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Tomassini L, Ascani G, Mancini P, Cacaci C, Scendoni R. A case of emergency reconstructive surgery following facial destructive gunshot wounds: clinical and medico-legal assessments. Int J Emerg Med 2023; 16:90. [PMID: 38114930 PMCID: PMC10731849 DOI: 10.1186/s12245-023-00572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Facial gunshot wounds present a complex challenge to both medical professionals and victims with significant physical, psychological, and economic implications for those who suffer these types of injuries. Reconstructive surgery offers satisfactory aesthetic and functional outcomes, improving a patient's quality of life. In these cases, the surgical procedure may encompass additional phases beyond those initially identified based on the type of wound and the extent of tissue destruction. As a result, each case necessitates thorough evaluation to determine an appropriate strategy. Nonetheless, it is worth noting that the outcomes achieved in terms of both aesthetics and functionality in this domain have the potential to be excellent. CASE PRESENTATION A 66-year-old man attempted suicide with a shotgun, causing severe facial injuries and fractures. He had a history of depression and was taken to the emergency department promptly. CT scans revealed brain and facial bone injuries, and he underwent surgery to control bleeding and tracheostomy. Postoperative recovery was successful. The patient's condition stabilized, and he was discharged after 10 days. Follow-up visits showed gradual healing. Despite an offer for further facial reconstruction, he declined, satisfied with the achieved results. CONCLUSIONS The present case report is intended to support the argument that effective facial reconstruction should be considered in the medico-legal assessment. It could be beneficial to introduce a new classification system and personalized evaluation methods with careful consideration given to treatment costs (which can be very high) and expected results. Since reconstructive surgery modifies damage and impacts the long-term costs of permanent impairments, its inclusion in the decision-making process would promote improved personalized care.
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Affiliation(s)
- Luca Tomassini
- International School of Advanced Studies, University of Camerino, Camerino, Italy.
| | - Giuliano Ascani
- Department of Maxillofacial Surgery, Spirito Santo Hospital, Pescara, Italy
| | - Paolo Mancini
- Department of Maxillofacial Surgery, Spirito Santo Hospital, Pescara, Italy
| | - Claudio Cacaci
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
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Panshak TE, Akhiwu BI, Ramyil AV, Saleh N, Wade P, Ladeinde AL, Mpyet C. Ophthalmic Injuries in Patients with Maxillofacial Trauma Presenting to a Teaching Hospital in North Central Nigeria. J West Afr Coll Surg 2022; 12:17-23. [PMID: 36388734 PMCID: PMC9641739 DOI: 10.4103/jwas.jwas_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ophthalmic injuries in patients with maxillofacial trauma are potential causes of a permanent visual loss. These injuries can easily be missed; hence, there is a need for the ophthalmic evaluation of patients with maxillofacial trauma. The main objective of this study was to determine the prevalence, patterns, etiology, and risk factors of ophthalmic injuries in patients presenting with maxillofacial trauma in a teaching hospital in North Central Nigeria. MATERIALS AND METHODS The study was a hospital-based, descriptive, cross-sectional study of 67 patients with maxillofacial trauma recruited over a 6-month study period. Information on the sociodemographic and clinical characteristics of the study participants was obtained. The data were analysed using SPSS version 20 statistical software. Pearson's chi-square test was used to test for statistical significance. RESULTS Ophthalmic involvement was seen in 77.6% of the study participants, with males and individuals aged 21-30 years being more commonly affected. The leading cause of ophthalmic injuries in patients with maxillofacial trauma was road traffic accident (RTA) (75.5%). Others included assaults and fall from heights. Amongst the RTA cases, 71.4% was due to motorcycle-related accident with 91.9% of the patients with ophthalmic injuries observed not to use helmet/seat belt. The use of alcohol and not wearing protective gears were seen as the risk factors. Simple zygomatic complex fracture was the most common trauma observed (44.2%). CONCLUSION Ophthalmologic assessment should be conducted for all patients presenting with maxillofacial trauma. The laws on the use of protective gears such as helmets and seat belts should be enforced.
