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Amin D, Marwan H, Rowan B, Abramowicz S, Zaid W. The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region. J Craniofac Surg 2023; 34:2317-2320. [PMID: 37665070 DOI: 10.1097/scs.0000000000009699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. MATERIALS AND METHODS This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. RESULTS Eight patients (mean age 55.8 y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9 cm 2 (range 17-85 cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90 d). CONCLUSION Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.
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Affiliation(s)
- Dina Amin
- Associate Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, NY
| | - Hisham Marwan
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Brian Rowan
- Department of Oral and Maxillofacial Surgery, School of Dentistry Louisiana State University Health Science Center, New Orleans, LA
| | - Shelly Abramowicz
- Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Waleed Zaid
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA
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Wu Y, Hua Z, Xiang Y, Zhu S, Chen W, Wei P. Evaluation of Facial Trauma Scars After Treating by Refining Plastic Surgery Techniques: A Follow-Up Study. J Craniofac Surg 2023; 34:e376-e380. [PMID: 36944605 PMCID: PMC10205111 DOI: 10.1097/scs.0000000000009298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/27/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Although early debridement and refining plastic surgery techniques have been shown to be effective in the treatment of facial scars after trauma, their postoperative outcomes have not been quantitatively evaluated by the relevant Scar Cosmesis Assessment and Rating (SCAR) Scale. This study was designed to provide a fair assessment of the appearance and local symptoms of scars after treatment by refining plastic surgery techniques and to share the operational skills of surgical repairs. PATIENTS AND METHODS Patients who received refining plastic surgery techniques were followed up, and facial scars were taken as high-definition photos, which were presented to 6 professional observers, 6 lay observers, and patients themselves to score the facial scars, including: scar spread, erythema, dyspigmentation, track marks or suture marks, hypertrophy/atrophy, itch and pain according to the SCAR. RESULTS There were 56 patients who met the inclusion criteria and 25 agreed to participate in the study. No hypertrophic scar was found, and all patients were satisfied with the scar control effect. The scores showed that the treatment was achieved good results in scar spread (pro group: 0.85±0.55, lay group: 0.96±0.68, patients: 0.92±0.64), erythema (pro group: 0.34±0.26, lay group: 0.45±0.37, patients: 0.32±0.48), hypertrophy/atrophy (pro group: 0.21±0.27, lay group: 0.21±0.31, patients: 0.32±0.48), and there was no significant difference in the scores of the 3 observation groups ( P >0.05). However, it is difficult to eliminate dyspigmentation (pro group: 0.29±0.26, lay group: 0.30±0.30, patients: 0.40±0.50), track marks or suture marks (pro group: 0.45±0.33, lay group: 0.59±0.30, patients: 0.36±0.49). Two (8%) patients complained of itch and 1 (4%) patient complained of both itch and pain in the past 24 hours. CONCLUSIONS The appearance of facial scars is satisfactory, the local symptoms are mild, and the evaluation among different aesthetics is affirmative after receiving refining plastic surgery techniques, which is just in line with the purpose of seeking beauty for the patients, and meanwhile can provide a good foundation for the comprehensive treatment of late scars, so that the treatment plan should be promoted.
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Zimmerman ZA, Sidle DM. Soft Tissue Injuries Including Auricular Hematoma Management. Facial Plast Surg Clin North Am 2021; 30:15-22. [PMID: 34809883 DOI: 10.1016/j.fsc.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Facial trauma accounts of 7% to 10% of emergency department visits in the United States every year. The management of facial soft tissue trauma is an essential skill for the facial plastic surgeon. Understanding preoperative evaluation, repair/management of concomitant injuries, postoperative care, and scar treatment help the facial plastic surgeon obtain the best functional and aesthetic results for the patient. Treating the face by subunit and avoiding common pitfalls is the key to achieving optimal results. This article can serve as a basis for surgical pearls and considerations when evaluating and repairing facial soft tissue trauma.
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Affiliation(s)
- Zachary A Zimmerman
- Northwestern-Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, 675 North St Clair Street, Suite 15-200, Chicago, IL 60611, USA.
| | - Douglas M Sidle
- Northwestern-Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, 675 North St Clair Street, Suite 15-200, Chicago, IL 60611, USA
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Ko AC, Satterfield KR, Korn BS, Kikkawa DO. Eyelid and Periorbital Soft Tissue Trauma. Oral Maxillofac Surg Clin North Am 2021; 33:317-328. [PMID: 34210399 DOI: 10.1016/j.coms.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Facial trauma often involves injuries to the eyelid and periorbital region. Management of these injuries can be challenging due to the involvement of multiple complex anatomic structures that are in close proximity. Restoration of normal anatomic relationships of the eyelids and periocular structures is essential for optimum functional and aesthetic outcome after trauma. This review provides an overview of the current literature involving soft tissue trauma of the eyelid and periorbital tissue, and highlights key steps in patient evaluation and management with various types of injuries.
