Changing patterns of severe craniomaxillofacial trauma in Auckland over eight years

Facial Fractures in Indigenous and Non-indigenous Populations of South Australia

INTRODUCTION

Maxillofacial trauma in indigenous populations is complex with sociocultural factors, access to health care, and poorer general health issues that impact outcomes. Assaults and road traffic accidents are disproportionately experienced by indigenous persons compared with non-indigenous.

METHODS

A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures that attended or were referred to the unit were included in this study. The primary objective was to analyze epidemiological trends of facial fractures and clinical outcomes in the South Australian indigenous and non-indigenous populations.

RESULTS

Maxillofacial fractures in indigenous persons were less than in non-indigenous (31.2 versus 38.2 y, P < 0.001) with 3.8 odds of a facial fracture. Assault was 2.9 times more likely to result in a facial fracture, falls 40.9% less likely, and sports 29.4% less likely compared with non-indigenous ( P < 0.001). Alcohol-related facial fractures had significantly higher rates [odds ratio (OR = 3.8)] compared with non-indigenous. Indigenous from most disadvantaged areas and very remote areas also had significantly higher odds of a facial fracture. Indigenous persons had higher operative rates (OR = 2.8), postoperative complications (OR = 3.1), and a 3.7-day mean difference for the length of stay (6.6 versus 2.9 d, P < 0.001).

CONCLUSIONS

Indigenous people are more likely to experience facial fractures from assault resulting in mandibular fractures, whereas non-indigenous people are likely to have sport or fall-related midface fractures. Young indigenous women from outer regional and very remote areas have greater odds of facial fractures caused by assault and alcohol with higher operative rates, postoperative complications, and extended length of stay.

A stitch in time saves nine: All about pediatric facial fracture

Fractures of the pediatric craniofacial skeleton can be challenging to engage in. The initial injury and subsequent treatment can cause long-term growth disturbances yielding problematic secondary deformities. It is important that clinicians involved in the care of these patients understand the differences between children and adult fracture patterns and understand the potential long-term effects on the growth of the pediatric skeleton and how to manage these problems when they occur.

Maxillofacial Bone Fractures in Children and Adolescents: Overview of 247 Cases in a Major Referral Hospital, Najran, Kingdom of Saudi Arabia

Study Design

A retrospective study investigating maxillofacial bone fractures in the pediatric and adolescent population.

Objective

The aim of this study was to present our experience in the management of pediatric facial bone fractures.

Methods

This was a retrospective study of maxillofacial bone fractures in children and adolescents between the ages <1 year and 19 years in a Saudi Arabian subpopulation. Data collected include demographics, etiology, pattern, and treatment of maxillofacial bone fractures. Data were analyzed using IBM SPSS Statistics for Windows Version 25 (IBM Corp.). Results were presented as simple frequencies and descriptive statistics.

Results

Of the 1297 patients with maxillofacial bone fractures, 247 were cases involving children and adolescents giving a prevalence of 19.0% (247 patients, N = 1297). There were 233 males and 14 females with an M:F ratio of 16.6:1. The ages ranged from 9 months to 19 years with a mean ± SD of 14.4 ± 4.6. The age-group between 16 and 20 years had the highest frequency of patients (144 (58.4%)). In the 1- to 5-year group, falls accounted for most of the etiology (15 (6.1%)), while in the 16- to 20-year group, motor vehicular accident (MVA) was the main reason (120 (48.6%)). The majority of the fractures occurred in the mandible with 151(61.1%) cases. Open reduction and internal fixation (ORIF) were the main treatment modality in 171 (69.2%) patients.

Conclusions

MVA was the main etiology of maxillofacial fractures in children and adolescents with male predominance, while the mandible had been the most frequently fractured bone. ORIF was the main treatment modality.

Pediatric Pedestrian Facial Fracture Patterns and Management Following Motor Vehicle Collisions

PURPOSE

Pedestrian trauma due to motor vehicle crashes can be especially destructive to the pediatric population as the facial skeleton is immature and developing. Almost half of crashes resulting in pedestrian death involved alcohol consumption, and children are often victims of irresponsible driving. The objective of this study was to examine the prevalence of facial fractures in this patient population in order to analyze management strategies that optimize functional recovery.

