The epidemiological analysis of maxillofacial fractures in Italy: The experience of a single tertiary center with 1720 patients

Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients

PURPOSE

The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic.

METHODS

This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed.

RESULTS

The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

Craniofacial Assault Against Women: A National Evaluation Defining At-risk Populations and Outcomes

INTRODUCTION

Few studies have analyzed epidemiologic factor associated with female patients presenting to the emergency department from facial fractures because of assault. Clearly understanding these factors may assist in developing effective strategies to decrease the incidence and sequelae of these injuries.

OBJECTIVES

To determine the epidemiology of facial fractures because of assault in the female population.

METHODS

All female facial fracture visits were queried in the 2019 Nationwide Emergency Department (ED) Sample database. The likelihood of a facial fracture encounter resulting from assault was modeled using logistic regression adjusting for demographics, insurance status, geographic region, location of patient residence, and income. Secondary outcomes analyzed hospitalization costs and adverse events.

RESULTS

Of all facial fractures 12.4% of female encounters were due to assault were due to assault. Of assaulted females, 72.8% were between the ages of 20 and 40, and Black women experienced a disproportionate share of assault encounters (odds ratio [OR]=2.55; CI, 2.29-2.84). A large portion (46.4%) of encounters occurred in patients living in the lowest quartile of median household income, and 22.8% of patients were uninsured (OR=1.34; CI, 1.09-1.66). Assaulted patients were more likely to have fractures in nasal bone (58.1% vs. 42.5%), orbit (16.8% vs. 10.9%), zygoma (4.1% vs 3.6%), and mandible (8.7% vs. 4.8%) compared with their nonassaulted counterparts.

CONCLUSIONS

Facial fractures were especially common in lower income, uninsured, urban, and Black populations. Examining the patterns of injury and presentation are critical to improve prevention strategies and screening tools, identifying critical patients, and develop a more efficient and effective system to treat and support female patients suffering facial fractures secondary to assault.

Epidemiological Study of Frontal Sinus Fractures: Evaluation of 16 Years of Care at the Faculty of Dentistry of Ribeirão Preto/Brazil

Purpose

Aiming to evaluate and study the epidemiological profile of frontal sinus fractures treated in the region of Ribeirão Preto-Brazil.

Methods

Sixteen years of activity in the Oral and Maxillofacial service of the Faculty of Dentistry of Ribeirão Preto/SP (FORP/USP), totaling 9,736 consultations, 4,524 with facial fractures, those diagnosed with frontal sinus fracture (113) were evaluated and selected for the study.

Results

Frontal sinus fractures accounted for 2.5% of facial fractures, the majority occurring in men (89.4%), concentrated in the age group 21-30 years old, with 52.2% of cases being caused by road traffic accidents (RTA). Associations with other facial fractures are common and appeared in 75.2% of cases. Treatment was followed either surgically, by open reduction internal fixation (52.2%) or conservatively (35.4%). Analyzing only the 28 isolated frontal sinus fractures, the most common treatment was conservative (46.4%). surgical treatment dropped to 25%. The most common postoperative complications were temporal branch paralysis and supraorbital nerve paresthesia, both occurring in 30.5% of surgical cases.

Conclusion

The frequency of frontal sinus fractures may be decreasing, but the pattern of occurrence in young men due to road traffic accidents does not seem to change, fortunately the appearance of serious complications is not common and it is usually associated with more severe trauma.

Changing trends in maxillofacial injuries among paediatric, adult and elderly populations: A 22-year statistical analysis of 3424 patients in a tertiary care centre in Northwest Italy

BACKGROUND

This retrospective study analysed the epidemiology of maxillofacial trauma over 22 years to assess whether there have been significant changes in the causes and characteristics of fractures in paediatric, adult and elderly populations.

MATERIALS AND METHODS

The following data were collected: age, sex, injury cause and mechanism, fracture site, Facial Injury Severity Scale, associated injuries, time of injury, type of treatment and length of hospital stay. The patients were analysed by age group (children [≤16 years], adults [17-60 years] and elderly [>60 years]) and divided into two time groups (group 1: 2001-2011; group 2: 2012-2022) that were compared to each other. Statistical analyses were performed using SPSS software.

RESULTS

Between 01 January 2001 and 31 December 2022, 3535 patients (2690 males and 845 females, mean age 39.3 years) were admitted for facial fractures. The comparison of the two temporal periods showed a decrease in the prevalence of males (p = .02), in road traffic injuries (p < .001), and in fractures of the lower third of the face (p = .005); there were significant increases in the mean age (p < .001), prevalence of the elderly (p = .006) and in fall- and assault-related injuries (p < .001 and p = .03, respectively). Assault injuries increased only in the 17-60 age group (p = .02) while RTA-related fractures decreased in all age groups (p < .05 for all comparisons). Bicycle accidents increased significantly, with a parallel decrease in motor vehicle accidents (both p < .001). Fall-related fractures increased only in 17-60 and >60 age groups (p < .001 and p = .02, respectively).

CONCLUSIONS

This study shows significant changing trends in the epidemiology of maxillofacial trauma. While road traffic policies have been effective in the last years, preventive measures for falls in the elderly population and new legislative measures to prevent interpersonal violence should be advocated.