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Affiliation(s)
- Audrey C Ko
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA
| | - Kellie R Satterfield
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA; Division of Plastic Surgery, UC San Diego Department of Surgery, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA; Division of Plastic Surgery, UC San Diego Department of Surgery, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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Evaluation of Polyethylene Surgical Drape as an Alternative Wound Dressing Material, Compared to Banana Leaf ( Musa paradisiaca) Dressing in Facial Abrasions. J Maxillofac Oral Surg 2020; 19:539-545. [PMID: 33071502 DOI: 10.1007/s12663-019-01256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/22/2019] [Indexed: 10/26/2022] Open
Abstract
Background and Objectives Facial abrasions, the most common squeal of trauma, have been treated widely by moist occlusive dressings. This novel study aims to evaluate polyethylene surgical drape dressing (PESG) as an alternative to autoclaved banana leaf (Musa paradisiaca) dressing in facial abrasions. Study Design Sixty patients who reported to our emergency department, having abrasions over head, neck and face region secondary to trauma, were included. Thirty patients were given PESG, and 30 were given banana leaf dressings. Dressings were changed daily for 7 days. Pain on dressing change, status of wound bed on every dressing change, handling characteristics of each dressing material and comfort to the patient were assessed. Results Analysis revealed that the properties of PESG dressings are parallel to banana leaf dressing in all aspects except pain on dressing change. PESG caused no pain during dressing change which was statistically significant (p < 0.011). Conclusion Facial abrasions can be effectively treated by PESG dressing. It is easily available in any hospital setting, has an ideal surface, i.e. impervious and smooth. It also maintains a moist condition, is completely painless and inexpensive. Hence, it can become a new standard for treating facial abrasions especially to poor patients in developing countries.
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Stirrup A, Cartwright B, Corsar K. Is this the end of the Oral and Maxillofacial Toolbox? A retrospective analysis of funding for acute OMFS soft tissue trauma provision within the UK. Br J Oral Maxillofac Surg 2020; 58:e133-e134. [PMID: 32636094 PMCID: PMC7334941 DOI: 10.1016/j.bjoms.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/05/2022]
Affiliation(s)
- A Stirrup
- OMFS Department, The Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Aberford Road, Wakefield, WF1 4DG.
| | - B Cartwright
- OMFS Department, The Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Aberford Road, Wakefield, WF1 4DG.
| | - K Corsar
- OMFS Department, The Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Aberford Road, Wakefield, WF1 4DG.
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Momesso GAC, Polo TOB, Cervantes LCC, Lima VND, Silva WPPD, Souza FÁ, Garcia-Júnior IR, Faverani LP. Importance of Oral and Maxillofacial Surgeons in the Emergency Attendance: Report of an Extensive Facial Cut-Blunt Injury. J Craniofac Surg 2019; 30:1614-1615. [PMID: 31299785 DOI: 10.1097/scs.0000000000005509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gustavo Antonio Correa Momesso
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, University Estadual Paulista (UNESP), Araçatuba, Brazil
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Agbara R, Obiechina AE, Ajike SO, Adeola DS. Pattern of maxillofacial injuries in patients with craniocerebral injuries: a prospective study. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: This prospective study highlights the pattern of oral and maxillofacial injuries in patients with associated craniocerebral injuries. Material and Methods: This was a prospective descriptive study conducted over a 22-month period. Information was collected using a structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) Version 13 (SPSS Inc., Chicago, IL, USA) and Microsoft Office Excel 2007 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05. Results: Three hundred and three consecutive patients were studied and this consisted of 254 males and 49 females. The difference in the gender distribution was statistically significant (p = 0.008). Road traffic crashes (n = 262; 86.5%) was the most common cause of injury and soft tissues orofacial injuries accounted for 61.7% of injuries. Le Fort II fractures were the major skeletal injuries. Glasgow Coma Score (GCS) of 13–15 had the highest frequency (n = 157; 53.4%). Intracerebral haemorrhage was the most common cerebral injury recorded and the commonest complication noted was dysocclusion. Discussion: Although middle third facial fractures were the most common skeletal injury, fractures of the upper third facial skeleton appear to be associated with lower GCS. Conclusion: Fractures of the facial skeleton are fairly common in craniocerebral injuries.
