The causes and consequences of maxillofacial injuries in elderly people

A multicentric prospective analysis of maxillofacial trauma in the elderly population

BACKGROUND/AIMS

The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world.

METHODS

The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non-parametric and association tests, as well as linear regression.

RESULTS

Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2-7.2). Statistical analysis showed that women were more involved in fall-related trauma compared with males (p < .001). It was also shown that road traffic accidents cause more fractures in the lower third (p < .001) and in the middle third-lower third complex compared with upper third (p < .001).

CONCLUSIONS

Maxillofacial fractures in the elderly were more frequent in European and Australian centres and affected men slightly more than women. Falls were the leading cause of fractures, especially among women. The middle third of the face was most often affected, and conservative treatment was the most common choice for the management of such patients.

Epidemiology of maxillofacial soft tissue injuries in an oral emergency department in Beijing: A two-year retrospective study

BACKGROUND/AIMS

Maxillofacial soft tissue injuries (STIs) may differ in epidemiological characteristics from other maxillofacial injuries. The aim of this study was to investigate the epidemiology of maxillofacial STIs in a public oral emergency department in Beijing, China, from 2017 to 2018.

MATERIAL AND METHODS

In this retrospective study, 5949 patients with maxillofacial STIs and complete medical records were evaluated. Gender, age, etiology, visit date and time, interval between accident and treatment, anatomic injury site, treatment modality, and the number of associated maxillofacial bone fractures or tooth injuries were analyzed.

RESULT

There were 3831 males and 2118 females (ratio 1.81:1). Patients younger than 10 years were the most frequently seen group (44.2%). Among adults, 20- to 29-years-old (16.2%) was the most prominent age group. The month of May (11.8%) had the highest incidence of maxillofacial STIs, and February (4.5%) had the lowest incidence. The average number of daily visits was significantly higher on holidays than on workdays. Of the 5949 patients, 45.9% attended at night, 2021 patients had dental trauma, and 31 had jaw fractures. The lips were the most common site of STIs, followed by the chin and gingiva. Lip and gingival STIs were more common in the 0- to 10-years-old group. Chin STIs were more common in the 20- to 39-years-old group. A fall was the leading cause of injury, especially in patients younger than 10 years and older than 70 years. Approximately 56.7% of the falls resulted in injuries to the lower one-third of the face. Sports injuries were more common among 10- to 29-years-old individuals.

CONCLUSION

STIs of the maxillofacial region were most likely to occur at night, in May and during holidays. Males, children younger than 10 years and 20- to 29-years-old adults were high-risk populations. Most maxillofacial STIs involved the lips, and one-third of the patients had dental trauma.

Is Decreased Local Bone Quality an Independent Risk Factor for Complications Following Fracture Fixation of Facial Bones

PURPOSE

Although osteoporosis is associated with increased risks of complications of fracture fixation in the orthopedic literature, the association between local bone quality (LBQ) and complications of facial fracture fixation is unknown. The authors aim to identify that if decreased LBQ is an independent risk factor for complications following facial fracture fixation?

METHODS

The authors conducted a prospective cohort study on patients over age of 50 years who underwent open reduction and rigid internal fixation for facial fractures. The primary predictor was LBQ (low or normal), decided by a combination of 3 panoramic indices. Other predictors included age, gender, body mass index (BMI), comorbidities, trauma-related characteristics, etc. The outcome variable was the presence of hardware-related, fracture-healing, wound, or neurosensory complications during 2-year follow-up. Univariate and multivariate regressions were performed to identify any significant association between predictor and outcome variables.

RESULTS

The sample was composed of 69 patients (27 females) with an average age of 58.6 ± 8.6 years and BMI of 25 ± 3.8. Low-LBQ patients were significantly older, more females, had lower BMI, mainly injured from falls, had more complications compared to their normal-LBQ counterparts. However, multivariable logistic regressions demonstrated that only age (adjusted OR: 1.12, P = 0.031, 95% CI: 1.01, 1.23) and diabetes (adjusted OR: 12.63, P = 0.029, 95% CI: 1.3, 122.53) were significantly associated with overall complications after confounding adjustment.