Patterns and Characteristics of Midface Fractures in North-Eastern Romania

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence.

Epidemiological aspects of dental trauma associated with maxillofacial injures: Ten years of clinical experience in Trieste, Italy

BACKGROUND/AIMS

The prevalence of dental injuries in patients with facial fractures is relevant. Epidemiologically, dental trauma in association with facial fractures generally affects the age group between 20 and 40 years old, with a higher prevalence in males. The aim of this retrospective study was to identify the incidence and etiology of dental trauma associated with facial fractures over a 10-year period.

METHODS

From January 2009 to April 2019, among 381 patients with facial fractures, 353 were included in this study. Age, gender, trauma etiology, injured teeth and dental treatment were investigated.

RESULTS

From 353 patients, with a mean age of 49.7 ± 19.9 years, 247 (70%) were males and 106 (30%) were females. Accidental falls were the most common type of injury (n = 118, 33.4%), followed by road accidents (n = 90, 25.5%), assaults (n = 60, 17%) and sports trauma (n = 37, 10.5%). Fifty-five subjects (15.60%) had dental injuries associated with facial fractures. Of the 145 teeth involved, 48 (33.1%) were diagnosed with luxation, 22 teeth (15.2%) were avulsed, 11 teeth (7.5%) suffered a concussion and there were 10 (6.8%) alveolar wall fractures.Uncomplicated enamel-dentin fracture was the more frequent hard tissue injury (n = 21, 14.5%), followed by complicated crown-root fracture (n = 10, 6.9%), infraction (n = 8, 5.5%), enamel fracture (n = 3, 2%) and complicated enamel-dentin fracture (n = 3, 2%). There was a peak in incidence between 21 and 40 years (42%). Males had a significantly higher risk of facial fractures with dental injury (75%). Maxillary incisors and canines (62.8%) were the most affected teeth.

CONCLUSIONS

There was a high prevalence of dental injuries associated with facial fractures. Maxillary incisors were the most injured teeth, with a higher prevalence in males.

Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature

Zygomaticomaxillary complex and isolated orbital walls fractures are one of the most common fractures of the midface, often presenting orbital symptoms and complications. Our study was born with the aim of understanding the trend in the incidence of orbital presurgical symptoms, specifically diplopia, enophthalmos and exophthalmos, in the Campania Region in southern Italy. We conducted a retrospective, monocentric observational study at the Maxillofacial Surgery Unit of the Federico II University Hospital of Naples, enrolling 402 patients who reported a fracture of the zygomaticomaxillary complex and orbital floor region from 15 June 2021 to 15 June 2022. Patients were evaluated by age, gender, etiology, type of fracture, preoperative orbital side effects and symptoms. Pre-surgical side effects were studied, and 16% of patients (n = 66) developed diplopia. Diplopia was most common in patients previously operated on for orbital wall fractures (100%), and least common in patients who reported trauma after interpersonal violence (15%) and road traffic accidents (11%). Exophthalmos appeared only in 1% (six cases); whereas it did not appear in 99% (396 cases). Enophthalmos was present in 4% (sixteen cases), most commonly in interpersonal violence cases (two cases). The frequency of orbital complications in patients with zygomaticomaxillary complex and isolated orbital walls fractures suggests how diplopia remains the most common pre-surgical orbital side effect.

A retrospective epidemiological review of maxillofacial trauma in a tertiary care centre in Goa, India

PURPOSE

Trauma accounts for the leading cause of morbidity and mortality worldwide in the present day and may rightly be called the new pandemic. The prominent nature of the face exposes it to various traumatic injuries. A timely, prompt diagnosis along with employment of correct and quick treatment greatly improves the outcome for these patients. The aim of this retrospective study was to analyse the characteristics of maxillofacial injuries over a decade.

METHODS

The data were collected manually from the medical records of patients who reported to the tertiary centre from 1 January 2011 to 31 December 2019. All injured patients irrespective of age/gender with complete hospital records of clinical and radiographical diagnosis of maxillofacial injuries were included. The demographic data, etiology, site and type of injury, and seasonal variation were analyzed. Data were tabulated into six age groups (0-7 years, 8-18 years, 19-35 years, 36-40 years, 41-59 years, and >60 years). Five etiological factors, i.e. road traffic accidents, falls, assaults, sports-related, and occupational accidents, were further evaluated based on genders. Facial injuries were classified into six types: panfacial fractures, mandibular fractures (subcategorized), midface fractures (subcategorized), dentoalveolar fractures, dental injuries, and soft tissue injuries. The monthly and seasonal variation of the injuries was also charted. Data were expressed as frequency and percent.

RESULTS

A total of 10,703 injuries were included from the tertiary centre from the period of 2011-2019, including 8637 males and 2066 females, with the highest occurrence of the injuries between 19 and 35 years. Road traffic accident was the principal etiological factor of the maxillofacial injuries in both genders (80.5%). This was followed by falls (9.6%), assaults (8.0%), occupational accidents (1.2%), and sporting injuries (0.7%). Midface fractures amounted for 52.5% (5623 fractures), followed by mandibular fractures (38.1%).