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Yamamoto R, Homma K, Masuzawa Y, Shimizu C, Ogata T, Hori S, Sasaki J. Early Complications Following Facial Laceration Repair Performed by Emergency Physicians After One Year of Wound Closure Training. AEM EDUCATION AND TRAINING 2018; 2:259-268. [PMID: 30386835 PMCID: PMC6194042 DOI: 10.1002/aet2.10115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/07/2018] [Accepted: 06/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Facial lacerations, which are common in the emergency department, have usually been repaired by non-facial trauma specialists, such as emergency physicians. Given the ongoing discussion regarding quality assurance or the optimal training model on facial laceration repair for nonspecialists, we sought to determine the impact of a 1-year wound closure training provided to emergency physicians. We hypothesized a decrease in early complications following facial wound closure after the training. METHODS A retrospective observational study was conducted between 2013 and 2015 at an academic center. We included patients with isolated facial lacerations that were repaired by emergency physicians and reviewed by board-certified plastic surgeons during a follow-up visit. Patients whose wounds were not reviewed within 3 days were excluded. The 1-year training curriculum, which consisted of several sessions of lecture, hands-on practice, and case review, had been developed by a multidisciplinary team and provided to emergency physicians. Patient data were divided between nonparticipant and participant groups, and a propensity score was developed to estimate the probability of being assigned to the participant group. The incidence of early complications, defined as the need for additional suturing or resuturing due to wound dehiscence, was compared among the groups after propensity score matching. RESULTS Although 132 patients satisfied all the inclusion criteria, 11 were excluded due to delayed initial wound review. Among the 70 patients who were eventually included in the participant group, 40 were matched with those in the nonparticipant group. The incidence of early complications was significantly lower in the participant group than in the nonparticipant group (5.0% vs. 20.0%, odds ratio = 0.21, 95% confidence interval = 0.07-0.61, p = 0.04). CONCLUSIONS The 1-year training provided to emergency physicians reduced the incidence of early complications following facial laceration repair. Accordingly, future wound closure training models should consider the 1-year training curriculum presented herein.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care MedicineKeio University School of MedicineTokyoJapan
| | - Koichiro Homma
- Department of Emergency and Critical Care MedicineKeio University School of MedicineTokyoJapan
| | - Yuya Masuzawa
- Department of Emergency and Critical Care MedicineKeio University School of MedicineTokyoJapan
| | - Chikako Shimizu
- Department of Emergency and Critical Care MedicineKeio University School of MedicineTokyoJapan
| | - Toshio Ogata
- Department of Plastic and Reconstructive SurgeryKeio University School of MedicineTokyoJapan
| | - Shingo Hori
- Department of Emergency and Critical Care MedicineKeio University School of MedicineTokyoJapan
| | - Junichi Sasaki
- Department of Emergency and Critical Care MedicineKeio University School of MedicineTokyoJapan
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Min JH, You YH, Cho YC, Jeong WJ, Park JS, Oh SK, Cho SU, In YN, Kwack CH, Yoo IS. Comparison of cosmetic appearances after facial lacerations repaired by junior residents and experts. Am J Emerg Med 2018; 37:817-822. [PMID: 30057072 DOI: 10.1016/j.ajem.2018.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The technical factors which improve cosmetic outcomes and which need to be emphasized in education of junior residents have yet to be described. We compared cases in which suturing was performed by either junior emergency medicine residents or experts, in order to determine the focus of future education and training. METHODS Wound registry data was reviewed and retrospectively analyzed from September 2015 to February 2016. Only patients who visited the emergency room with facial lacerations were enrolled, and their wound registry data sheets were reviewed. Practitioners were divided into junior resident and expert groups. We assessed the progress using the Stony Brook Scar Evaluation Scale (SBSES) 5-10 days following suturing. RESULTS Sixty-six patients were enrolled; 43 (65.2%) were men. The median (interquartile range) cosmetic scores (SBSES scale) for suturing performed by junior residents or experts were 3 (2-4) and 5 (4-5), respectively (p = 0.001). The percentage of maximum scores for each SBSES category was significantly lower in the junior resident group than in the expert group for width (68% vs. 86%), hatch marks (68% vs. 93%), and overall appearance (41% vs. 80%) (all p < 0.001). CONCLUSIONS There were significant differences in scar widths and hatch marks, which were attributable to the skill level of the practitioner who performed the suturing of facial lacerations. Junior residents should be educated about maintenance of proper tension, atraumatic technique, and performing appropriate trimming or debridement.
