery of Neuruppin. Most of them were aged between 16 and 25 years. In the majority of the cases, the injuries resulted from acts of violence (40%) and road accidents (35.7%), although the number of care accidents is decreasing. The ratio of mandibular to midfacial fractures is 2.2: 1. Multiple injuries were found in 60% of the patients. The use of surgical treatment methods increased to 30%.

[Relationship between injury dynamics and site of maxillofacial fractures. Comparative study of 100 cases]

One hundred cases of facial mass fractures observed in the period April-September 1988 have been assessed using a clinico-anamnestic type investigation. Among trauma patients there is a prevalence of male patients aged between 10 and 30. Fractures located at the middle third and mandible occur in a practically equivalent number. Most traumas are the result of road accidents, following by falls. A good degree of correlation was observed between trauma aetiology and dynamics on the one hand and type and gravity of fractures on the other. Direct fractures, with greatest comminution of fragments prevail in high speed traumas; indirect fractures are most frequent in low speed traumas (cyclists and accidental).

A comparison of radiographic treatment methods for evaluation of the orbit

The use of conventional radiography, complex motion tomography, and computed tomography for evaluation of eight patients with orbital floor fractures indicates that CT scans in an axial plane with coronal and sagittal reformations offer the best radiographic evaluation of the orbit.

An analysis of 2,067 cases of zygomatico-orbital fracture

A ten-year review of 2,067 cases of zygomatico-orbital fractures is presented. The age and sex distribution, anatomical types of fractures, associated maxillofacial and nonmaxillofacial trauma, and causes of the injuries are described. The majority of fractures were sustained by males and resulted from trauma inflicted in altercations. The most common associated facial fractures were mandibular; the most common associated nonmaxillofacial trauma was extremity fractures. Motorcycle accidents caused the most significant amount of associated trauma, followed by motor vehicle accidents in which no seat restraint was used by the victim. Treatment, when indicated, consisted of elevation via a temporal approach followed by fixation where necessary. The fixation methods used are presented and discussed.