CONCLUSION

The current study describes a change in the incidence of injuries along with variation in the demographic data. The implementation of safety gears and stricter traffic laws along with public awareness may aid in the reduction of maxillofacial injuries.

Orbital bone fractures: 10 years' experience at the Rome trauma centre: retrospective analysis of 543 patients

Orbital fractures are among the most frequent facial traumas. This study retrospectively analysed patients treated in Umberto I Hospital Trauma-Centre, Sapienza University of Rome from 1 January 2010 to 31 December 2020. The inclusion criteria were as follows: diagnosis of pure/impure orbital bone fracture, complete clinical and radiological records, and a minimum 12-month follow up. Gender, age, aetiology, fracture type, treatment, and associated complications were analysed using IBM SPSS Statistics, and p values of <0.05 were considered significant. In total, 1393 patients presented with orbital trauma, 543 of whom met the inclusion criteria and underwent surgery (394 males (72.6%) and 149 females (27.4%); mean (range) age 39.2 (7-90) years). Assault (n = 165, 30.4%) was the most common cause of trauma, followed by road traffic accidents and sports-related incidents. Diplopia was the major symptom at diagnosis (n = 183, 33.6%). Open reduction and internal fixation via a sub-eyelid approach was the preferred treatment, achieving a significant reduction in the functional changes induced by fracture (p < 0.05). Our data will aid future studies of maxillofacial traumatology and suggest that education and prevention measures could reduce the incidence of this type of trauma.

Etiology and pattern of maxillofacial trauma

Introduction

Maxillofacial trauma can be limited to superficial lacerations, abrasions, and facial bone fractures. The objective of this study was to determine the etiology, pattern, and predictors of soft tissue and bony injuries.

Materials and methods

This study was conducted in the department of maxillofacial surgery Lady Reading hospital Pakistan from Jan 2019 to June 2021. The nonprobability consecutive sampling technique was used for the selection of patients. All patients were assessed clinically and radiologically. The neurosensory examination was done for any altered sensation, anesthesia, or paresthesia. Motor nerve function was also assessed clinically. Data were analyzed using SPSS version 26. The etiology and pattern of maxillofacial trauma were stratified among age and genders using the chi-square test to see effect modifiers. Tests for regression analysis were also applied. P≤0.05 was considered significant.

Results

A total of 253 patients meeting inclusion criteria were included in this study. The majority of these patients were males, 223 (88.1%), while only 30 (11.9%) were females. The mean age for the group was 25.4 ± 12.6 years. RTAs were the most common causes of trauma (63.6%) followed by assault (15.0%), falls (11.5%), FAIs (5.9%), and sports (0.4%). The most vulnerable skeletal part was the mandible (22.9%) followed by Zygoma (7.1%), significantly predicted by RTAs. Soft tissue laceration analysis showed a high frequency of multiple lacerations (38%) significantly predicted by FAIs. The frequency of trigeminal nerve injury was 5.5% (14 patients) and that of the facial nerve was 1.6% (4 patients). The strongest association of nerve injury was with firearm injury (47%), followed by road traffic accidents and sports injuries.

Conclusion

Road traffic accident was the most common etiological factor and mandible fracture was commonly predicted by RTA. Trigeminal nerve injuries were common, frequency of nerve injuries was highly associated with mandible fracture and was predicted by FAI.

Maxillofacial Fractures in the Province of Terni (Umbria, Italy) in the Last 11 Years: Impact of COVID-19 Pandemic

The main purpose of this retrospective study is to analyze the main causes and the main anatomical structures involved in maxillofacial traumas in the province of Terni, Umbria. From January 2009 to July 2021, 603 patients were admitted with a maxillofacial trauma diagnosis and underwent surgery at “Santa Maria Hospital” in Terni, Italy. The collected data included sex, age, nationality, cause of trauma, type of fractures, comorbidities, clinical signs, symptoms, date of admission, and date of discharge from the hospital. Causes were divided into 5 categories: road traffic accidents, accidental falls, physical assault, sport accidents, and occupational injuries. Men were more involved than women, with a male:female ratio of 325:1. The mean age of the population was 41.7 years. The main cause of trauma were road traffic accidents (36%), followed by accidental falls (27%), an increasing phenomenon during the current SARS-CoV-2 global pandemic. The orbital floor was the most fractured anatomical site, followed by zygoma and nasal bones.

Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases

Systematic assessment of computed tomography (CT) scans and clinical symptoms is necessary to quickly indicate the correct treatment of zygomatico-orbital (ZMO) fractures. For this purpose, a clinical scoring system (=Clinical Score) was developed and correlated with CT scans to analyse its validity. Every operated, isolated, and unilateral ZMO fracture between January 2012 and December 2016 was screened retrospectively, including patient and treatment data. All available CT scans were analysed, and the grade of dislocation was measured for each case and plane. Four hundred and sixty-one cases were included and showed a median surgery time of 66.0 min (5.0−361.0) and a median postoperative hospital stay of three days (0−25). The distribution of gender, aetiologies and age groups was significantly different (each p = 0.001), and the aetiology had a significant influence on the Clinical Score (p = 0.038). The degree of dislocation in the coronary and sagittal planes correlated significantly with the Clinical Score with regard to the orbital involvement (p < 0.001, ρ = 0.566; p < 0.001, ρ = 0.609). The simple, quick, and easy-to-apply Clinical Score showed a significant correlation with the most important planes in CT scans as well as with the clinical course. It may facilitate fast risk stratification of the patient. However, the validity of the proposed score in determining indications must now be evaluated in a prospective setting, including both operated and non-operated fractures.