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Affiliation(s)
- Jin Hong Min
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea; Department of Emergency Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Se Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Sung Uk Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Yong Nam In
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungbuk-do, Republic of Korea
| | - Chi Hwan Kwack
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju-si, Chungbuk-do, Republic of Korea
| | - In Sool Yoo
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea; Department of Emergency Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Republic of Korea
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Petti S. Elder neglect-Oral diseases and injuries. Oral Dis 2018; 24:891-899. [PMID: 29029370 DOI: 10.1111/odi.12797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/11/2022]
Abstract
Elder neglect (EN) is the failure of a designated caregiver to meet the needs of a dependent older person. World EN prevalence, meta-analyzed in this study, is 1.0% or 1.8% according to different statistical methods. Referring alleged EN cases to Adult Protective Services (APSs) by healthcare workers (HCWs) is mandatory in many countries. However, only few claims are substantiated, as EN could be confused with Self-Neglect, and neglect could be unintentional or due to caregiver unawareness. Screening tools are inaccurate, and their use is discouraged by public health organizations, because they lead to too many false positives, which engulf the already overwhelmed APSs. HCWs need effective tools with objective judgments, which do not hamper the HCW-caregiver-patient rapport and prevent lawsuits when allegations are unfounded. Orofacial EN manifestations (poor oral/denture hygiene, lack of needed/improper dentures, dry mouth, skin/mucosal rashes) are essential Forensic Markers of EN. I classified EN-associated oral diseases according to the unmet needs into four groups: (1) traumatic injuries due to lack of caregiver vigilance (e.g., maxillofacial fractures); (2) diseases due to oral hygiene deficiency (e.g., root caries); (3) diseases typical of the elderly with late/no diagnosis (e.g., oral cancer); and (4) diseases typical of the elderly exacerbated by psychological distress (e.g., oral lichen planus).
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Affiliation(s)
- S Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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13
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Abdul Razak N, Nordin R, Abd Rahman N, Ramli R. A retrospective analysis of the relationship between facial injury and mild traumatic brain injury. Dent Traumatol 2017. [PMID: 28649703 DOI: 10.1111/edt.12355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS The association between facial injury characteristics and mild traumatic brain injury (mTBI) is unclear. The aim of this study was to determine the association between facial injury characteristics and mTBI. METHODS A retrospective review utilizing patients' medical records at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia, was performed. Records of subjects with a history of facial trauma from 1 April 2012 to 31 December 2012 were selected. Various levels and surgical speciality records were reviewed to ascertain the diagnoses of facial injuries and mTBI. RESULTS A total of 348 medical records with the diagnosis of facial injuries were included. The prevalence of mTBI among these patients was 41.4% (95% CI 36.2-46.6). The majority of the patients with mTBI were in the age group of 18-25 years old. Patients with or without facial lacerations that were located on the lower face had a significant association with mTBI, P=.001, compared to other types of soft tissue injury. In addition, a statistically significant association was observed between facial fractures occurring to the middle face and mTBI, P=.018. Pearson chi-square test also showed statistically significant association between the severity of facial injuries and mTBI, P=.018. CONCLUSIONS Mild traumatic brain injury should be suspected in patients with facial injuries and particularly those with lower face lacerations, midface fractures, moderate to severe facial injury and presence of multiple injuries.
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Affiliation(s)
- Nurliza Abdul Razak
- Oral and Maxillofacial Surgery, Hospital Teluk Intan, Teluk Intan, Perak, Malaysia
| | - Rifqah Nordin
- Department of Oral & Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Roszalina Ramli
- Department of Oral & Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Abstract
The management of soft tissue injury after facial trauma poses unique challenges to the plastic surgeon, given the specialized nature of facial tissue and the aesthetic importance of the face. The general principles of trauma management and wound care are applied in all cases. The management of severe injuries to the face is discussed in relation to the location and the mechanism of injury. Facial transplants have arisen in the past decade for the management of catastrophic soft tissue defects, although high morbidity and mortality after these non-life-saving operations must be considered in patient selection.
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Affiliation(s)
- Tara L Braun
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Rosen T, Reisig C, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Mtui EP, Flomenbaum NE, Lachs MS. Describing visible acute injuries: development of a comprehensive taxonomy for research and practice. Inj Prev 2016; 23:340-345. [PMID: 27913598 DOI: 10.1136/injuryprev-2016-042131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little literature exists classifying and comprehensively describing intentional and unintentional acute injuries, which would be valuable for research and practice. In preparation for a study of injury patterns in elder abuse, our goal was to develop a comprehensive taxonomy of relevant types and characteristics of visible acute injuries and evaluate it in geriatric patients. METHODS We conducted an exhaustive review of the medical and forensic literature focusing on injury types, descriptions, patterns and analyses. We then prepared iteratively, through consensus with a multidisciplinary, national panel of elder abuse experts, a comprehensive classification system to describe these injuries. RESULTS We designed a three-step process to fully describe and classify visible acute injuries: (1) determining the type of injury, (2) assigning values to each of the characteristics common to all geriatric injuries and (3) assigning values to additional characteristics relevant for specific injuries. We identified nine unique types of visible injury and seven characteristics critical to describe all these injuries, including body region(s) and precise anatomic location(s). For each injury type, we identified two to seven additional critical characteristics, such as size, shape and cleanliness. We pilot tested it on 323 injuries on 83 physical elder abuse victims and 45 unintentional fall victims from our ongoing research to ensure that it would allow for the complete and accurate description of the full spectrum of visible injuries encountered and made modifications and refinements based on this experience. We then used the classification system to evaluate 947 injuries on 80 physical elder abuse victims and 195 unintentional fall victims to assess its practical utility. CONCLUSIONS Our comprehensive injury taxonomy systematically integrates and expands on existing forensic and clinical research. This new classification system may help standardise description of acute injuries and patterns among clinicians and researchers.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Christopher Reisig
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA.,Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Veronica M LoFaso
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Thomas J McCarthy
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Estomih P Mtui
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Mark S Lachs
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
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Clevenger TN, Luna G, Fisher SK, Clegg DO. Strategies for bioengineered scaffolds that support adipose stem cells in regenerative therapies. Regen Med 2016; 11:589-99. [PMID: 27484203 DOI: 10.2217/rme-2016-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Regenerative medicine possesses the potential to ameliorate damage to tissue that results from a vast range of conditions, including traumatic injury, tumor resection and inherited tissue defects. Adult stem cells, while more limited in their potential than pluripotent stem cells, are still capable of differentiating into numerous lineages and provide feasible allogeneic and autologous treatment options for many conditions. Adipose stem cells are one of the most abundant types of stem cell in the adult human. Here, we review recent advances in the development of synthetic scaffolding systems used in concert with adipose stem cells and assess their potential use for clinical applications.
