Leading causes of facial trauma in the major trauma outcome study

Demographic Discrepancies of Vitamin D Deficiency in Craniofacial Fracture Patients

Background

The relationship between craniofacial fracture and vitamin D status has not been studied. Given the important role vitamin D status plays in postfracture prognosis, a deep investigation into this relationship is due. The primary objective of this study was to assess the demographic discrepancies in the vitamin D status of patients with craniofacial fracture.

Methods

The Cerner Health Facts database was used to collect data on serum 25-hydroxyvitamin D, demographics, hospital admission and discharge, and fracture type of 76 craniofacial fracture patients with available vitamin D levels from October 2015 until May 2018. Pairwise Spearman Correlation was used for multivariate data analysis.

Results

Of the 76 craniofacial fracture patients identified, 55.3% were insufficient in vitamin D and 32.9% were deficient in vitamin D. Vitamin D deficiency and insufficiency were more common in women, African American individuals, and patients over 50 years of age.

Conclusions

The investigation revealed a high prevalence of vitamin D deficiency and insufficiency in craniofacial fracture patients. Despite the higher incidence of fractures in men and Caucasian individuals, women and African American individuals with craniofacial fractures had poorer vitamin D status. Clinicians should consider empiric vitamin D supplementation following craniofacial fracture in high-risk groups.

Delphi Method Consensus on Priority Global Otolaryngology-Head and Neck Surgery Conditions and Procedures

OBJECTIVE

The objective of this study was to develop an international expert consensus on priority otolaryngology-head and neck surgery conditions and procedures globally for which national health systems should be capable of caring.

STUDY DESIGN

The Delphi method was employed via a multiround online survey administered to attending otolaryngologists in an international research collaborative of >180 otolaryngologists in >40 countries.

SETTING

International online survey.

METHODS

In round 1, participants listed the top 15 otolaryngologic conditions and top 15 otolaryngology procedures for their World Bank regions. In round 2, participants ranked round 1 responses in order of global importance on a 5-point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as 50% of the round 2 Likert responses being ranked as "important" or "very important." Descriptive statistics were calculated for each round.

RESULTS

The survey was distributed to 53 experts globally, with a response rate of 38% (n = 20). Fifty percent (n = 10) of participants were from low- and middle-income countries, with at least 1 participant from each World Bank region. Ten consensus surgical procedures and 10 consensus conditions were identified.

CONCLUSION

This study identified a list of priority otolaryngology-head and neck surgery conditions and surgical procedures for which all national health systems around the world should be capable of managing. Acute and infectious conditions with preventative and emergent procedures were highlighted. These findings can direct future research and guide international collaborations.

Clinical Analysis and CT 3D-Mediated Precise Internal Fixation in Maxillofacial Fracture

BACKGROUND/PURPOSE

To retrospectively analyze the epidemiological features, clinical diagnosis, and treatment of 610 patients with maxillofacial fractures, while providing a reference for the prevention and optimized treatment of maxillofacial fractures.

METHODS

Data of patients with maxillofacial fractures who were treated and followed up at the Second People's Hospital of Kashi Prefecture from June 2012 to April 2018 were summarized. The epidemiological features, clinical manifestations, fracture sites, treatment methods, and results were analyzed.

RESULTS

The highest incidence was in the age range of 20 to 49 years. The main cause of fracture was traffic injury. Mandibular fractures accounted for 37.77%, zygoma and zygomatic arch fractures for 37.00%, and maxillary fractures for 21.19%. Atypical zygomatic arch fractures were more common in the maxilla, followed by Le Fort I and II fractures. Closed fractures accounted for 85.97%. Many (73.39%) patients were treated with computed tomography 3-dimensional (3D)-mediated precision modified incision internal fixation with satisfactory results.

CONCLUSIONS

There is a high incidence of maxillofacial fractures among young men, especially in summer, with the most common injuries being traffic-related injuries. The most common site is the mandible, followed by the zygomatic arch, zygomatic complex, and maxilla. Computed tomography 3D-mediated precision modified incision internal fixation can achieve satisfactory results.

Face Treatment Using Nonsurgical Mini-Invasive Techniques as Postsurgical Procedure for Traumatic Injury

BACKGROUND

Facial trauma can cause major psychological damage and compromise a patient's quality of life. Unfortunately, surgery cannot always solve this problem or provide an acceptable result.

OBJECTIVES

Treatment with injectables may provide a solution that is minimally invasive and better accepted by patients as a means to improve poor outcomes after facial trauma.