CONCLUSIONS

The results of the present study indicate that reduced LBQ is not an independent risk factor for complications following facial fracture fixation. The increased risk of complications in low-LBQ patients is more likely to be attributed to other age-related comorbidities such as diabetes. Therefore, the authors recommend detailed workup and good control of comorbidities in elderly trauma patient.

Maxillofacial Trauma in Geriatric Population

BACKGROUND/AIM

The worldwide population is increasingly aging. Maxillofacial fractures of the geriatric population have been increased. Evaluation of the demographic variables, causes and the patterns of maxillofacial traumas in the elderly population is the main aim of this study.

MATERIALS AND METHODS

Seven hundred thirteen maxillofacial tomography images which were scanned between 2010 and 2019 were evaluated. Data from 50 patients aged 65 years old and/or older, who were treated for maxillofacial fracture at the Department of Otorhinolaryngology, Gaziantep University, were retrospectively analyzed. Two groups were created according to the facial fracture pattern. Facial fractures were reclassified into 2 groups; mandibula, orbital, zygomaticomaxillary complex group fractures and the other group of frontal, naso-orbito-ethmoid fractures and were used as a comparison.

RESULTS

The mean age of the patients was 72.5 (min 65- max 93). The gender distribution was 17 females (34%) and 33 males (66%). The most common fractured bone was the nasal bone and the least one is the frontal bone. Approximately one-quarter of 50 fractures were seen in 70 to 79 years old. Falling is more common in females and men are more prone to work-related accidents than home-related accidents.

CONCLUSION

Facial fractures in the elderly often seen in midface location. Falling is the common etiology of facial fracture in all genders at elderly. However, male dominance is seen in other etiological factors. Additional diseases in the elderly seem to increase the severity of facial fracture.

Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population

OBJECTIVE

To assess the prevalence and surgical treatment of facial fractures in a Swiss population aged 65 and over.

BACKGROUND

The knowledge of the characteristics of geriatric trauma may help to prevent injuries and better allocate clinical resources for the management of multimorbid patients.

MATERIAL AND METHODS

This study retrospectively evaluated a cohort of 181 patients who presented at the Bern University Hospital in Switzerland from May 2012 to September 2016. Data on age, gender, aetiology and type of trauma, treatment and complications, co-morbidities and associated injuries were obtained.

RESULTS

Women were most frequently affected (55.2%). Mean age was 80 years. Zygomatic complex fractures were the most frequent type of fractures (37%), followed by isolated orbital fractures (27.6%). Falls were the most common cause of trauma (76.1%). Thirty-five per cent of all patients were taking anticoagulation or platelet aggregation medication. Hospitalisation was required in 88.4%, whereby 92.3% of the patients underwent surgical treatment. Surgery had to be performed immediately in three cases to treat compression of the optic nerve. Median hospital length of stay was 4 days, with 68% of patients returning to a domestic environment and 32% being transferred to another institution for further treatment.

CONCLUSION

The most common cause of facial injuries is a fall while standing in a domestic environment. Midface fractures were the most common type of fractures.

A Retrospective Review of Facial Fractures in Wales

Facial fractures are the third most common type of fracture, with the nose most frequently involved. In the United Kingdom, their incidence is rising among young males particularly, and recent reports suggest that nasal injuries in females are becoming more common, which is attributed to “ladette” culture. The aim of this study was to investigate if there is any correlation in Wales with the rise in female facial fractures reported in England. A retrospective analysis of National Health Service Wales Informatics Service data (NHS WIS) shows that facial fractures were more likely to occur in males, in their teens or twenties, most commonly caused by assault and linked to alcohol consumption in this demographic. The most common cause of facial fracture in Wales was due to an accident which differs from England. The overall number of facial fractures in both males and females did not change significantly. It may be that the binge drinking culture is not as prevalent in Wales as it is in England. The reasons for this may be mutifactorial, reflecting geographical, cultural and socio-economic factors. Our findings do not correlate with the literature regarding the epidemiology of facial fractures. We suggest that binge drinking and “ladette culture” is not seen as commonly in Wales from the point of view of the ill effects of alcohol consumption.