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Affiliation(s)
| | - Benjamin Idemudia Akhiwu
- Department of Oral and Maxillofacial Surgery, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria,Address for correspondence: Dr. Benjamin Idemudia Akhiwu, Department of Oral and Maxillofacial Surgery, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria. E-mail:
| | - Alice Venyir Ramyil
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Naomi Saleh
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patricia Wade
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Akinola Ladipo Ladeinde
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Caleb Mpyet
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
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Bonitz L, Wruck V, Peretti E, Abel D, Hassfeld S, Bicsák Á. Long-term evaluation of treatment protocols for isolated midfacial fractures in a German nation-wide craniomaxillofacial trauma center 2007-2017. Sci Rep 2021; 11:18291. [PMID: 34521960 PMCID: PMC8440643 DOI: 10.1038/s41598-021-97858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
An update on the trends in maxillofacial traumatology provides additional information on the actual and changing needs. This retrospective study aimed to review all patient records of patients treated for isolated midface fractures in the Department of Cranial- and Maxillofacial Surgery at the Dortmund General Hospital between 2007 and 2017. The patient radiographs and patient files were reviewed. The safety and efficacy of the applied methods were controlled by assessing complications based on the Clavien-Dindo classification system. The statistical analysis included descriptive methods including regression analysis and χ2-test. In eleven years, 3474 isolated midface fracture sites have been identified in 2868 patients. The yearly trend is slightly increasing, in elderly clearly worsening, in children and youth decreasing. The male-to-female ratio was 2.16:1 for the whole study population, in the age group 18-25 y.o. 6.95:1 while in elderly above 80 y.o. 1:2.51, the age group specific incidence reflects this result, too. The most common fractures were nasal bone fractures (1405), zygomatic fractures (832) and orbital floor fractures (700). The average hospital stay was 2.7 days, the most fractures were operated within 24 h. The complication rate was 2.02% (Clavien-Dindo class II-V). The incidence of midfacial fractures is increasing in the total population and especially in elderly, but decreasing in children. Development of injury prevention measures is needed in this population. The diagnostic and therapeutic procedures are appropriate, as there is a low complication rate and short inpatient stay observed.
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Affiliation(s)
- Lars Bonitz
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Vivienne Wruck
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Elena Peretti
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Dietmar Abel
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Stefan Hassfeld
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Ákos Bicsák
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany.
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany.
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Balla SC, Jha KN, Ramanujam S, Srikanth K, Rajalakshmi AR. Maxillofacial trauma and ocular injuries: reports from a prospective study from Pondicherry, India. Orbit 2021; 41:457-463. [PMID: 34253120 DOI: 10.1080/01676830.2021.1939727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the spectrum and the factors affecting the visual outcome of ocular injuries associated with maxillofacial trauma. METHODOLOGY A prospective observational study was carried out from January 2019 to June 2020 on patients of maxillofacial trauma at a rural tertiary care centre, in Pondicherry, India. Detailed history was obtained. Investigations including imaging was done as indicated. Predictors of eye injuries and prognostic factors for vision were assessed. RESULTS A total of 135 eyes of 126 patients were evaluated. Males constituted 92.06%. Road traffic accident (RTA), domestic injuries, assault, and work-place-related injuries accounted for 86.5%, 4.7%, 2.3%, and 2.3%. Alcohol consumption (42.06%) and lack of eye protective device (94.4%) and injury to posterior segment were the major risk factors. On presentation 80.6% had visual acuity ≥ 6/12. Orbital and maxillofacial fractures were noted in 70.6% of cases. Closed-globe injury was seen in 83 (61.4%) and open-globe injury in 2 (1.4%). Majority (86.7%) suffered soft tissue injuries. Common sight-threatening injuries were traumatic optic neuropathy (4.4%), vitreous haemorrhage (0.7%), retrobulbar haemorrhage (0.7%), and commotio retinae (0.7%). CONCLUSION Most of the injuries in this population occurred from RTA, with associated fractures, adnexal and globe injuries. Alcohol consumption and lack of eye protective device were the major risk factors. Patients with open-globe injuries and injuries with posterior segment involvement had poor visual outcome.