METHODS

This retrospective study involved 50 patients (29 men, 21 women) who underwent primary surgery to treat facial trauma between January 2015 and January 2017. Based on the facial area affected by poor outcomes (upper face, midface, and lower face), patients underwent ≥1 aesthetic medicine treatments with hyaluronic acid dermal fillers and botulinum toxin injections. To evaluate patient satisfaction and the effect of the treatment on quality of life, patients were asked to complete 2 questionnaires, POSAS and FACE-Q, prior to treatment and 90 days after the last treatment session.

RESULTS

Questionnaire scores indicated improvements in aesthetic and psychological metrics, perceived both by the patient and the observer.

CONCLUSIONS

Minimally invasive aesthetic treatments represent a valuable adjunct to surgical procedures for improving facial aesthetics after injury and consequently the quality of life of patients affected by facial trauma.

LEVEL OF EVIDENCE: 4

Occupational group, educational level, marital status and deleterious habits among individuals with maxillofacial fractures: retrospective study

Background

To investigate the occupational profile, educational level, marital status and deleterious habits to the health of patients with maxillofacial fractures of a population of northeastern Brazil.

Material and Methods

A retrospective study of patients records admitted to the Division of Oral and Maxillofacial Surgery at the Walter Cantídio University Hospital (Fortaleza, Brazil) who sustained maxillofacial fractures was conducted in the period between 2006 and 2015.

Results

A total of 338 patients rendered 355 fractures. Males were the most affected (p<0.001), with prevalence in the third decade of life (p<0.001). There was a predominance of motorcycle accidents (p<0.001), home workers (p<0.001), low educational status (p = 0.032), and no cigarette use (p<0.001) or alcohol (p = 0.023). Fractures of the zygomatic-orbital complex were the most prevalent in the sample (p<0.001).

Conclusions

The sociodemographic profile exerted a significant influence on the epidemiological profile of maxillofacial fractures in a Brazilian population during the study period.

Key words:Epidemiological studies, trauma, facial bones.

Traumatic Foreign Body into the Face: Case Report and Literature Review

This paper describes a case of mouth opening limitation, secondary to a facial trauma by cutting-piercing instrument, whose fragments had not been diagnosed in the immediate posttrauma care. Description of an unusual surgical maneuver and a literature review are presented.

Epidemiological profile of 277 patients with facial fractures treated at the emergency room at the ENT Department of Hospital do Trabalhador in Curitiba/PR, in 2010

Introduction: Epidemiological studies that focus on facial injuries are of great interest for the knowledge of occurrence and severity of presentation.

Aim: To study the epidemiological profile of 277 patients who suffered facial fractures at the Hospital do Trabalhador (HT), with an emphasis on variables such as sex, age, cause, and anatomical sites of fractures, comparing the clinical findings with other studies.

Method: Retrospective nonrandomized chart review of 277 patients who were treated at HT by the ENT service during the full year 2010, victims of facial fractures.

Results: Of 277 patients, 74.72% were male and 25.27% female (ratio 3:1). According to age, the fractures were distributed as follows: 0–9 years: 4.69%, 10–19 years: 17.32%, 20–29 years: 23.82%, 30–39 years: 20.21%, 40–49 years: 16.24%, 50–59 years: 10.83%, 60–69 years: 3.97%, and 60–79 years: 2.88%. The cause of trauma was most frequently interpersonal violence, 36.45%, followed by falls, 23.09%, and motor vehicle crashes with 17.32%. Regarding location, nasal fracture was the most common, with 44.75%, followed by the mandible, 14.32%, orbit, 12.78%, maxillary, 12.02%, zygomatic, 9.97%, 3.32% and front Le Fort 2.88%.

Conclusion: The patients were mostly males, aged 21–30 years, victims of aggression with the most commonly fractured bone being the nose. The adoption of personal and public strategies and measures may prevent facial fractures.

Epidemiological survey of head and neck injuries and trauma in the United States

OBJECTIVE

Head and neck trauma results in a range of injuries, spanning minor lacerations to life-threatening airway compromise. Few studies provide in-depth analysis of injuries to the head and neck (HN). We aim to (1) describe HN injury prevalence in the US and (2) investigate patient disposition and the outcome of mortality.

STUDY DESIGN

Case series with chart review.

SETTING

Nationwide emergency department (ED) sample.

METHODS

The 2011 database was queried for encounters with a primary diagnosis of HN injury, as categorized by the Barell Injury Matrix. Weighted estimates for demographics, injury category, and mechanism were extracted. Predictors of mortality and admission were determined by multivariable regression.