Impact of COVID-19 lockdown on incidence of maxillofacial fractures: A retrospective analysis

COVID-19 lockdown restrictions greatly influenced people's behaviour and movements, and therefore patient presentation may differ in maxillofacial trauma surgery during lockdown. The aim of this study is to evaluate the impact of a lockdown on the incidence, types and mechanisms of injury of maxillofacial fractures. In this single-centre retrospective cohort study patients who visited the maxillofacial surgeon after traumatic injury between 15 March and 1 June in the years 2018, 2019, 2020 and 2021 were included. The primary outcome is the incidence of maxillofacial fractures during the lockdown in 2020 compared to the pre-lockdown and post-lockdown periods. Secondary outcomes are type of fracture and mechanism of injury. A total of 130 patients with maxillofacial fractures were identified. During the lockdown 0.51 (95% CI 0.32–0.84) times less maxillofacial fractures were reported. A significant association was found between mechanism of injury and lockdown compared to the post-lockdown period. No further associations were found between a lockdown and type of fracture or mechanism of injury. In conclusion, the incidence of maxillofacial fractures was significantly lower compared to equivalent time periods in other years, but recovered after lockdown.

Facial fractures in post-revolution Tunisia as violence indicator: About 476 cases

INTRODUCTION

On January 2011, Tunisia had known a revolution. To move from dictatorship to democraty project, the country suddenly fell into political instability, which was accompanied by a wave of social violence. Traumatology, and, particularly, maxilla-facial traumatology, is usually a reliable indicator of the degree of violence.

AIM

The aim of this study was to establish the epidemiological profile of facial fractures during the various phases of political transition through which Tunisia has passed since revolution (2012-2016).

PATIENTS AND METHODS

A retrospective cross-sectional study was conducted among all patients with facial fractures admitted to the department of Oral and Maxillo facial Surgery of University Hospital of Sahloul during five years (2012-2016). Fractures diagnosed late at the sequelae stage were excluded. Data of patients were recorded according to medical files, including cause of injury, age and gender, injury mechanisms and type of facial fracture.

RESULTS

During the period of the study, a total of 476 patients were identified, with a sex-ratio of 7.2 to 1, patients ranged in age from 1 year to 76-years-old with a mean age of 27 years. Assaults were the most common cause of injury (39.1%). Mandible was fractured in 257 cases (54.2%) followed by zygoma (116 cases, 24.4%), nasal bone (99 cases, 20.8%) and Orbital walls (98 cases, 20.6%).

DISCUSSION

The epidemiological profile of facial fractures in Tunisia has been changed since 2011. Facial fractures occur mainly after assaults, which are an indicator of increased social violence accompanying political instability present in our country.

A new aesthetic pretrichial approach for upper third-facial fractures and pathologies: The "Crown incision"

BACKGROUND

The coronal incision represents the cornerstone for the treatment of upper-third maxillofacial pathologies. However, this approach leaves long scars that in numerous patients, it can cause extensive surrounding alopecia and sensory skin deficits. This clinical evidence prompted the authors to propose a full pretrichial incision, the crown incision, in order to overcome these drawbacks.

METHODS

A retrospective study was performed to investigate and report the aesthetic and functional outcomes of 15 patients treated with this new approach.

RESULTS

In the postoperative period, no major or minor complications were detected. The aesthetic evaluation of the scar by the operator and the patient showed overlapping results. The overall rating was 2.93 for the patient and 2.87 for the surgeon, on a scale from 0 (as normal skin) to 10 (very different from normal skin). The recovery of sensitivity in the innervation territories of the supratrochlear and supraorbital nerves was found to be complete in 14 patients. In one case, the sharp/blunt discriminative sensitivity was absent in all three points assessed.

CONCLUSIONS

This study showed the crown incision to be a safe approach with an optimal recovery of scalp sensitivity and excellent aesthetic results even in bald patients. Therefore, it can be considered a valid aesthetic and effective alternative to the classic coronal approach and should form part of the craniomaxillofacial surgical armamentarium.

Evaluation of Panfacial Fractures in a German Supraregional Trauma Center between 2015 and 2017 - A Retrospective Study

Introduction:

Panfacial fractures represent the most severe injuries to the face. The combination of these fractures determines the treatment strategy. This study aims to retrospectively review the data of adult patients treated for complex facial skull fractures in a hospital in Dortmund, Germany from 2015-2017.

Materials and Methods:

We extracted related patient data from the hospital electronic repository and reviewed the patient files and radiological images. The fractures were classified based on the AO-Classification. The statistical analysis was performed by descriptive statistical methods. The main goal was to determine the most common fracture combinations.