METHODS

A retrospective chart review was performed for all facial fractures resulting from motor vehicle collisions with pedestrians in the pediatric population at a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies.

RESULTS

During the time period examined, 55 patients were identified as 18 years of age or younger and having sustained a facial fracture as the result of being struck by a motor vehicle. The mean age was 11.3 (range 1-18) years, with a male predominance of 69.0%. There were a total of 125 fractures identified on radiologic imaging via CT or X-ray. The most common fractures were those of the orbit (20.0%), mandible (19.2%), and nasal bone (10.4%). The mean Glasgow Coma Scale on arrival was 12.1 (range 4-15). Fifteen patients were intubated on, or prior to, arrival to the trauma bay. The most common concomitant injuries were intracranial hemorrhage, long bone fractures, and cervical spine fractures. The mean operative time was 216.9 (range 63-515) minutes. Surgery was required in 36 patients, with most undergoing open reduction and internal fixation with titanium plates and screws. Two patients required resorbable plates, and one required Medpor implants. The mean hospital length of stay was 9.9 (range 1-59) days. Two patients expired.

CONCLUSIONS

There is currently a dearth of literature regarding the management and patterns of injury for pediatric pedestrian injuries due to motor vehicle collisions. The impact of these injuries can be devastating with concomitant life-threatening complications, and may influence the future development of the facial skeleton after healing of the bone and soft tissue. The authors hope this study can provide insight and further investigation regarding prevention and management.

Clinical Signs and Intraocular Pressure Changes in Patients with Orbitozygomatic Complex Fractures

Objectives

The study investigated the association between intraocular pressure changes and clinical ocular signs in 51 patients with orbitozygomatic complex fractures. Diplopia, chemosis, enophthalmos, subconjunctival haemorrhage, periorbital ecchymosis and extraocular muscles entrapment were assessed.

Study Design

Intraocular pressure was measured in mmHg at different time intervals with Perkins and Goldman tonometers; within first 3 days of injury (T1), 24 h post-elevation within 3-14 days of injury (T2), 1 month after initial treatment assessment (T3), 2 months after initial treatment assessment (T4), and 3 months after initial treatment assessment (T5). Intraocular pressure changes between T2/T1 and T3/T1 were analysed as change 1 and change 2, respectively, with paired t test. Significance was set at p < 0.05.

Results

Minimum intraocular pressure recorded in the affected eye was 5 mmHg at T1 and T2, while maximum intraocular pressure was 28 mmHg at T1. Mean intraocular pressure at T1 and T2 was 15.90 ± 4.73 mmHg and 16.80 ± 4.43 mmHg, respectively. All eye signs had completely resolved at T3 except enophthalmos, which persisted till T5. Statistical significant relationship exist between orbitozygomatic complex fracture and enophthalmos (T1: p = 0.04). subconjunctival haemorrhage (T2: p = 0.003), periorbital ecchymosis (T2: p = 0.005),and T3: p = 0.001).

Conclusion

Chemosis, diplopia, enophthalmos, periorbital ecchymosis and subconjunctival haemorrhage showed positive contributory effect to intraocular pressure elevation in orbitozygomatic complex fracture.

An Overview of Maxillofacial Trauma in Oral and Maxillofacial Tertiary Trauma Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah