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Affiliation(s)
- Tracy N Clevenger
- Center for Stem Cell Biology & Engineering, University of California, Santa Barbara, CA, USA.,Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Department of Molecular, Cellular & Developmental Biology, University of California, Santa Barbara, CA, USA.,Institute for Collaborative Biotechnologies, University of California, Santa Barbara, CA, USA
| | - Gabriel Luna
- Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Center for Bio-Image Informatics, University of California, Santa Barbara, CA, USA
| | - Steven K Fisher
- Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Center for Bio-Image Informatics, University of California, Santa Barbara, CA, USA
| | - Dennis O Clegg
- Center for Stem Cell Biology & Engineering, University of California, Santa Barbara, CA, USA.,Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Department of Molecular, Cellular & Developmental Biology, University of California, Santa Barbara, CA, USA.,Institute for Collaborative Biotechnologies, University of California, Santa Barbara, CA, USA
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Park KH, Song JM, Hwang DS, Kim YD, Shin SH, Kim UK, Lee JY. A clinical study of emergency room visits for oral and maxillofacial lacerations. J Korean Assoc Oral Maxillofac Surg 2015; 41:246-50. [PMID: 26568926 PMCID: PMC4641215 DOI: 10.5125/jkaoms.2015.41.5.246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/20/2015] [Accepted: 08/26/2015] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This study investigated patients with oral and maxillofacial lacerations who visited the emergency room over a three-year period in an effort to determine the optimal treatment for these injuries. MATERIALS AND METHODS This study examined 1,742 patients with oral and maxillofacial lacerations with 2,014 different laceration locations who visited the emergency room of Pusan National University Hospital (Busan, Korea) over three years, from January 2011 to December 2013. Patients were classified by sex, age, visit day, cause of injury, injury site, and the presence or absence of soft tissue and tooth injuries. RESULTS The male to female ratio was 2.50:1. Patients under 10 years old were seen most frequently. Most emergency room visits were on weekends. Among intra-oral lacerations, the lip area was the most vulnerable site; among extra-oral lacerations, the chin area was most frequently injured. The most frequent etiology was a slip down. Most lacerations occurred without bone fracture or tooth damage. CONCLUSION Laceration may differ in large part as compared with the fracture. Therefore, it is necessary to continue collecting data on oral and maxillofacial lacerations to establish optimal emergency room diagnosis and treatment strategies.
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Affiliation(s)
- Kun-Hyo Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae-Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Dae-Seok Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Uk-Kyu Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae-Yeol Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
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Lee SJ, Cho YD, Park SJ, Kim JY, Yoon YH, Choi SH. Satisfaction with facial laceration repair by provider specialty in the emergency department. Clin Exp Emerg Med 2015; 2:179-183. [PMID: 27752594 PMCID: PMC5052843 DOI: 10.15441/ceem.15.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 11/23/2022] Open
Abstract
Objective We compared patient satisfaction with scarring after facial laceration repair in the emergency department (ED) based on the specialty of the provider. Methods Patients with facial lacerations admitted to the ED from 2009 to 2013 were divided into two groups. One group of patients underwent repair by an emergency physician (EP) and the other by a plastic surgeon (PS). From August 2014 to September 2014, we randomly selected 10% of all patients and assessed their degree of satisfaction with scarring over the phone using a 5-point Likert scale. Results The male to female ratio was 2.81 in the EP group and 2.05 in PS (P<0.001). The proportion of those aged 0 to 9 years among all the patients was higher in the PS group than in the EP group (50.8% vs. 30.1%, respectively, P<0.001). The duration of ED stay was 107.8±84.6 minutes in the EP group and 225.9 ± 161.8 minutes in the PS group (P<0.001). Among these patients, 228 responded to a telephone survey. A poor satisfaction score of 1 to 2 was more common in female or young patients who underwent repair by an EP (P<0.05). However, the overall satisfaction among all respondents did not differ between the two groups. Conclusion Although female patients and the guardians of young children who underwent simple facial laceration repair by a PS were more satisfied than those treated by an EP, the satisfaction of the entire group of patients did not differ according to the treatment provider.