RESULTS

We identified 131 million ED encounters. A weighted total of 5,418,539 visits were related to primary HN injuries. Average age was 30 (SE = 0.4), and 56.8% were male. Sixty-four percent of injuries were attributed to fall or blunt trauma. Open wounds comprised 41.8% of injuries. The most common procedure was laceration repair (70%). The majority of patients (97%) were discharged home. Mortality rate was less than 1%. Predictors of admission and mortality (P < .05) included multiple trauma, vessel trauma, and burns. Other risk factors included foreign-body, older age, and male gender.

CONCLUSIONS

Primary HN injuries commonly present to emergency rooms in the US. The majority of HN injuries are non-life threatening and do not require admission to the hospital or result in death. These data have implications for HN injury surveillance and may be used to risk-stratify patients who present with injuries in the acute care setting.

Concomitant dental injuries in maxillofacial fractures - a retrospective analysis of 1219 patients

BACKGROUND/AIM

Traumatic dental injuries are frequently combined with maxillofacial fractures, but literature addressing this topic is rare. In a retrospective study, the frequency of dental lesions in inpatients with traumatic facial injuries was analyzed.

MATERIAL AND METHODS

All patients referred to the Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University Mainz for inpatient treatment due to facial fractures between January 2001 and December 2007 were analyzed regarding the type of fracture, its localization, and potential concomitant dental injuries. In addition a systematic review was performed to compare the findings of this study with existing data.

RESULTS

Altogether 1219 facial trauma patients underwent inpatient treatment. 184 (15.87%) out of those had 451 injured teeth, and 4.9% were edentulous. The most frequent causes were assaults (25.1%), followed by falls (19.6%) and bike accidents (10.1%). Avulsion, especially of the upper incisors, occurred in most cases (27.9%). Assaults caused 1.29 dental fractures per patient, while traffic-related accidents led to three to four times higher injury-rates.

CONCLUSIONS

With almost every sixth patient having at least one kind of dental injury, this study shows that a thorough anamnesis and examination of the dental status are absolutely necessary, especially in patients who suffered from high-speed impacts or collisions with low-resilience surfaces.

Maxillofacial fractures in the province of Latina, Lazio, Italy: review of 400 injuries and 83 cases

A retrospective study was performed to assess maxillofacial fractures in patients treated at the public "S.M. Goretti Hospital" hospital from 2011 to 31/8/2012. Data were prospectively recorded including age and sex, cause and mechanisms of injury, soft tissue injuries, dentoalveolar trauma, facial bone fractures and type of treatment. The pre-surgical and post-surgical hospitalization days were also analysed. Causes were grouped into five categories: road traffic collision, sports accidents, occupational accidents, assaults and domestic accidents. The analyses involved descriptive statistics. Records from 83 patient sustaining 95 maxillofacial fractures were evaluated. The zygoma was the most fractured anatomical site in both males and females, accounting for 32% of injuries, followed by isolated fracture of the orbital floor (blow-out and blow-in) with 11%. The age group between 18 and 39 years showed the highest rate of incidence of maxillofacial fractures. Men were more involved than women in all cases with a male:female ratio of 5,4:1. Accidents were the most frequent cause of maxillofacial fractures in the age group between 18 and 39 years and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 and 59 years. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Road traffic collisions were the main aetiologic factor associated with maxillofacial trauma.

Pattern of Assault-induced Oral and Maxillofacial Injuries in Ado-Ekiti, Nigeria

Background:

Assault, though a major cause of maxillofacial injuries in the developed nations, has not been adequately investigated among Nigerian population. This study aimed to analyze the pattern of maxillofacial injuries caused by assault in our institution.

Methods:

A descriptive clinical survey of patients with assault-induced oral and maxillofacial injuries presenting to our maxillofacial surgery clinic/emergency ward was carried out. Demographic data and pattern of injuries obtained from patients’ record and department trauma database were analyzed.

Results:

156 patients presented with oral and maxillofacial injuries between October 2009 and December 2010. Thirty-four cases were due to assault and male to female ratio was 1.8:1. The mean age of the patients was 21.4±6.26 years (age range 2–48 years). 23.6% (n=8) of the injuries were due to domestic violence between spouses while 35.3% (n=12) resulted from fight. Students unrest and armed robbery attack accounted for six cases each (17.7%, n=6), while there were two cases due to child battering. 64.3% (n=22) of the injuries sustained involved soft tissues while 35.7% involved hard tissues. Contusion was the most common isolated soft tissue injury accounting for 56% (n=10) while dentoalveolar fracture was the most encountered hard tissue injury (62.5%, n=16).

