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Deininger C, Wichlas F, Necchi M, Deluca A, Deininger S, Trieb K, Tempfer H, Kriechbaumer L, Traweger A. Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review. J Clin Med 2024; 13:2437. [PMID: 38673709 PMCID: PMC11050981 DOI: 10.3390/jcm13082437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.
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Affiliation(s)
- Christian Deininger
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Florian Wichlas
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Marco Necchi
- Department of Surgery and Orthopaedics, Hospital Sterzing, Margarethenstraße 24, 39049 Sterzing, Italy;
| | - Amelie Deluca
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Susanne Deininger
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria;
| | - Klemens Trieb
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
- Department for Orthopaedics and Traumatology, Center for Clinical Medicine, Faculty of Medicine and Dentistry, Danube Private University, 3500 Krems, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Lukas Kriechbaumer
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
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Abstract
ABSTRACT The compulsory use of helmet by motorcyclists has lowered the incidence of facial trauma, but there are few studies evaluating the effects of different helmet types on such injuries. The authors collected retrospective data from the medical records of 287 motorcyclists presenting facial injuries treated at the maxillofacial surgery department of the "University Magna Graecia" of Catanzaro city in South Italy between 1 January 2007 and 1 August 2018. Patients were wearing 2 types of crash helmets at the time of the trauma, full face ones or open-face ones, and were compared using the Facial Injury Severity Scale (FISS). Those wearing open-face helmet were 3 times more than those wearing full-face helmet, with a higher FISS score.The purpose of this study was to investigate the impact of Italy's compulsory helmet law on the change in helmet use and in particular if protection offered by helmets w4as different according to helmet type. The authors correlated the FISS scores among motorcyclists wearing these 2 tipologies of crash helmet.
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YONTAR Y, TATAR S, BAYKAN H. Closed reduction of zygomatic arch fractures by using Tubbs-Logan mitral valve dilator. ENT UPDATES 2020. [DOI: 10.32448/entupdates.709516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Giudice A, Cristofaro MG, De Cicco D, Barca I, Dell'Aversana Orabona G, Califano L. Percutaneous Reduction of Isolated Zygomatic Arch Fractures: A 5-Year Experience. J Oral Maxillofac Surg 2020; 78:973-978. [PMID: 32171599 DOI: 10.1016/j.joms.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated the outcomes and differences in surgical time and hospitalization length for patients with an isolated zygomatic arch (ZA) fracture treated by percutaneous wire reduction with external fixation. PATIENTS AND METHODS We designed and developed a retrospective study of patients with isolated ZA fractures treated from 2014 to 2019. The predictor variable was the operative treatment, represented by percutaneous reduction with external fixation. The primary outcome variables were the surgical time and hospitalization length. Other variables, including functional and esthetic results (evaluated by clinical and radiologic assessments) and the rate of immediate and delayed complications during a 6-month minimum follow-up period, were considered. Descriptive statistics were computed and compared with the international reported data. RESULTS A total of 15 patients met specific inclusion and exclusion criteria. The 15 fractures were grouped using the classification reported by Kim et al as type 1A (n = 9) and type 1B (n = 6). No significant differences were found between the 2 groups, except for the fracture type. The operative treatment was performed with the patient under general anesthesia (n = 12) or local anesthesia with sedation (n = 3). Only 1 patient developed a complication (early hematoma). No other cases of early or delayed complications were reported. Two patients required a traditional surgical operation with the Gilles approach. The average hospitalization length and surgical time were 0.8 night and 18.4 minutes for the type 1A group and 0.7 night and 19.0 minutes for the type 1B group, respectively. Optimal esthetic and functional outcomes were obtained for all 15 patients. CONCLUSIONS The results of the present study suggest that optimal esthetic and functional results can be obtained, minimizing the effect on soft tissues and patient discomfort, with a short surgical time and low rate of complications.
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Affiliation(s)
- Amerigo Giudice
- Professor, Università degli Studi di Catanzaro "Magna Graecia", Catanzaro, Italy
| | | | - Davide De Cicco
- Resident, Department of Maxillofacial Surgery, Università degli Studi Federico II di Napoli, Naples, Italy
| | - Ida Barca
- Physician, Maxillofacial Surgery Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Giovanni Dell'Aversana Orabona
- Professor, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi Federico II di Napoli, Naples, Italy.