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Affiliation(s)
- Sang-Jae Lee
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Duck Cho
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung-Jun Park
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jung-Youn Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Hoon Yoon
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
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19
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Udeabor S, Akinmoladun VI, Olusanya A, Obiechina A. Pattern of midface trauma with associated concomitant injuries in a nigerian referral centre. Niger J Surg 2014; 20:26-9. [PMID: 24665199 PMCID: PMC3953630 DOI: 10.4103/1117-6806.127105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM The aim of this study was to determine the pattern of midface trauma with associated concomitant injuries seen in our environment. METHODOLOGY This was a prospective analysis of trauma patients with midfacial injuries presenting at a referral center in South West Nigeria. In addition to socio-demographic data, the following information was also obtained: Mechanism of injuries, type of midfacial injuries, concomitant/associated injuries and treatment. RESULTS A total of 101 patients with midfacial injuries were involved. They were made up of 85 males and 16 females. The 20-29 year age group was mostly affected (44.6%) and the most common cause of midface injuries was road traffic accident (91.1%). The zygoma was fractured more than any other midfacial bone (46.0%). A total of 144 associated injuries were recorded among these patients, head and ocular injuries accounted for 49 (34%) and 35 (24.3%) respectively. The patients were mostly treated conservatively or by closed reduction. CONCLUSION The rate of head and ocular injuries among patients with midfacial injury was high. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary approach is important for optimum management of these patients.
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Affiliation(s)
- Samuel Udeabor
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Victor I Akinmoladun
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adeola Olusanya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ambrose Obiechina
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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20
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21
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Abstract
Traumatic facial soft tissue injuries are commonly encountered in the emergency department by plastic surgeons and other providers. Although rarely life-threatening, the treatment of these injuries can be complex and may have significant impact on the patient's facial function and aesthetics. This article provides a review of the relevant literature related to this topic and describes the authors' approach to the evaluation and management of the patient with facial soft tissue injuries.
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Affiliation(s)
- James D Kretlow
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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22
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Etiology and patterns of facial lacerations and their possible association with underlying maxillofacial fractures. J Craniofac Surg 2012; 22:e19-23. [PMID: 22134310 DOI: 10.1097/scs.0b013e31822ec934] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study was designed to analyze the etiology and patterns of soft-tissue facial lacerations associated with maxillofacial fractures and to identify associations between facial lacerations and underlying fractures. METHODS Of 1960 patients who had been admitted for maxillofacial fractures between 2001 and 2010, only patients with complete clinical records presenting with facial lacerations were considered for this study. Facial lacerations were classified according to the MCFONTZL system. RESULTS Of the 1960 patients admitted with maxillofacial fractures, 637 had 836 associated facial lacerations. Motor vehicle accidents and falls were responsible for most injuries to patients with facial lacerations. According to etiology, fractures resulting from work-related accidents more frequently produced associated lacerations.For all causes of injury, more facial lacerations were observed over the "T" area formed by the upper orbit and forehead, nose, upper and lower lips, and chin. Lacerations and maxillofacial fractures were more frequently localized to the middle third of the face, followed by the inferior third.There was a strong association between lacerations and fractures in the chin region, considering both symphyseal and parasymphyseal fractures (direct trauma) and condylar fractures (indirect trauma). CONCLUSIONS An association between facial lacerations and underlying maxillofacial fractures was observed, particularly in the inferior orbital area and over the zygoma, mandible, and chin.
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23
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Understanding Craniofacial Blunt Force Injury: A Biomechanical Perspective. FORENSIC PATHOLOGY REVIEWS 2009. [DOI: 10.1007/978-1-59745-110-9_3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Macedo JLSD, Camargo LMD, Almeida PFD, Rosa SC. Perfil epidemiológico do trauma de face dos pacientes atendidos no pronto socorro de um hospital público. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000100004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar os dados epidemiológicos e a localização dos traumas de face de pacientes atendidos no Hospital Regional da Asa Norte (HRAN), Brasília, Distrito Federal. MÉTODO: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRAN-DF, visando avaliar o perfil epidemiológico dos pacientes atendidos pela equipe da Unidade de Cirurgia Plástica vítimas de trauma de face no período de 1 de janeiro a 31 dezembro de 2004. RESULTADOS: O estudo compreendeu 711 pacientes, destacando-se o sexo masculino (72,8%). Quanto à causa, predominou a agressão física, seguida por acidente com veículos/motos. As quedas foram a causa predominante das lesões em crianças, mas verificou-se a participação cada vez maior da agressão física como mecanismo de trauma facial com o aumento da idade. A relação de homem:mulher foi de 3:1. A faixa etária mais atingida foi de 21 a 30 anos, representando 35,3% dos pacientes. As fraturas foram encontradas em 24,9% das lesões faciais. O nariz foi o local mais acometido nas fraturas de face (76,8%). CONCLUSÃO: A violência interpessoal foi a principal causa de trauma de face. A queda da própria altura mostrou-se como importante mecanismo de trauma nos extremos de idade.