The aims of this study were to provide an overview of maxillofacial trauma and its relationship to patient's demographic data and alcohol consumption within the state of Sabah. It was a retrospective study of maxillofacial trauma cases treated by Oral and Maxillofacial Surgery Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, from January 1, 2009, until December 31, 2013. A total of 630 maxillofacial trauma cases were included. Details of the trauma were collected from patients' record, including patients' cause of injuries, injuries suffered, treatment indications, and treatment received. Patients' demographic data (age, gender), alcohol consumption in relation to causes, and type of maxillofacial injury were analyzed. There were 538 male (85.4%) and 92 female (14.6%) patients (ratio: 5.8:1), with mean age of 31.0 years. Most common causes of maxillofacial injury were motor vehicle accident (MVA; 66.3%), followed by fall (12.4%) and assault (11.6%). Motorcyclists made up more than half of the total cases (53.1%). Cases referred were primarily due to soft-tissue injury (458 cases). Other cases were dentoalveolar and maxillofacial bone fractures. Treatment provided for the fractures included open reduction and internal fixation (22.9%), closed reduction (28.7%), and conservative management (48.4%). Toilet and suturing were done for all patients with soft-tissue injury. Maxillofacial trauma is a major problem in Sabah. It affects mostly males in the age group of 21 to 30 years. Most of the MVA patients were motorcyclists. Mandibular fracture with parasymphysis involvement recorded the highest number. Most of the patients preferred conservative management, probably due to financial and logistic issue.

The Impact of the Nasal Trauma in Childhood on the Development of the Nose in Future

AIM:

To prevent and to treat nasal trauma in children properly, because it can lead to displacement or depression of the nasal bones or septum. Second, our aim was, for the patient to recognise and create a mature decision for eventual nose changes which will be made with the operative intervention or they are not mature enough and the decisions were made by their parents.

MATERIAL AND METHODS:

Our retrospective study was made at University Clinic for Ear, Nose and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje in the period of 6 years (2005-2016). Seventy-three patients were admitted with recent or previous nasal trauma or nasal deformity. The first group of 32 were children and adolescents from 6-14 years old who were admitted to our hospital because of recent nasal trauma. The second group of 41 children and adolescents from 6-14 years old were admitted to our hospital because of previous nasal trauma, which was not treated on time, or it was not treated properly. They were admitted to our clinic for surgical intervention septo/rhinoplasty. The second group of patients fills the brief psychological questioner prepared by Clinical psychiatrist from University Clinic of Psychiatry, in Skopje, and their psychological reactions were taken into consideration.

RESULTS:

Eleven of the children and adolescents who had nasal fracture without dislocation, who have no symptoms, minimal swelling, and no septal deviation or hematoma, were observed with a specific follow-up: 3 days after nasal fracture, then every week in the first month, after 1 month, and after 3 months period. Sixteen of children and adolescents who had a nasal fracture with subluxation of nasal septum were operated with closed reduction (repositio nasi) under general anaesthesia. The others with septal hematomas and subperichondrial abscess were treated as in adults’ patients. The second group of 41 children and adolescents from 6-14 years old consisted with with the previous nasal trauma which was not treated on time or it was improperly treated. In 24 (58.54%) of these patients septoplasty was performed and in 17 (41.46%) was performed rhino septoplasty.

CONCLUSION:

Often, difficult septal deformations in children are followed with deformation of the nasal pyramid (rhino scoliosis, rhino lordosis). In those cases, we cannot solve septal pathology without nasal pyramid intervention in the same time and opposite. Clinical reports have not produced solid evidence for the statement that septal surgery has no negative effect on nasal growth or can serve for correcting abnormal growth. The functional and esthetic problems of the patient, however, mean a continuous stimulus for further clinical and experimental investigations.

Mandibular fractures in iraq: an epidemiological study

The purpose of this study was to evaluate the epidemiological characteristics of the mandibular fractures relating to gender, age, the etiology of injury, and the rendered treatment modalities and complications. The data of the patients who sustained mandibular fractures were retrieved and were analyzed retrospectively, and based on these data a descriptive analysis was conducted. A total of 112 patients were included in this study; the most common cause was road traffic accidents (RTAs) followed by assaults and missile injuries. The most frequently involved age group was 11 to 20 years, treatment modalities included conservative, closed reduction and indirect fixation, and open reduction and internal fixation (ORIF) in 11.6, 79.5, and 8.9% of the cases, respectively. Most of the major complications were injury related. This study showed RTAs to be the most frequent cause followed by assaults, it also showed that a high percentage of assault victims were females mainly of low socioeconomic status. Another distinguishing feature in this study was the high incidence of missile injuries in the form of bullets and blasts. Closed reduction still has an important role in the treatment of fractures of mandible especially when the necessary equipments for ORIF are not readily available. A higher complication rate was observed in patients diagnosed with multiple and comminuted fractures as well as those caused by violence in the form of missile and assault injuries.