Results:

A total of 188 patients with panfacial fractures were identified (181 adults, 7 children and adolescents). The gender and age distribution corresponded to the international literature (male-to-female ratio: 3.1:1, most common injuries among young men). 2–9 fracture sites were identified per patient, resulting in a fracture frequency of 3.13 per patient. 69 different fracture combinations have been identified. The most common ones were combinations of lateral and central mid-face fractures, and combinations of nasal bone fractures with lateral midface fractures or nasal bone fractures combined with mandibular fractures. Between 1 and 13 osteosynthesis implants per patient were used for osteosynthesis; the most commonly used plates were 2.0 mm and 1.5 mm straight plates. The average inpatient stay was 3 days (standard deviation [SD] = 3.0 days), and the average operation time (incision to suture) was 39.5 min (SD = 53.5 min).

Discussion:

Panfacial fractures are the most complex maxillofacial injuries. The complication rate in this study (4.5%) is below the international data. The treatment of panfacial fractures requires designated centers with experienced teams and good interdisciplinary cooperation.

Protective Effects of Helmet Type on Facial Injuries

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.

Mandibular Fractures Epidemiology and Treatment Plans in the Center of Italy: A Retrospective Study

ABSTRACT

The epidemiology of maxillofacial fractures is variable in different geographic regions. Economic and social conditions, laws and types of behavior can be considered the most important factors influencing these differences.Mandibular fractures were first cited in 1650 BC in an Egyptian papyrus. Today, these fractures are one of the most prevalent facial skeletal injuries.A 4-year retrospective study was performed and the trauma - related data were collected from medical and radiological archives. The analysis comprised patients admitted for mandibular fracture at Sapienza University of Rome - Policlinico Umberto I between January 1, 2016 and December 31, 2019. The data include age, sex, etiology, anatomical sites of the fractures, eventual maxillofacial associated fractures and treatment.We collected 172 patients, 138 males (80.2%) and 34 females (19.8%) with 270 mandibular fractures. The average age was 35.4 years. The youngest and oldest patients were aged 6 and 90 years, respectively. The age group 20 to 29 years was the most represented with 52 patients (30.2% of the total sample). Assaults were the most common etiology (n = 53, 30.8%), followed by falls (n = 45, 26.2%). The condyle was the most involved region (n = 86, 32%), followed by parasymphysis region (n = 72, 26.6%) and angle (n = 62, 23%).154 patients (89.5%) reported only mandibular fractures. Eighteen patients (10.5%) had other associated maxillofacial fractures; the most frequently encountered maxillofacial fractures associated with mandibular fractures were the zygomatic complex fractures (n = 9, 5.2%). Open reduction and internal fixation was the most preferred surgical treatment (n = 115, 66.9%).This study showed that mandibular fractures predominate in 20 to 29 years group and in the male sex. Assaults are the most frequent cause. The prevalent fracturing site is condylar process. Orbital - maxillary - zygomatic complex fractures were the most common associated maxillofacial fractures and open reduction and internal fixation was the preferred surgical strategy.The results of this analysis agree to other studies and provide important clinical information that will help in study of these injuries.

The role of prosthetic, orthodontic and implant-supported rehabilitation in the management of secondary malocclusion to maxillofacial trauma- A systematic review

PURPOSE

Different approaches have been proposed to treat malocclusion secondary to the treatment of maxillofacial trauma. This study aimed to investigate the efficacy of prosthodontic treatment, orthodontic treatment, and implant-supported rehabilitation for the management of secondary malocclusion after maxillofacial trauma.

STUDY SELECTION

We searched five electronic databases and hand searched eight journals. The types of studies included were randomized controlled trials, cohorts, case-controls, and case series with at least eight patients with maxillofacial trauma and postoperative malocclusion. These studies used prosthetic treatment and implant-supported rehabilitation for secondary malocclusion after maxillofacial trauma. Risk of bias of eligible studies to be included in the final analysis was assessed independently by two authors using a tool for methodological quality assessment and synthesis of case series and case reports.

RESULTS

After initial screening and identification of titles and abstracts, full text of 44 articles were found and evaluated against inclusion criteria. Of these 42 articles were excluded and remaining two were included in the review. Both the studies were case series with moderate to high risk of bias.

CONCLUSIONS

Both prosthetic treatment and implant-supported rehabilitation have the potential to restore secondary malocclusion after maxillofacial trauma. However, because less number of well-designed studies with high risk of bias were included in this systematic review, the findings should be interpreted with caution. Well-designed high-quality studies are required to draw definitive conclusions.

The Epidemiology and Management of Maxillofacial Fractures at a Tertiary Care Hospital in a Conflict-Torn Region in Somalia