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Hussaini HM, Rahman NA, Rahman RA, Nor GM, Ai Idrus SM, Ramli R. Maxillofacial trauma with emphasis on soft-tissue injuries in Malaysia. Int J Oral Maxillofac Surg 2007; 36:797-801. [PMID: 17630250 DOI: 10.1016/j.ijom.2007.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 12/08/2006] [Accepted: 04/09/2007] [Indexed: 10/23/2022]
Abstract
Soft-tissue injuries with or without facial bone involvement are the most common presentation following maxillofacial trauma. The objective of this study was to look at the distribution, pattern and type of soft-tissue injury in relation to aetiology. Records of patients over a period of 5 years (1998-2002), who sustained maxillofacial injuries and were treated at Kajang Hospital, a secondary referral hospital, were reviewed. Out of 313 patients with maxillofacial injuries, 295 patients sustained soft-tissue injuries. Males (79%) between 21 and 30 years old (34%) were the majority of patients. Road-traffic accident was the main cause of soft-tissue injuries (75%) with motorcycle accident being the most frequent (40%). The upper lips (23%) and the lower lips (18%) were the most common extraoral site involved, while the labial mucosa and sulcular areas, both accounting for 21%, were the most common intraoral sites. Stringent road-traffic regulations should be practiced in developing countries, as morbidity arising from road-traffic accidents poses a national economic and social problem.
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Affiliation(s)
- H M Hussaini
- Department of Oral Pathology & Oral Medicine, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Islam S, Ansell M, Mellor TK, Hoffman GR. A prospective study into the demographics and treatment of paediatric facial lacerations. Pediatr Surg Int 2006; 22:797-802. [PMID: 16947027 DOI: 10.1007/s00383-006-1768-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2006] [Indexed: 10/24/2022]
Abstract
To evaluate the demographics and treatment of facial lacerations occurring in a paediatric patient cohort. We undertook a prospective study of 106 children who sustained a soft tissue facial injury and who presented to an Accident and Emergency department in a UK district general hospital supporting a population of 750,000. Approximately 31,000 are dependent children between the age of 0-12 years. Our results show that the majority of paediatric patients who sustained a facial laceration were male (62%). The frequency of this injury was greatest amongst males across all age groups. The majority of children above 3 years of age sustained their injury outdoors. The peak time for injury varied for different age groups. The 0-3 year olds sustained the highest incidence of injuries around 17:00 h. A bi-modal time pattern was seen in the 4-6 year age group, initially at 12:00 h with a second peak at 17:00 h. The most frequent aetiology was play. A significant finding was that 8% of the injuries that were managed resulted from a dog bite. Almost 50% of children above 4 years of age, who required primary closure of their laceration, were able to tolerate their treatment being performed under local anaesthesia. The pattern of facial lacerations in our study supports the results of previous studies. Our data has provided further insight into the presentation of these injuries. These studies are valuable in targeted injury prevention programmes aimed at potentially reducing the nature, incidence and severity of facial soft tissue trauma in children in the UK.
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Affiliation(s)
- S Islam
- Department of Oral and Maxillofacial Surgery, University Hospitals of Coventry and Warwickshire (UHCW) NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.
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Allonby-Neve CL, Okereke CD. Current management of facial wounds in UK accident and emergency departments. Ann R Coll Surg Engl 2006; 88:144-50. [PMID: 16551405 PMCID: PMC1964044 DOI: 10.1308/003588406x94977] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The objective of this study was to determine the current practice in the management of adult facial soft tissue injuries in patients presenting to UK accident and emergency departments. MATERIALS AND METHODS Questionnaire study to the lead clinicians of 217 UK emergency departments seeing over 30,000 new patients annually. RESULTS There was a 76% response rate. Suturing was the preferred method of closure, with the majority of clinicians preferring 6/0 or 5/0 non-resorbable sutures. Use of a regional nerve block would be considered by a quarter of clinicians, and adrenaline vasoconstrictor by a third. Referral rates ranged from 5-77% for a more complex wound. Maxillofacial services were preferred by 51% of respondents; on-site referral availability was indicated by only 28%, with an average journey of 16 miles for treatment. Up to 30% of clinicians considered prescribing antibiotics after wound closure, with flucloxacillin and co-amoxiclav most commonly suggested. Accident and emergency review rates ranged from 16% to 45%, with most wounds either being referred to the GP or no formal review being suggested. CONCLUSIONS The results of this survey suggest that there is considerable variation in the initial management, referral and review of facial wounds in the UK. Further work is required to formulate guidelines for optimal patient care, ideally in conjuncture with the receiving surgical specialties.