Conclusion:

There is need for preventive strategies to reduce the incidence of assault-induced maxillofacial injuries.

The use of Portland cement in the repair of mandibular fractures in rats

PURPOSE

To evaluate the bone healing of mandibular fractures following the use of Portland cement.

METHODS

Thirty-two male Wistar rats were divided into control and experimental groups. In the control group the rats were submitted to a mandibular fracture, which was reduced, and the soft tissues were sutured. In the experimental group the rats had the mandibular fracture reduced and maintained with the Portland cement. The animals were euthanized 7 and 21 days after surgery by injecting a lethal dose of anesthetic. The following variables were studied: weight of the animals, radiographic images, histopathological features and time of surgery.

RESULTS

A weight loss was observed in the specimens of both groups at the different times of evaluation, a greater difference in weight before and after surgery being found in the experimental group, which was statistically significant (p <0.05, p = 0.041). From the histological point of view, with a margin of error (5.0%) the only two significant differences (p <0.05) recorded in the variables were "Material deployed" and "Bone resorption" during the evaluations at 7 and 21 days, respectively.

CONCLUSION

The Portland cement served to promote bone healing.

Maxillofacial injuries in the Wenchuan earthquake

BACKGROUND

We retrospectively analyzed the characteristics and treatment of maxillofacial injuries in the patients who were victims of the Wenchuan earthquake on May 12, 2008 to improve the maxillofacial injuries database and provide reference on patients' treatment after earthquake.

METHODS

We investigated 2944 cases by talking with the patients during the first 1 and half months after the earthquake and analyzed the results.

RESULTS

Of the 2944 patients, 419 (14%) patients had maxillofacial injuries (man:woman, 1:1.07; mean age, 41.3 years old). Approximately 52% of the patients were injured by pressure and burying. Soft tissue injuries (91%) were considerably more prevalent than facial fractures (14%) and dentoalveolar injuries (17%). Of the patients with facial fractures, the numbers of cases of midface fracture (32 patients) were similar to the number of lower face fractures (31 patients). The most vulnerable bone regions were nasal-orbital-ethmoid bone (58.6%) and zygomatic bone (51.7%). Three hundred sixty patients (86%) demonstrated associated injuries, of which extremity injuries were the most prevalent. Ninety-two patients (22%) had wound infections, but only four patients (1%) had a general infection. Of the patients with maxillofacial injuries, only 77 patients (18.4%) received prehospital treatment.

CONCLUSION

Our analysis of the characteristics of maxillofacial injuries after the Wenchuan earthquake may improve our emergency treatment procedures in future disaster situations.

The design and implementation of chinese maxillofacial trauma registry, analysis and injury severity score system

BACKGROUND

: The aim of this study was to develop a tool which can be used to do a collaborative and prospective survey on the epidemiologic characteristics, treatment and outcome of maxillofacial trauma in China and to ameliorate the existing score and treatment methods of maxillofacial trauma.

METHODS

: Chinese Maxillofacial Trauma Registry, Analysis and Injury Severity Score System were developed. Functional modules of this system include clinical data, user management, data inspection, data retrieval, statistic analysis, follow-up survey, injury severity score, system maintenance. The Client/Server and Browser/Server database structure were applied to achieve telematic. The Abbreviated Injury Scale code rules of facial region were revised in detail to embody the characteristics of maxillofacial trauma. Maxillofacial Injury Severity Score (MISS) was designed to evaluate the severity of function derangement in maxillofacial trauma. Thousand nine hundred fifty-nine patients with facial injuries were classified into different groups by the number of fractures and site of injuries. The severity of different groups were evaluated with Injury Severity Score (ISS), Revised Facial Injury Severity Score (RFISS) and MISS, respectively. The results of ISS, RFISS, and MISS were statistically analyzed.

RESULTS

: By distributed applying of the system, the survey networks of Chinese maxillofacial trauma had been founded. The classification of trauma etiology, injury type, and severity were meliorated. With the help of the system, the input, management, retrieval and statistically analysis of maxillofacial trauma data can be conveniently and accurately accomplished. Furthermore, the ISS, RFISS, and MISS can be automatically calculated and analyzed according to the code rules of Abbreviated Injury Scale and Revised Abbreviated Maxillofacial Injury Scale.