The etiology of maxillofacial fractures (MFFs) varies according to the geographical location and density of the population. This study aimed to analyze the etiology, pattern, and treatment of MFFs. Epidemiological characteristics and treatment modalities of MFFs have never been evaluated in Somalia. The study included 45 patients who were operated on for MFFs at a tertiary care hospital in Somalia (2018-2019). Patient demographics, fracture causes, types, associated non-facial injuries, treatment modalities, and hospitalization-time were evaluated. The most common etiological factors of the MFFs were explosion (24.4%) and assault (24.4%), followed by gunshot (22.2%), sports accident (15.6%), motor vehicle accident (11.1%), and fall from height (2.2%) patients, respectively. The main site of injury was the mandible bone (64.4%) followed by nasal bone, maxilla, zygomatic, and orbital region. The most common non-facial injuries of the MFFs were soft tissue laceration (37.8%) followed by femoral fracture (6.7%), clavicle fracture (4.4%), and femoral fracture with chest injuries (2.2%). The most applied treatment was open reduction microplate +/- intermaxillary fixation (77.8%). Due to the size of the mandible fractures, an iliac autograft (6.7%) was performed. The mean length of the hospital stay was 11.8 +/- 8.4 days (range, 1-45 days), and some patients (15.6%) needed intensive care due to severe injuries. This will be the first study aiming to analyze the etiology, pattern, and treatment of MFFs in Somalia. This study deals with the social aspects of Somalia, and it shows that MFFs develop as a result of highly interpersonal violence in a young man.

Mandible Fractures Associated With the Introduction of an E-Scooter-Sharing System

ABSTRACT

With the introduction of an e-scooter-sharing system in Germany, standing electric scooters became popular modes of transportation in many urban areas. But the increase in popularity has resulted in an increase in traumatic injuries associated with e-scooter accidents. The purpose of this investigation was to determine the common fracture pattern of patients with mandible fractures as a result of an electric scooter accident. The authors performed a retrospective investigation of 52 patients who were admitted to the trauma unit of an oral and maxillofacial department from June until November 2019 with a fracture of the mandible. Our study investigated the first 6 months of e-scooter sharing system in a major city with more than 1 million inhabitants. Our cohort consists of 52 patients, 38 males, and 14 females with a mean age of 37 years. E-scooter related mandible fractures were with 21% the third biggest group, after physical assault and falls. 45% of these patients were intoxicated by alcohol. Furthermore, the majority of e-scooter patients presented more than one fracture of the mandible (73%). For our cohort, a typical combination of a symphysis or body fracture and bilateral affected ramus and/or condyle was the prevalent recorded fracture combination (55%) of e-scooter related traumata. Small scooter wheels, a speed of 15 miles or 20 kilometers per hour and the individual clinging to the handlebar falling predestinate these vehicles for accidents with craniofacial trauma. Among all cranio-facial traumas mandible fractures were mostly documented for e-scooter accidents. The severity of e-scooter related mandible fractures and their fracture pattern should be recognized by trauma units.

Influence of SARS-CoV-2 lockdown on the incidence of facial trauma in a tertiary care hospital in Rome, Italy

BACKGROUND

Italy has been the first affected country in the western hemisphere by SARS-CoV-2 with over 200,000 cases during the first months of the pandemics. To control the spread of the virus, the whole country was placed under lockdown with limitations in the circulation of people and vehicles from March 2020 to the first half of the month of May.

METHODS

We aimed to analyze the incidence and type of facial traumas referred to our tertiary care hospital during the months of Italy lockdown due to SARS-CoV-2 spread compared with those during the same months of 2019 to determine eventual variations in the incidence, type and causes of trauma.

RESULTS

During the 2 months of COVID-19-related lockdown, a dramatic decrease in facial trauma patients was observed at our tertiary care hospital with a shift toward older age ranges. Regarding the causes of trauma, the largest percentage reduction was found in road, sports and work accidents; this percentage reduction was not found in aggressions.

CONCLUSIONS

A small increase in the percentage was also found regarding surgical indications, likely because more severe cases were more prone to be referred to the hospital despite the fear of being infected.

Have There Been any Changes in the Epidemiology and Etiology of Maxillofacial Trauma During the COVID-19 Pandemic? An Italian Multicenter Study

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on people's behavior. The aim of this study has been to evaluate how the SARS-CoV-2 pandemic has impacted the incidence and the features of maxillofacial fractures presented at 6 Italian tertiary centers. Clinical records of all the patients diagnosed for facial fractures between February 23 and May 23, 2019 and 2020 were retrospectively reviewed. Any differences in patient number and characteristics and fracture etiology and site between the 2 groups were then statistically analyzed.

There has been a 69.1% decrease in the number of incoming patients during the pandemic. The number of foreign patients has decreased significantly (23.3% versus 9.6%, P = 0.011) while the average age has increased (38.6 versus 45.6 years old, P = 0.01). Specific statistical significant differences for accidental falls (31.8% versus 50.1%, P = 0.005) and sports injuries (16.9% versus 1.4%, P < 0.001) were found. Concerning fracture sites, significant differences have been found in relation to nasal (22.5% versus 11.4%, P = 0.009) and frontal sinus (0.9% versus 4.4%, P = 0.037) fractures. In conclusion, SARS-CoV-2 pandemic has significantly changed the epidemiology and the etiology of facial traumas.