Global trends in maxillofacial fractures

Background The etiology, demographics, fracture site in facial injury patients have been reported worldwide. However, few studies have attempted to identify changes in maxillofacial fractures over time periods and between countries. The statistics are vastly different due to variations in social, environmental, and cultural factors. Methods Data were collected from departmental records between 1996 and 2006 for patients treated at Christchurch Hospital for facial fractures. Variables examined included incidence, demographics, site of fracture, and treatment methods. Results A total of 2563 patients presented during the study period, 1158 patients in the first half and 1404 patients in the second half. Male-to-female ratio was 4:1 in both periods and males in 16- to 30-year group accounted for about half of all patients. Interpersonal violence was the most common cause of injuries, and there was a decrease in injuries caused by motor vehicle accidents. Approximately half of all patients required hospitalization and surgery, and the most common method of treatment was open reduction and internal fixation. Conclusion Maxillofacial fracture is a common injury in young males following interpersonal violence in New Zealand. Studies in other countries and over different time periods yield interesting differences in the etiology, demographics, and fractures patterns. These are due to environmental, societal, cultural, and legislative differences.

Managing the pediatric facial fracture

Facial fracture management is often complex and demanding, particularly within the pediatric population. Although facial fractures in this group are uncommon relative to their incidence in adult counterparts, a thorough understanding of issues relevant to pediatric facial fracture management is critical to optimal long-term success. Here, we discuss several issues germane to pediatric facial fractures and review significant factors in their evaluation, diagnosis, and management.

Metaanalysis of maxillofacial trauma in the northern districts of kerala: one year prospective study

PURPOSE

There is an increased incidence of maxillofacial trauma all over the world. A study was conducted to find out the epidemiological characteristics of maxillofacial trauma in Northern districts of Kerala.

METHODS

All the trauma patients who attended the Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, Kerala during the period of 2006-2007 was included in the study. The incidence, prevalence, age and sex distribution, seasonal and daily variations and aetiology of maxillofacial trauma were studied. The pattern and demographic distribution of fractures of maxillofacial skeleton also were studied.

RESULTS

This study indicates a significant increase in the incidence of maxillofacial trauma in the region. There was a male predominance and the highest incidence was in the age group of 20-40 years. Road traffic accident was the most common aetiological factor causing maxillofacial trauma. More than 30% of trauma cases suffered fracture of maxillofacial skeleton. There was an increased incidence of midface fracture when compared to mandibular fractures in the study. Most common site of mandibular fracture was in the parasymphysis region and in the midface was the zygomatic complex region.

CONCLUSION

The increased incidence of maxillofacial trauma following road traffic accidents noted in this study reveals the need for formulating preventive measures in the state of Kerala. Increasing facilities for the management of maxillofacial trauma at local hospitals and medical colleges is mandatory. Training of the paramedical personnel, health workers and also the public regarding first aid and primary trauma care is also necessary.

1,454 mandibular fractures: a 3-year study in a hospital in Belo Horizonte, Brazil

OBJECTIVE

To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.

METHODS

The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson's chi-square, Bonferroni, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests, and analysis of variance.

RESULTS

There were 1,454 mandibular fractures in 1,023 patients. Males of 20-29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends.

CONCLUSION

The individuals with mandibular fractures due to "traffic accidents" were younger than those due to "violence" and "falls". There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures.