CONCLUSION

: The system has satisfactory stability, security, compatibility, and specialty. It can be used to collect standard cases of maxillofacial trauma and to do a collaborative research on the epidemiologic characteristics, treatment, and outcome of facial injuries. MISS is more accurate, objective, and credible than ISS and RFISS in reflecting the severity of maxillofacial trauma and evaluating the curative effect and prognosis.

Perfil epidemiológico do trauma de face dos pacientes atendidos no pronto socorro de um hospital público

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.

Trends in the Use of CT and Radiography in the Evaluation of Facial Trauma, 1992–2002: Implications for Current Costs

OBJECTIVE

CT has replaced conventional radiography of the face in many trauma centers. Concern exists that increased costs are associated with increased use of CT. Our goal was to compare the amount of CT and radiography performed for facial trauma at a level 1 trauma center in 1992 and in 2002 and to determine hospital costs for the imaging of these patients.

MATERIALS AND METHODS

The changes in volume and types of facial imaging examinations were determined comparing 1992 and 2002. Hospital costs of different imaging examinations were determined for 2002. Current costs of imaging facial trauma were compared with what 2002 costs would have been if the practice pattern in 1992 had continued.

RESULTS

In 1992, 890 patients were evaluated for facial trauma. Six hundred seventy-one had only radiography, 153 only CT of the face, and 66 both CT and radiography. In 2002, 828 patients were evaluated. Five hundred eighty-four patients had only CT of the face; 228, only radiography; and 16, both CT and radiography. The number of facial imaging examinations per patient in 1992 and 2002 was 1.23 and 1.03, respectively. The 2002 hospital cost of a facial CT examination was $121 and of a facial radiography series was $154. Using CT instead of radiography for evaluating facial injury resulted in an overall cost savings of 22% per patient in 2002.

CONCLUSION

The availability of CT has not resulted in increased use of facial imaging. The increased use of CT from 1992 to 2002 results in decreased current costs for the hospital.

Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries

INTRODUCTION

Cranio-maxillofacial trauma management requires pertinent documentation. Using a large computerized database, injury surveillance and research data describe the whole spectrum of injuries. The goal of this study was to assess the effect of the five main causes of accidents resulting in facial injury on the severity of cranio-maxillofacial trauma.

PATIENTS AND METHODS

During a period of 10 years (1991-2000) 9,543 patients were admitted to the Department of Oral and Maxillofacial Surgery, University Hospital of Innsbruck with cranio-maxillofacial trauma. Data of patients were prospectively recorded including cause of injury, age and gender, type of injury, injury mechanisms, location and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures and concomitant injuries. Statistical analyses performed included descriptive analysis, chi square test, Fisher's exact test, and Mann-Whitney's U test. This was followed by logistic regression analyses for the three injury types to determine the impact of the five main causes on the type of injury at different ages in facial trauma patients.

RESULTS

Five major categories/mechanisms of injury existed: in 3,613 (38%) cases it was activity of daily life, in 2991 (31%) sports, 1170 (12%) violence, in 1,116 (12%) traffic accidents, in 504 (5%) work accidents and in 149 (2%) other causes. A total of 3,578 patients (37.5%) had 7,061 facial bone fractures, 4,763 patients (49.9%) suffered from 6,237 dentoalveolar, and 5,968 patients (62.5%) from 7,769 soft tissue injuries. Gender distribution showed an overall male-to-female ratio of 2.1 to 1 and the mean age was 25.8+/-19.9 years; but both varied greatly depending on the injury mechanism (facial bone fractures: 35.4+/-19.5 years, higher risk for males; soft tissue injuries: 28.7+/-20.5, no gender preference; dentoalveolar trauma: 18+/-15.6, elevated risk for females). For patients sustaining facial trauma, logistic regression analyses revealed increased risks for facial bone fractures (225%), soft tissue lesions (58%) in patients involved in traffic accidents, and dental trauma (49%) during activities of daily life and play accidents. When compared with other causes, the probability of suffering soft tissue injuries and dental trauma, but not facial bone fractures, is higher in sports-related accidents, 12 and 16%, respectively.

CONCLUSION

This study differentiated between injury mechanisms in cranio-maxillofacial trauma. The specially trained surgeons treating cranio-maxillofacial trauma are the primary source of information for the public and legislators on implementing preventive measures for high-risk activities. In facial trauma, older persons are prone to bone fractures (increase of 4.4%/year of age) and soft tissue injuries (increase of 2%/year of age) while younger persons are more susceptible to dentoalveolar trauma (decrease of 4.5%/year of age).