Neuroinflammation Mediated by Glia Maturation Factor Exacerbates Neuronal Injury in an in vitro Model of Traumatic Brain Injury

Traumatic brain injury (TBI) is the primary cause of death and disability affecting over 10 million people in the industrialized world. TBI causes a wide spectrum of secondary molecular and cellular complications in the brain. However, the pathological events are still not yet fully understood. Previously, we have shown that the glia maturation factor (GMF) is a mediator of neuroinflammation in neurodegenerative diseases. To identify the potential molecular pathways accompanying TBI, we used an in vitro cell culture model of TBI. A standardized injury was induced by scalpel cut through a mixed primary cell culture of astrocytes, microglia and neurons obtained from both wild type (WT) and GMF-deficient (GMF-KO) mice. Cell culture medium and whole-cell lysates were collected at 24, 48, and 72 h after the scalpel cuts injury and probed for oxidative stress using immunofluorescence analysis. Results showed that oxidative stress markers such as glutathione and glutathione peroxidase were significantly reduced, while release of cytosolic enzyme lactate dehydrogenase along with nitric oxide and prostaglandin E2 were significantly increased in injured WT cells compared with injured GMF-KO cells. In addition, injured WT cells showed increased levels of oxidation product 4-hydroxynonenal and 8-oxo-2'-deoxyguanosine compared with injured GMF-KO cells. Further, we found that injured WT cells showed a significantly increased expression of glial fibrillary acidic protein, ionized calcium binding adaptor molecule 1, and phosphorylated ezrin/radixin/moesin proteins, and reduced microtubule associated protein expression compared with injured GMF-KO cells after injury. Collectively, our results demonstrate that GMF exacerbates the oxidative stress-mediated neuroinflammation that could be brought about by TBI-induced astroglial activation.

Treatment of Facial Fractures at a Level 1 Trauma Center: Do Medicaid and Non-Medicaid Enrollees Receive the Same Care?

BACKGROUND

Timing of surgical treatment of facial fractures may vary with the patient age, injury type, and presence of polytrauma. Previous studies using national data sets have suggested that trauma patients with government insurance experience fewer operations, longer length of hospital stay (LOS), and worse outcomes compared with privately insured patients. The objective of this study is to compare treatment of facial fractures in patients with and without Medicaid insurance (excluding Medicare).

METHODS

All adults with mandibular, orbital, and midface fractures at a Level 1 Trauma Center between 2009 and 2018 were included. Statistical analyses were performed to assess the differences in the frequency of surgery, time to surgery (TTS), LOS, and mortality based on insurance type.

RESULTS

The sample included 1541 patients with facial fractures (mandible, midface, orbital), of whom 78.8% were male, and 13.1% (208) were enrolled in Medicaid. Mechanism of injury was predominantly assault for Medicaid enrollees and falls or motor vehicle accidents for non-Medicaid enrollees (P < 0.001). Patients with mandible and midface fractures underwent similar rates of surgical repair. Medicaid enrollees with orbital fractures underwent less frequent surgery for facial fractures (24.8% versus 34.7%, P = 0.0443) and had higher rates of alcohol and drug intoxication compared with non-Medicaid enrollees (42.8% versus 31.6%, P = 0.008). TTS, LOS, and mortality were similar in both groups with facial fractures.

CONCLUSIONS

Overall, the treatment of facial fractures was similar regardless of the insurance type, but Medicaid enrollees with orbital fractures experienced less frequent surgery for facial fractures. Further studies are needed to identify specific socioeconomic and geographic factors contributing to these disparities in care.

Histological assessment of the effects of teriparatide therapy on mandibular fracture healing: A preclinical study

OBJECTIVE

This study was performed to evaluate the effects of teriparatide therapy on mandibular fracture healing in a rat model.

SUBJECTS AND METHODS

A unilateral mandibular fracture, 5 mm posterior to the last molar tooth, was surgically created in 120 rats. Half of the animals received a daily subcutaneous injection of 2 μg/kg teriparatide while the control rats received normal saline, starting from the day of surgery until sacrifice. Twenty rats from each group were sacrificed on postoperative days 10, 20, and 30. The healing process was evaluated histologically and scored using a grading system (ranging from 1 to 10).

RESULTS

On day 10 the fracture gaps of the control and teriparatide groups were mainly filled with fibrous tissue and new trabecular bone, respectively. On day 20 a large amount of new trabecular bone and some areas of fibrocartilaginous tissue were seen in the fracture gaps of the control rats. In the teriparatide group the fracture area was entirely filled with trabecular bone, which in some areas had been replaced by mature bone. On day 30 the fracture gaps of the control group were entirely bridged by new trabecular bone, while in the teriparatide group they was predominantly filled with mature bone. At all three time-points the mean healing scores for the teriparatide group (6.20 ± 0.70, 8.50 ± 0.69, and 9.85 ± 0.37, respectively) were significantly higher (p < 0.001) than for the control group (4.90 ± 0.55, 7.15 ± 0.59, and 8.90 ± 0.64, respectively).

CONCLUSION

Based on the results of this study, teriparatide should be tested in humans in order to establish whether comparable results can be achieved.

Analysis of the effect of repair materials for orbital blowout fracture on complications

AIM

To investigate the effect of repair materials for orbital blowout fractures on the occurrence of postoperative complications.

METHODS

The clinical data and follow-up data of 54 subjects with orbital blowout fractures were retrospectively analyzed. The study was divided into three groups according to the used repair materials: titanium mesh (16 cases), Medpor (12 cases), and Medpor titanium mesh (26 cases). All test data were analyzed using the SPSS version 23.0 statistical software. The mean age and duration of disease between the groups were compared through one-way analysis of variance. The Chi-square (χ ²) test was used to compare the number of males and females, different fracture types, and different surgical approaches among groups. The χ ² test was used to compare the frequencies for complications in each group.