Pattern of craniofacial injuries in patients admitted to Tanta University Hospital--Egypt

The goal of this work was to determine the craniofacial injury patterns in hospitalized patients to facilitate the awareness, by identifying, describing and quantifying trauma for use in planning and evaluation of preventive programs. Two-hundred and fifty five patients with craniofacial injuries were registered at the department of neurosurgery in Tanta University Hospital. Data were collected including age, gender, medical history, cause of injury and type of injury, location and frequency of soft tissue injuries, skull fractures, facial bone fractures, brain injuries and concomitant injuries, patient symptoms, clinical signs and the radiological findings. The most common causes of craniofacial injuries were road traffic accidents, followed by activity of daily life and assaults. Gender distribution showed that, males were at higher risk than females with a ratio of 5.5/1. In total of skull fractures, 47.84% were fissure fracture and 24.31% were depressed fractures. In total of brain injuries, 7.06% for concussion, 4.71% for contusion, 10.98% for brain laceration, 14.12% for pneumocephalus and 36.47% for brain edema. Regression analysis revealed increased risk for skull fractures and brain injuries in traffic accidents were 84.78%, 94.20%, respectively, and 59.14%, 50.54% in activity of daily life, but the probability of soft tissue injuries increase in traffic accident and violence.

Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt

Mandibular fracture is one of the most common facial skeletal injuries. Although its main causes are road crashes and violence, the relation between these causes varies from one country to another. We made a retrospective study of the medical records and radiographs of 509 patients treated for mandibular fracture at the University of Alexandria Hospital between 1991 and 2000. The data that we collected included age, sex, aetiology, date of injury, anatomical site of the fracture, associated maxillofacial trauma, and treatment. The prevalence of mandibular fractures was higher in male subjects in all age groups, and the male:female ratio was 3.6:1. Most fractures were sustained by men in the age group 21-30 years and girls between 0 and 10 years, and the monthly incidence was constant. Road crashes were the main cause, followed by falls and assaults. Fractures of the angle were the most common (22%) followed by parasymphyseal fractures (21%) and the lowest was in the coronoid region (1%).

Occupational Maxillofacial Fractures: A 3-Year Survey in Central Switzerland

PURPOSE

The aim of this study was to determine occupational facial fractures in central Switzerland. Concomitant injuries were also studied.

MATERIALS AND METHODS

The Department of Cranio-Maxillofacial Surgery at the University Hospital in Berne provides a 24-hour maxillofacial trauma service for its population (1.6 million). The present study was comprised of 42 patients (8.4% of treated maxillofacial injuries) with occupational maxillofacial fractures registered at this unit between 2000 and 2002. Information on the topic of occupation, the cause of the accidents, and the topographic location of the fractures was analyzed.

RESULTS

The mean age of the patients was 44.4 years, with a male to female ratio of 41:1. Sixty-nine percent of the injuries occurred in farm and forestry workers and in construction laborers during the summertime (33%). Workers in these occupations carried a 127-fold (farm and forestry workers) and a 44-fold (construction laborers) higher risk of incurring maxillofacial fractures than did service and office workers. Injuries were most frequently (43%) caused by a thrown, projected, or falling object. Eighty-two percent of the fractures occurred in the midface region and at the skull base. Fifty-nine percent of the patients had concomitant injuries. In 69%, surgery was necessary, the mean duration of their hospital stay being 4.8 days.

CONCLUSION

The probability of sustaining work-related maxillofacial traumata is correlated to the nature of the occupation. Farm and forestry workers are at the highest risk, most frequently injured by being struck by an object or an animal. The introduction of personalized safety measures should become obligatory in high-risk occupations.

Pediatric facial fractures: recent advances in prevention, diagnosis and management

During the last 25 years, there have been considerable advances in the prevention, diagnosis and management of craniomaxillofacial injuries in children. When compared to adults, the pattern of fractures and frequency of associated injuries are similar but the overall incidence is much lower. Diagnosis is more difficult than in adults and fractures are easily overlooked. Clinical diagnosis is best confirmed by computed tomographic (CT) scans. Treatment is usually performed without delay and can be limited to observation or closed reduction in non-displaced or minimally displaced fractures. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. Open reduction and rigid internal fixation is indicated for severely displaced fractures. Primary bone grafting is preferred over secondary reconstruction and alloplastic materials should be avoided when possible. Children require long-term follow-up to monitor potential growth abnormalities. This article is a review of the epidemiology, diagnosis and management of facial fractures in children.