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Affiliation(s)
- Shravya Choudhary Balla
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Kirti Nath Jha
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Sathyanarayanan Ramanujam
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Krishnagopal Srikanth
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
| | - Adithyapuram Ramachandran Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Deemed-to-beUniversity, Pondicherry, IndiabeUniversity, Pondicherry, India
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Abstract
Clinical evaluation of patients with trauma is challenging, especially in the presence of neurologic injuries. Vision loss after trauma is a harmful and usually overlooked consequence that may be avoided with a prompt and accurate intervention. Head CT is commonly performed in patients with trauma. However, radiologists may be unfamiliar with the CT findings associated with injuries that may affect eyesight. Understanding the visual pathway anatomy and its critical landmarks is paramount for recognizing these findings. This article describes the use of head CT to evaluate the visual pathway to help avoid vision loss in patients with trauma. Injuries are presented in terms of those affecting the globe (rupture, hemorrhage, and lens trauma), optic nerve (direct and indirect traumatic optic neuropathy), orbit (orbital compression syndrome), and vasculature (traumatic carotid-cavernous sinus fistula and posterior cerebral artery injury or ischemia). Techniques for measuring the globe on CT to assess for injury are illustrated. Indications for screening CTA of the head and neck in patients with suspicion for blunt traumatic vascular injury are summarized. Emphasis is placed on the CT findings that warrant an emergency intervention to prevent traumatic visual impairment.
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Abstract
Purpose: Vision loss after orbital surgery is one of the most dreaded complications faced by the orbitofacial surgeon. This literature review was conducted in an attempt to determine the risk factors for severe vision loss and discuss the applied anatomy related to various types of orbital surgery - orbital tumor excisions, orbital decompression, and post-traumatic orbital reconstruction.Methods: A literature search was conducted via PubMed and Google Scholar. All cases of vision loss following orbital tumor biopsy or excision, orbital decompression, and orbital trauma reconstruction were reviewed.Results: The incidence of postoperative blindness appears to be more after orbital tumor excisions (4.7%), compared to post-traumatic orbital reconstruction (2.08%) and orbital decompressions for thyroid orbitopathy (0.15%).The causes of vision loss include ischemic optic neuropathy, traumatic optic neuropathy, retinal and ophthalmic artery occlusions, and orbital compartment syndrome.Conclusion: Apart from careful patient selection, proper counseling about the risk of postoperative blindness is of utmost importance. Detailed preoperative treatment planning, meticulous atraumatic intraoperative dissection under direct visualization, with attention to the danger zones and vital structures, close intraoperative and postoperative monitoring, and urgent management of potentially reversible compressive causes of vision loss can improve outcomes.
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Affiliation(s)
- Prerana Kansakar
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore.,Department of Ophthalmology, Grande International Hospital, Kathmandu, Nepal
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore
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Abstract
INTRODUCTION Yet uncommon, blindness is a potential associated injury of facial fractures. METHODS Epidemiology, mechanisms, fracture types, and outcome of facial fractures-associated blindness in a 10-year period are retrospectively reviewed. RESULTS Out of 907 facial fractures patients, 10 had blindness, giving a frequency of 1.1%. There were 9 men and 1 woman whom age range was 6 to 59 years (mean: 31.2 years). Intentional injury patients were significantly the most at risk of blindness (P = 0.02). In all the patients, the fracture involved at least 1 of the orbit walls. Risk of blindness was significantly higher in naso-fronto-orbito-ethmoidal complex fractures (P = 0.03). The vision loss was recorded in 13 eyes (unilateral in 7 patients and bilateral in 3). Its predominant mechanism was a globe rupture or perforation, recorded in 8 eyes. A treatment with intention to improve the vision was attempted in 1 patient only. None of the patients had vision recovery. DISCUSSION The findings of this study commend comprehensive ophthalmologic evaluation in any patient with an orbit wall fracture.