RESULTS

The baseline characteristics of age and gender in each group were matched (F=1.763, P=0.172; χ ²=0.026, P=0.987). In addition, there was no difference in the type of fracture and surgical approach (χ ²=0.460, P=0.977; χ ²=0.691, P=0.952), or the incidence of complications (χ ²=0.081, P=0.960) between the three groups.

CONCLUSION

Although there is no difference in effect of various repair materials on the incidence of complications, the effect of repair materials on postoperative complications of orbital blowout fractures should not be ignored.

Epidemiological Study of the Socioeconomic Impact of Mandible Fractures in a Spanish Tertiary Hospital: Review of the Literature

Introduction

Mandibles fractures are one of the most frequent pathologies treated in an Oral and Maxillofacial Department and represent a serious public health problem.

Materials and Methods

We present a retrospective study of patients treated for mandible fractures by the Oral and Maxillofacial Surgery Department in a Spanish tertiary hospital during 2010-2012.

Results

One hundred and thirty-nine patients with 201 mandible fracture sites were assisted in our department; 15% were female and 85% were male, with a male-to-female ratio of 5.5:1. The observed mean age was 35 years with a range between 15 and 89 years. The most frequent etiology of fractures was the assault (43%) followed by falls (32%). The most common fracture site was the mandibular angle (35%), followed by the parasymphysis (30%). Concerning combined fractures (60%), the most repeated association was the angle and the parasymphysis. The principal imaging test for diagnosis was the orthopantomography. The intermaxillary fixation was performed in the 25% of cases, and the rest of mandible fractures were fixed by osteosynthesis. The surgical treatment had an average of 4.2 days after the trauma, and the mean time of hospitalization was 6.5 days.

Conclusion

The principal aim of the treatment of mandible fractures is to restore the function of the patient occlusion. A malocclusion after surgery may decrease the patient quality of life, so a correct fracture reduction could shrink health spending. After the result shown in the present study, the social education should be improved in the developed countries with the objective of decline in the amount of aggressiveness.

Traffic accidents, maxillofacial injuries and risk factors: A systematic review of observational studies

AIM

This study aimed to evaluate the scientific evidence regarding the risk factors for maxillofacial injuries among victims of traffic accidents.

METHOD

A systematic review of articles published until February 2017 was carried out in the following databases: PubMed, Web of Science, Scopus, and Cochrane Library. Studies were selected by two independent reviewers (ϰ = 0.841). The risk of bias in the selected studies was assessed using an adapted version of the Newcastle-Ottawa Scale for observational studies.

RESULTS

A total of 2703 records were found, of which only three articles fulfilled the inclusion criteria and were analyzed, including 422 244 patients. The male/female ratio ranged from 3.4: 1 to 6: 1. All eligible studies performed the multivariate statistical analysis. Eleven risk factors for maxillofacial traumas were identified: victim's gender (P < 0.05), age group (P < 0.05), residence region (P < 0.05), impact characteristics (P < 0.05), increased net change in velocity due to collision (P < 0.05), increase in occupant's height (P < 0.05), nonuse of protective equipment (P < 0.05), type of accident (P < 0.05), time of occurrence (P < 0.05), lesion severity (P < 0.05), and occurrence of concomitant lesions (P < 0.05).

CONCLUSION

The results suggest that sociodemographic characteristics, as well as those related to the collision patterns and circumstances of traffic accidents, may influence the occurrence of maxillofacial injuries. However, the results should be interpreted with caution due to the high heterogeneity among studies.

The Influence of Socioeconomic Factors on the Epidemiology of Maxillofacial Fractures in Southern Italy

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.

Maxillofacial Fracture Patterns in Road Traffic Accidents

Objective:

The objective of this study is to analyze the maxillofacial fracture pattern from road traffic accidents (RTAs) in cases treated surgically in a tertiary hospital during July 2008–June 2018.

Materials and Method:

Data available in the department of oral and maxillofacial surgery of the institution of patients with maxillofacial fractures sustained due to RTAs that were treated in the department between the period July 2008 and June 2018 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation.

Results:

A total of 348 patients with maxillofacial fractures were diagnosed, of which 335 were male and 13 were female. The ages ranged from 7 to 70 years. The maximum cases were in the age group of 16–30 years with 181 fractures followed by 31–45 group with 133 fractures, 45–60 years with 21 fractures, 0–15 years with 8 fractures, and >60 years with five fractures. The maximum incidence of fractures was in the mandible with 168 cases followed by 92 in zygomatic complex, combination of fractures in 53 cases, 13 LeFort I fractures, nine frontal bone fractures, three fractures in other areas, five nasal fractures, and five LeFort II fractures. Males predominated the cases of mandibular fractures involving multiple sites and cases involving multiple bones.

Conclusion:

A maximum number of maxillofacial fractures cases were in the second and third decades of life, and the high-speed vehicles and lack of protective safety accessories such as helmets and seatbelts were responsible for the wide variety of pattern fractures of facial bones.