Facial trauma and the risk of intracranial injury in motorcycle riders

STUDY OBJECTIVE

We describe the associations among facial fracture, helmet use, skull fracture, and traumatic brain injury in injured motorcycle riders.

METHODS

The study population consisted of 5,790 motorcycle riders who sustained an injury from a crash in 1991, 1992, or 1993 and were identified from emergency department or hospital records in 28 hospitals in 11 California counties. Diagnostic information was abstracted from ED or hospital records and coded to the 1990 Abbreviated Injury Scale. The risk of traumatic brain injury was examined by using odds ratios and 95% confidence intervals. Logistic regression analysis was used to examine the associations among helmet use, skull fracture, facial fracture, and traumatic brain injury.

RESULTS

Facial injury was diagnosed in 24.4% of all injured riders, including 411 with one or more facial fractures. The odds of traumatic brain injury were 3.5 times greater with than without a facial injury and 6.5 times greater with a facial fracture than with no facial injury. Significantly increased odds of traumatic brain injury were observed for fracture of all bones of the face, but the highest odds of traumatic brain injury were found in riders with fractures to bones of the upper face. Helmet use status and the presence of skull fracture were found to be significant effect modifiers. Facial fracture with concurrent skull fracture increased the risk of traumatic brain injury dramatically. Facial fractures are more strongly associated with traumatic brain injury in helmeted riders.

CONCLUSION

The presence of facial fractures increases the risk of traumatic brain injury. Riders with facial fractures should be screened for brain injury, regardless of helmet use status.

Prevalence of dental trauma in 6000 patients with facial injuries: implications for prevention

OBJECTIVE

In contrast to epidemiologic studies on facial injuries reporting on dental trauma, facial bone fractures with dentoalveolar injuries, or soft tissue injuries individually, the purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation of the impact of sport, work, violence, traffic, household, and play accidents in the relationships among dental trauma, facial trauma, and other concomitant trauma. Finally, preventive considerations are discussed.

STUDY DESIGN

Six thousand patients registered at the University Hospital of Innsbruck's Department of Oral and Maxillofacial Surgery during a period of 6 years 4 months were admitted for dental trauma, facial trauma, or both. Records were analyzed for cause of injury, age, gender, monthly distribution, frequency, type of injury, and frequency of dental trauma in relation to facial injuries and concomitant injuries.

RESULTS

The incidence of dental injuries with respect to the total number of facial injuries was as follows: 57.8% in play and household accidents, 50.1% in sports accidents, 38.6% in accidents at work, 35.8% in acts of violence, 34.2% in traffic accidents, and 31% in unspecified accidents. The overall incidence revealed was 48.25%.

CONCLUSION

Our findings support the fact that in the mosaic of traumatic injuries, the frequencies of tooth trauma and its sequelae are underestimated and that such trauma and sequelae occur without a predictable pattern of intensity and extensiveness. Preventive approaches are the sole way to minimize the number of these injuries. Substantial progress made in treating facial and dental trauma in the last 2 decades only improves functional and esthetic outcomes among the population that has suffered dental injury.

Epidemiologic features of facial injuries among motorcyclists

STUDY OBJECTIVE

To describe the extent, nature, and severity of facial injuries among motorcyclists injured in a crash requiring hospital treatment.

METHODS

The study population consisted of 5,790 motorcycle riders who sustained a nonfatal crash injury during 1991, 1992, or 1993 in 10 California counties. The injured riders were identified in 28 hospitals during 1991 and 1992 and in 18 of these 28 hospitals in 1993. Information was collected from crash reports and hospital records. All injuries were coded according to the 1990 Abbreviated Injury Scale.

RESULTS

Facial injury was present in 24.3% of injured riders, a high proportion of them young men. Among riders wearing helmets, 36.8% had facial injuries, compared with 53.8% of those not wearing helmets. Soft tissue injuries and facial fractures were present in 72% and 22% of the injured, respectively. The maxilla (22%), orbit (16%), and nasal (16%) bones were the most frequently fractured facial bones. The frequency of multiple facial injuries, severity of facial injuries, and incidence of high-severity facial fractures was greater among nonhelmeted riders compared with helmeted riders. Upper facial fractures were more common among riders without helmets compared with those wearing helmets.

CONCLUSION

This study provides evidence of the protective value of helmets to reduce risk of facial injury. Information on the positive effect of facial injury sparing provided by helmet use should be incorporated into helmet promotion programs.