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Agam MS, Zada G. Complications Associated With Transsphenoidal Pituitary Surgery: Review of the Literature. Neurosurgery 2018; 65:69-73. [PMID: 31076790 DOI: 10.1093/neuros/nyy160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/04/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew S Agam
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California
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Thurston TE, Jackson AS, Nazir N, Crowe D, Andrews BT. Risk Assessment of Isolated Single-Wall Orbit Fractures and Eye Injury: . J Craniofac Surg 2018; 29:943-5. [DOI: 10.1097/scs.0000000000004412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Stathopoulos P, Igoumenakis D, Mezitis M, Rallis G. Blindness after facial trauma: epidemiology, incidence and risk factors: a 27-year cohort study of 5708 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:129-133. [PMID: 29673800 DOI: 10.1016/j.oooo.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This was a 27-year study of a cohort of 5708 patients who had sustained maxillofacial fractures. Our purpose was to present the etiology, mechanism of trauma, site, and concomitant injuries that led to visual loss. We hypothesize that fractures caused by high-energy impact of the midface may be associated with blindness. A discussion of the treatment approaches is also included. STUDY DESIGN The study included 5708 patients who had sustained a maxillofacial fracture during the years 1985-2012. Patients' records were reviewed for gender, age, fracture site, etiology of trauma, concomitant injuries, method of treatment, length of hospital stay, and cause of blindness. The relationship of the above variables to blindness was investigated. RESULTS The incidence of loss of vision was 0.34%. A very strong association between firearm injuries and blindness was observed (P < .001). These patients spent much longer time in hospital (P < .01) and suffered serious concomitant injuries involving the brain. CONCLUSIONS Retrobullbar hemorrhage should be treated with lateral canthotomy, whereas in traumatic optic neuropathy, observation seems to be the safest thing to do. In patients with penetrating injuries of the globe, the immediate involvement of an ophthalmic surgeon is of paramount importance.
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Affiliation(s)
- Panagiotis Stathopoulos
- Dublin Dental University Hospital, Consultant Oral and Maxillofacial Surgeon St James and Mater Hospital, Dublin, Ireland.
| | | | - Michalis Mezitis
- Consultant Oral and Maxillofacial Surgeon, KAT General Hospital of Athens, Athens, Greece
| | - George Rallis
- Consultant Oral and Maxillofacial Surgeon, KAT General Hospital of Athens, Athens, Greece
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Etemadi Sh M, Shahnaseri S, Soltani P, Kalantar Motamedi MR. Management of Naso-Orbito-Ethmoid Fractures: A 10-Year Review. Trauma Mon 2016; In press. [DOI: 10.5812/traumamon.29230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Huempfner-Hierl H, Bohne A, Wollny G, Sterker I, Hierl T. Blunt forehead trauma and optic canal involvement: finite element analysis of anterior skull base and orbit on causes of vision impairment. Br J Ophthalmol 2015; 99:1430-4. [PMID: 26089215 DOI: 10.1136/bjophthalmol-2015-306646] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/04/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical studies report on vision impairment after blunt frontal head trauma. A possible cause is damage to the optic nerve bundle within the optic canal due to microfractures of the anterior skull base leading to indirect traumatic optic neuropathy. METHODS A finite element study simulating impact forces on the paramedian forehead in different grades was initiated. The set-up consisted of a high-resolution skull model with about 740 000 elements, a blunt impactor and was solved in a transient time-dependent simulation. Individual bone material parameters were calculated for each volume element to increase realism. RESULTS Results showed stress propagation from the frontal impact towards the optic foramen and the chiasm even at low-force fist-like impacts. Higher impacts produced stress patterns corresponding to typical fracture patterns of the anterior skull base including the optic canal. Transient simulation discerned two stress peaks equalling oscillation. CONCLUSIONS It can be concluded that even comparatively low stresses and oscillation in the optic foramen may cause micro damage undiscerned by CT or MRI explaining consecutive vision loss. Higher impacts lead to typical comminuted fractures, which may affect the integrity of the optic canal. Finite element simulation can be effectively used in studying head trauma and its clinical consequences.