Pediatric facial fractures: recent advances in prevention, diagnosis and management

During the last 25 years, there have been considerable advances in the prevention, diagnosis and management of craniomaxillofacial injuries in children. When compared to adults, the pattern of fractures and frequency of associated injuries are similar but the overall incidence is much lower. Diagnosis is more difficult than in adults and fractures are easily overlooked. Clinical diagnosis is best confirmed by computed tomographic (CT) scans. Treatment is usually performed without delay and can be limited to observation or closed reduction in non-displaced or minimally displaced fractures. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. Open reduction and rigid internal fixation is indicated for severely displaced fractures. Primary bone grafting is preferred over secondary reconstruction and alloplastic materials should be avoided when possible. Children require long-term follow-up to monitor potential growth abnormalities. This article is a review of the epidemiology, diagnosis and management of facial fractures in children.

Management of isolated orbital floor blow-out fractures: a survey of Australian and New Zealand oral and maxillofacial surgeons

BACKGROUND

This is the first report of involvement of Australian and New Zealand oral and maxillofacial surgeons in the management of isolated orbital floor blow-out fractures and was conducted to obtain comparisons with the results from a recent similar survey of British oral and maxillofacial surgeons.

METHODS

A questionnaire survey was sent to all 113 practising members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons in April 2002 with a second mailout 1 month later.

RESULTS

Sixty-nine per cent of the respondents were referred isolated orbital floor blow-out fractures for management, and just over half of these respondents estimated that 50% or more of the cases went to surgery. The materials most commonly used in orbital floor reconstruction were resorbable membrane for small defects and autologous bone for large defects.

CONCLUSION

As in Britain, management of isolated orbital floor blow-out fractures comprises part of the surgical spectrum for many oral and maxillofacial surgeons in Australia and New Zealand. The management protocol was observed to be very similar between the two groups.

Etiology and patterns of facial fractures in the United Arab Emirates

A retrospective study on facial fractures was carried out in the Department of Oral and Maxillofacial Surgery at Tawam Hospital (Al Ain, United Arab Emirates) between January 1, 1998 and December 31, 2001. The study included 144 patients with a mean age of 26.5 years; the most frequently injured patients belonged to the 16- to 20-year-old age group. The male predilection was 83%. Road traffic accident was the most common causative factor (59%), followed by falls (21.5%), accidents where camels were involved (5.5%), work- and sport-related accidents (4.8% and 4.8%, respectively), and assault (4.1%). A total of 53.4% of the patients suffered isolated mandibular fractures, 32.6% had isolated midface fractures, and 13.8% had combined midface and mandibular fractures. Associated injuries were noted in 22.2% of the patients. The number of patients treated increased from 28.3 (1990-1995) to 36 (1998-2001) on an annual average; a reduction in isolated nasal fractures and associated injuries, including facial lacerations, was noted with no change in age or etiology predilection. Sufficient data could not be obtained to determine if the favorable results with the associated injuries were a result of the effect of a compulsory seat belt law introduced on June 1, 1998, but the increasing number of maxillofacial injuries suggests that the seat belt law is ignored in this country.

Management of orbitozygomatic fractures

BACKGROUND

Management of orbitozygomatic fractures forms part of the scope of practice of many oral and maxillofacial surgeons. As aspects of management vary among surgeons who treat such injuries, this confidential study was undertaken to examine some of the protocols of Australian and New Zealand oral and maxillofacial surgeons.

RESULTS

Eighty-one per cent of the respondents treated orbitozygomaticfractures and on average, each treated approximately 24 cases per year. Also, about one in five cases required orbital floor exploration.Further, the preferred imaging baseline was computed tomography plus plain X-rays, while the preferred implant materials for orbital floor reconstruction were autologous bone and resorbable membrane. The incidence of postoperative retrobulbar haemorrhage was estimated at approximately 1:1000.

CONCLUSION

Most oral and maxillofacial surgeons treat orbitozygomatic injuries as part of their surgical scope.