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Affiliation(s)
- C L Allonby-Neve
- Department of Accident and Emergency Medicine, Leeds General Infirmary, Leeds, UK.
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Abstract
The purpose of this study was to determine patterns of facial laceration seen in the Accident and Emergency Department and identify how they are related to the mechanism of injury. A retrospective analysis of facial lacerations of an adult presenting to Accident and Emergency department was made over a 6-month period. There were 197 consecutive facial lacerations. The mean age of patients was 46 years. There were 137 male and 60 female patients. The aetiology of lacerations was falls (48%), assaults (11%), hit by an object by accident (21%) and hit stationary object by accident (15%). Mechanism of injury was found to be related to common patterns of laceration. Lacerations affecting the forehead mainly occurred in falls and those affecting the peri-orbital and peri-oral areas in assault. Lacerations were mainly linear, with a mean length of 2.4 cm, and about 75% were precipitated by blunt injury. Identification of common patterns of injury corresponding to a certain mechanism may allow assessment of the difficult or non-compliant patient. Understanding mechanisms of injury will allow safety planners to design safer domestic and workplace environments.
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Affiliation(s)
- S Lo
- Accident and Emergency Department, Wexham Park Hospital, Slough, UK
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Bolt R, Watts P. The relationship between aetiology and distribution of facial lacerations. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.injury.2003.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Buitrago-Téllez CH, Schilli W, Bohnert M, Alt K, Kimmig M. A comprehensive classification of craniofacial fractures: postmortem and clinical studies with two- and three-dimensional computed tomography. Injury 2002; 33:651-68. [PMID: 12213415 DOI: 10.1016/s0020-1383(02)00119-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A comprehensive classification of midfacial/craniofacial fractures, based on two- and three-dimensional computed tomography (2D and 3D-CT) is presented. We performed a postmortem analysis of 24 patients who had died from trauma with signs of craniofacial fractures, based on 2D and 3D-CT studies with pathoanatomical findings. In addition, CT findings for 100 patients with craniofacial injuries requiring an emergency CT were correlated with surgical findings and follow-up results. On the basis of the analysis of a total of 377 fractures a classification system is proposed. The system is based on the use of the AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) scheme, defining three types (A, B, C), three groups within each type (e.g. A1, A2, A3) and three subgroups within each group (e.g. A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest). The craniofacial region is divided into three units: the lower midface (I), the upper midface (II) and the craniobasal-facial unit (III). Lateral and central fractures are also distinguished. Type A fractures are non-displaced fractures, type B are displaced fractures and type C are complex/defect fractures. Groups A1, B1 and C1 comprise fractures of an isolated unit; groups A2, B2 and C2, combined fractures without involvement of the skull base; and groups A3, B3 and C3 are those combined fractures with involvement of the skull base. A correlation between the severity of the fracture and (i). the number of posttraumatic functional limitations (Spearman rank test, correlation coefficient r=0.42), (ii). the need for bone grafting or dural plastic (r=0.39) and (iii). facial asymmetry (r=0.37), was observed. The proposed classification system allows standardised documentation of midfacial and craniofacial fractures, including those not precisely defined by the Le Fort classification scheme.
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Affiliation(s)
- Carlos H Buitrago-Téllez
- Department of Radiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
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Maharaj D, Sharma D, Ramdass M, Naraynsingh V. Closure of traumatic wounds without cleaning and suturing. Postgrad Med J 2002; 78:281-2. [PMID: 12151570 PMCID: PMC1742370 DOI: 10.1136/pmj.78.919.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In less than ideal situations wounds have to be closed without extensive cleaning using sterile adhesive strips (Steristrips). This prospective analyses the efficiency of this technique and compares it to the more conventional approach. METHODS Altogether 147 lacerations were closed with sterile strips with no wound cleaning. Patients were subsequently followed up for a minimum of three months. RESULTS The sepsis rate in compliant patients was 1.4% with a total complication rate of 2.7%. CONCLUSION This technique, while contradicting the "sacred tenets" of wound closure, is a cheap, quick, and effective alternative to routine closure of traumatic wounds in a casualty department.
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Affiliation(s)
- D Maharaj
- Department of Surgery, University of the West Indies, General Hospital, Port-of-Spain, Trinidad, West Indies.
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