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Affiliation(s)
- Heike Huempfner-Hierl
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Alexander Bohne
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Gert Wollny
- Biomedical Imaging Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Ina Sterker
- Department of Ophthalmology, Leipzig University Hospital, Leipzig, Germany
| | - Thomas Hierl
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
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Mehravaran R, Akbarian G, Nezhad CM, Gheisari R, Ziaei M, Zadeh FG. Evaluation of the relationship between the pattern of midfacial fractures and amaurosis in patients with facial trauma. J Oral Maxillofac Surg 2013; 71:1059-62. [PMID: 23566693 DOI: 10.1016/j.joms.2013.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/25/2012] [Accepted: 01/07/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the relation between patterns and numbers of midfacial bone fracture patterns and amaurosis in traumatized patients. MATERIALS AND METHODS This is a cross-sectional study of traumatized patients with midfacial fractures who presented to Shahid Rajaee and Chamran hospitals (Shiraz, Iran) from 2010 through 2011. The predictor variable was midfacial fractures and the outcome variable was amaurosis. P < .05 was considered statistically significant. RESULTS The study was composed of 112 subjects. Prevalence of amaurosis was 6.25% (7 of 112). Le Fort III fracture was the only fracture pattern that had a significant association with amaurosis (P = .004). Nasoorbitoethmoid fracture was the second most correlative pattern, although this relation was not statistically significant. CONCLUSIONS This study showed a meaningful relation between Le Fort III fractures and amaurosis in patients with facial trauma. There was also a high prevalence of nasoorbitoethmoid fracture in blinded patients.
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Affiliation(s)
- Reza Mehravaran
- Department of Oral and Maxillofacial Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Kraft A, Abermann E, Stigler R, Zsifkovits C, Pedross F, Kloss F, Gassner R. Craniomaxillofacial trauma: synopsis of 14,654 cases with 35,129 injuries in 15 years. Craniomaxillofac Trauma Reconstr 2013; 5:41-50. [PMID: 23449961 DOI: 10.1055/s-0031-1293520] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 06/16/2011] [Indexed: 10/15/2022] Open
Abstract
Craniomaxillofacial (CMF) trauma occurs in isolation or in combination with other serious injuries, including intracranial, spinal, and upper- and lower-body injuries. It is a major cause of expensive treatment and rehabilitation requirements, temporary or lifelong morbidity, and loss of human productivity. The aim of this study was to evaluate patterns of CMF trauma in a large patient sample within a 15-year time frame. Between 1991 and 2005, CMF trauma data were collected from 14,654 patients with 35,129 injuries at the Department of Cranio-Maxillofacial and Oral Surgery in Innsbruck, assessing a plethora of parameters such as injury type and mechanism as well as age and gender distribution over time. Three main groups of CMF trauma were evaluated: facial bone fractures, dentoalveolar trauma, and soft tissue injuries. Statistical comparisons were carried out using a chi-square test. This was followed by a logistic regression analysis to determine the impact of the five main causes for CMF injury. Older people were more prone to soft tissue lesions with a rising risk of 2.1% per year older, showing no significant difference between male and female patients. Younger patients were at higher risk of suffering from dentoalveolar trauma with an increase of 4.4% per year younger. This number was even higher (by 19.6%) for female patients. The risk of sustaining facial bone fractures increased each year by 4.6%. Male patients had a 66.4% times higher risk of suffering from this type of injury. In addition, 2550 patients (17.4%) suffered from 3834 concomitant injuries of other body parts. In summary, we observed changing patterns of CMF trauma over the last 15 years, paralleled by advances in refined treatment and management options for rehabilitation and reconstruction of patients suffering from CMF trauma.
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Affiliation(s)
- Anna Kraft
- Department of Cranio-Maxillofacial and Oral Surgery
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