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Canas M, Fonseca R, Diaz L, Filippis AD, Afzal H, Aldana JA, Machica C, Leonard J, Liang SY, Bochicchio K, Bochicchio GV. Open Mandible and Maxillary Fractures Associated with Higher Risk of Infection in Victims of Assault. Surg Infect (Larchmt) 2023; 24:376-381. [PMID: 36799978 PMCID: PMC10398716 DOI: 10.1089/sur.2022.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: Victims of assault (VOA) often present with fractures of the mandible and maxilla. They represent a complex challenge because of possible compromise of the airway, and infection-related complications because of potential involvement of the oral cavity. We hypothesized that open mandible and maxillary fractures in VOA are associated with a higher rate of infection compared with non-VOA patients with open facial fractures. Patients and Methods: Patients admitted to our level 1 trauma center from 2005 to 2020 with a diagnosis of open mandible and maxillary fractures were included. Demographics, mechanisms of injury, fracture location, cultures, infectious complications, antibiotic treatments, and clinical outcomes were abstracted. Patients were stratified by their mechanism of injury into VOA or non-VOA and were compared using χ2 and Student t-test using SPSS (IBM Corp, Armonk, NY). Results: We identified 316 patients with open mandible and maxillary fractures. There were 198 patients categorized as being VOA, and 118 as non-VOA. Nineteen of 316 patients were diagnosed with infection related to the fracture (3.8% abscesses, 1.9% cellulitis, and 1.9% osteomyelitis). Although the Injury Severity Score (ISS) was higher in non-VOA patients (5.8 ± 2.6 vs. 4.9 ± 1.8; p < 0.013), most of the infections were in the VOA cohort (17/19; 89.5%; p < 0.013). Conclusions: Open fractures of the mandible and maxilla in VOA are associated with a greater risk of infection compared with non-victims of assault. The relation between VOA and poor SDH has been studied recently; clinicians should be aware of this association and implement special considerations and appropriate follow-up visits to decrease the rate of infection in this currently expanding population.
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Affiliation(s)
- Melissa Canas
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ricardo Fonseca
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leonardo Diaz
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alejandro De Filippis
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hussain Afzal
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jose A. Aldana
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chris Machica
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer Leonard
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y. Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelly Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grant V. Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Sharifi F, Samieirad S, Grillo R, Da Graça Naclério-Homem M, Bardideh E, Manafi A, Mohammadi Z, Eshghpour M. The Causes and Prevalence of Maxillofacial Fractures in Iran: A Systematic Review. World J Plast Surg 2023; 12:1-11. [PMID: 37220578 PMCID: PMC10200082 DOI: 10.52547/wjps.12.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/05/2023] [Indexed: 05/25/2023] Open
Abstract
Background Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes. Methods A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed. Results A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low. Conclusion Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.
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Affiliation(s)
- Faeze Sharifi
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, University of São Paulo, São Paulo, Brazil
- Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil
| | | | - Erfan Bardideh
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Manafi
- Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Mohammadi
- Department of Medical education, Tehran university of Medical Sciences, Tehran, Iran
| | - Majid Eshghpour
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
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Ashkenazi I, Givon A, Hershkovitz Y, Bodas M, Jeroukhimov I. Violence against women in Israel: injury mechanisms and clinical outcomes following hospitalization. Eur J Trauma Emerg Surg 2022; 49:973-979. [PMID: 36183300 DOI: 10.1007/s00068-022-02117-4] [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: 04/09/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of this study was to evaluate the relative contributions of different mechanisms of assault to injury and mortality in women in Israel. METHODS We identified females hospitalized between 2011 and 2020 following an assault, secondary to blunt, stabbing, or shooting mechanisms of injury, in the Israeli Program for Registration of Trauma Patients (National Trauma Registry). To avoid bias due to temporary hospitalizations for non-medical reasons, we included patients with injuries graded as Abbreviated Injury Scale ≥ 2. RESULTS Females accounted for 8.1% (926/11,486) of assault patients in the study population. Compared to males, females were older (40.7 vs. 31.0 years; p < 0.001), more commonly injured by the blunt trauma mechanism (72.1 vs. 48.6%; p < 0.001), and more commonly injured at a place of residence (50.9 vs. 8.2%; p < 0.001). There were no differences in the number of body areas injured, severe Injury Severity Score, and median hospitalization. Males were operated more commonly (44.6 vs. 40.0%; p = 0.008). Mortality in females and males was similar (2.8 vs. 2.3%; p = 0.43). Secondary analysis revealed that blunt injuries were responsible for 61.2% of the severe cases (ISS ≥ 16), 61.4% of the operations, 54.9% of the Intensive Care Unit (ICU) admissions, and 53.8% of the mortality observed in females. When compared to males injured by blunt trauma, females injured by this mechanism were older (43.0 ± 24.7 vs. 32.8 ± 16.1 years; p < 0.001) and had higher mortality (2.1 vs. 0.9%; p = 0.007). CONCLUSIONS Assault by mechanisms other than stabbing and shooting should be recognized as a source of severe morbidity and mortality in females.
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Affiliation(s)
- Itamar Ashkenazi
- General Surgery Division, Rambam Health Care Campus, HaAliya HaShniya St 8, 3109601, Haifa, Israel.
| | - Adi Givon
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Yehuda Hershkovitz
- Trauma Unit, General Surgery Division, Shamir Medical Center, Beer Yaakov, Israel
| | - Moran Bodas
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.,School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Jeroukhimov
- Trauma Unit, General Surgery Division, Shamir Medical Center, Beer Yaakov, Israel
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Stanbouly D, Chuang SK. What Are the Risk Factors of Incurring Maxillofacial Fractures From Unarmed Hand-To-Hand Combat? J Oral Maxillofac Surg 2021; 80:481-489. [PMID: 34748772 DOI: 10.1016/j.joms.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of our study was to determine the risk factors of incurring maxillofacial fractures among individuals who engage in unarmed hand-to-hand combat. METHODS The following retrospective cohort study was competed using data from the Nationwide Inpatient Sample. The primary predictor variable was blood alcohol level. The primary outcome variable maxillofacial fracture. We used SPSS to conduct all statistical analyses. RESULTS Our final sample consisted of 9,441 patients injured from unarmed hand-to-hand combat. The mean age of the sample was 38.7 years. The most common age group was young adults (42.9%), followed closely by middle-aged adults (41.9%). The number of males was nearly 4 times that of females. The mandible was the most frequently fractured maxillofacial bone. Concerning the mandible per se, the angle (37.1%) was the most frequently fractured site, while the coronoid process (0.2%) was the least frequently fractured site. Relative to females, males were 2.7 times more likely to incur a craniomaxillofacial fracture (P < .5). CONCLUSIONS Males had an increased risk of maxillofacial fracture relative to females. The mandible, particularly the angle, was the most frequently fractured maxillofacial bone. We speculate this is because hooks are frequently thrown in unarmed hand-to-hand combat.
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Affiliation(s)
- Dani Stanbouly
- Dental Student, Columbia University College of Dental Medicine, New York, NY
| | - Sung-Kiang Chuang
- Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA; Private Practice, Brockton Oral and Maxillofacial Surgery Inc.; Attending, Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA; Visiting Professor, Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, School of Dentistry, Kaohsiung, Taiwan.
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