| | - Luigi Califano
- Head, Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi Federico II di Napoli, Naples, Italy
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Johner JP, Wiedemeier D, Hingsammer L, Gander T, Blumer M, Wagner ME. Improved Results in Closed Reduction of Zygomatic Arch Fractures by the Use of Intraoperative Cone-Beam Computed Tomography Imaging. J Oral Maxillofac Surg 2020; 78:414-422. [DOI: 10.1016/j.joms.2019.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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Cinal H, Barin EZ, Çakmak MA, Kara M, Yilmaz K, Tan O. Novel Surgical Technique for Repair of Zygomatic Fractures: Lever Technique. Plast Surg (Oakv) 2019; 27:135-140. [PMID: 31106171 DOI: 10.1177/2292550319828791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Zygoma is a very crucial component for the anteroposterior positioning of the midface and for the maintenance of facial contours. Zygomatic fractures are considered as the second most common type of facial fractures following nasal fractures. We have developed a new reduction technique called "lever," which is based on the application of lifting force as an alternative to the methods in which the pulling force is applied. Patients Over a 12-year period, 90 patients were treated with minimal access approach and 130 patients were treated with open reduction internal fixation (ORIF), using the lever technique. Results In the follow-up period, no complications occurred in any of the patients who underwent minimal access approach. Miniplate removal operation was performed in 3 of the patients. Enophthalmos developed in one patient. Since 4 of the 7 suboptimal reduction patients did not experience any functional or cosmetic problems, no treatment was necessary and the remaining 3 patients underwent fat graft due to the presence of malar depression. Conclusion This minimally invasive surgical procedure we have developed can be successfully used both in the minimal access approach and in ORIF, especially in delayed cases. We recommend this method due to the reasons that it is safe to conduct, easy to learn, fast to apply, simple to perform, and also economical to deploy.
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Affiliation(s)
- Hakan Cinal
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Ensar Zafer Barin
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Mehmet Akif Çakmak
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Murat Kara
- Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Kerem Yilmaz
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Onder Tan
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
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The Influence of Socioeconomic Factors on the Epidemiology of Maxillofacial Fractures in Southern Italy. J Craniofac Surg 2019; 29:2119-2123. [PMID: 29771827 DOI: 10.1097/scs.0000000000004603] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable and its analysis is crucial to establish effective treatment and prevention of these injuries. The aim of this multicentric retrospective study was to analyze causes, demographics, incidence, characteristics of 987 patients diagnosed with maxillofacial trauma between 2011 and 2015 at Complex Operative Unit of Maxillofacial Surgery of Federico II University of Naples and Magna Graecia University of Catanzaro, Italy; 657 male and 310 female patients were admitted in the study. The most frequently observed fracture involved the mandible (399 patients, 35.4%), followed by zygomatic complex (337 patients, 29.9%), orbital walls (160 patients, 14.2%), and nasal bones (129 patients, 11.4%). The most frequent cause of fracture was assaults (30.4%), followed by road traffic injuries (27.2%), falls (23.2%), sport accidents (15.4%), and others causes (2.6%). Significant variations of etiology have been detected between the 2 hospitals in relationship with different migration flow trends and cultural and socioeconomic features. Epidemiological analysis of maxillofacial fractures is crucial to identify the trauma burden and to help in developing a more efficient system to plan resource allocation and to deliver care and preventive measures establishing clinical and research priorities for effective treatment and prevention of these injuries.
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Recent advances in the management of oral and maxillofacial trauma. Br J Oral Maxillofac Surg 2015; 53:913-21. [DOI: 10.1016/j.bjoms.2015.08.261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/20/2015] [Indexed: 11/17/2022]
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Lahmiti S, Aziz Z, Lakouichmi M, Hiroual A, Bouaichi A, Mansouri Hattab N. [Towel clip reduction of zygomatic arch fracture]. ACTA ACUST UNITED AC 2015; 116:92-4. [PMID: 25742703 DOI: 10.1016/j.revsto.2015.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 11/16/2014] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Isolated fractures of the zygomatic arch (IFZA) are common in maxillofacial emergencies. They usually require a closed reduction. Several reduction techniques have been proposed. The reduction using a Ginestet-type hook is the gold standard technique. DISCUSSION The reduction using a towel clip under local anesthesia is an economical, simple, reliable and safe alternative technique for the reduction of IFZA. We describe this procedure.
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Affiliation(s)
- S Lahmiti
- Service de chirurgie maxillo-faciale et esthétique, faculté de médecine et de pharmacie, université Cadi-Ayyad, CHU Mohammed VI, 40000 Guéliz, Marrakech, Maroc
| | - Z Aziz
- Service de chirurgie maxillo-faciale et esthétique, faculté de médecine et de pharmacie, université Cadi-Ayyad, CHU Mohammed VI, 40000 Guéliz, Marrakech, Maroc
| | - M Lakouichmi
- Service de chirurgie maxillo-faciale et esthétique, faculté de médecine et de pharmacie, université Cadi-Ayyad, CHU Mohammed VI, 40000 Guéliz, Marrakech, Maroc
| | - A Hiroual
- Service de chirurgie maxillo-faciale et esthétique, faculté de médecine et de pharmacie, université Cadi-Ayyad, CHU Mohammed VI, 40000 Guéliz, Marrakech, Maroc
| | - A Bouaichi
- Service de chirurgie maxillo-faciale et esthétique, faculté de médecine et de pharmacie, université Cadi-Ayyad, CHU Mohammed VI, 40000 Guéliz, Marrakech, Maroc
| | - N Mansouri Hattab
- Service de chirurgie maxillo-faciale et esthétique, faculté de médecine et de pharmacie, université Cadi-Ayyad, CHU Mohammed VI, 40000 Guéliz, Marrakech, Maroc.
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