Epidemiology of facial fractures in the elderly

Facial fractures are considered more common in young individuals. However, they are also increasing in the aging population. Investigation of the characteristics of such fractures is important so as to be able to devise preventive measures and specifications for their proper treatment. We carried out a descriptive retrospective epidemiological study. The information was taken from a database of medical files of patients over 65 years of age in the setting of the emergency ward. Patient information was included for 157 patients aged 65 to 100 years. Two-thirds of the individuals with facial trauma were women. Twenty-eight had a prior history of cognitive impairment. For half of the cases, the trauma occurred at their place of residence, while accidents and falls in public areas were not uncommon. The most frequent site for the fractures was the middle third of the face. These facial fractures were serious in light of their location, as well as the associated skeletal and intracranial lesions. The number of such fractures can be expected to increase with time. Their hospital cost is higher than with younger individuals. Preventative measures need to be devised and the treatment should be all-encompassing.

Interpersonal Violence Is Associated With Increased Severity of Geriatric Facial Trauma

PURPOSE

The geriatric population is rapidly increasing in number with increased demand on health care resources including those spent on the treatment of maxillofacial trauma. The purpose of this analysis was to investigate the independent and cumulative associations between potential risk factors (age, gender, mechanism of injury, drug use, and alcohol use) for and the severity of geriatric facial trauma.

METHODS

This was a cross-sectional analysis of secondary data of geriatric (individuals aged ≥65 years) facial trauma using the Allegheny General Hospital Trauma Registry database. Data were collected for diagnosis codes that reflected facial trauma (International Classification of Diseases, Ninth Revision codes 802.0 to 802.9, 800.1 to 801.9, and 803.0 to 804.9) and specific mechanisms of injury (E810 to E819, motor vehicle traffic accidents; E880 to E888, accidental falls; and E960 to E969, injury purposely inflicted by other persons). The Facial Injury Severity Scale (FISS) is a validated measurement that was used to determine the severity of the facial trauma and calculated through analysis of the abstracted data obtained from the trauma registry and patient records. Pearson correlations, 2-way independent t test, 1-way analysis of variance, and multiple linear regression were used to test hypotheses for independent and cumulative associations between the risk factors for and the severity of geriatric facial trauma. Statistical significance was set at the P < .05 level.

RESULTS

The sample was composed of 229 patients with a mean age of 72.3 ± 4.5 years. A statistically significant association between mechanism of injury and the severity of geriatric facial trauma (P = .019) was found. Specifically, interpersonal violence (assault) was associated with the greatest facial trauma severity (FISS score, 4.2) when compared with motor vehicle collisions (FISS score, 2.2; P = .011) and falls (FISS score, 2.4; P = .016).

CONCLUSIONS

Interpersonal violence (assault) is associated with increased severity of geriatric facial trauma compared with other risk factors.

Analysis of 126 hospitalized elder maxillofacial trauma victims in central China

Background

The aim of this study was to analyzed the characteristics and treatment of maxillofacial injuries in the elder patients with maxillofacial injuries in central China.

Material and Methods

We retrospectively analyzed the characteristics and treatment of maxillofacial injuries in the patients over the age of 60 to analyze the trends and clinical characteristics of maxillofacial trauma in elder patients from the First Affiliated Hospital of Zhengzhou University (from 2010 to 2013) in central China and to present recommendations on prevention and management.

Results

Of the 932 patients with maxillofacial injuries, 126 aged over 60 years old accounting for 13.52% of all the patients (male:female, 1.74:1; mean age, 67.08 years old). Approximately 52% of the patients were injured by falls. The most frequently observed type of injuries was soft tissue injuries (100%), followed by facial fractures (83.05%). Of the patients with soft tissue injuries, the abrasions accounted the most, followed by lacerations. The numbers of patients of midface fracture (60 patients) were almost similar to the number of lower face fractures (66 patients). Eighty two patients (65.08%%) demonstrated associated injuries, of which craniocerebral injuries were the most prevalent. One hundred and four patients (82.54%) had other systemic medical conditions, with cardiovascular diseases the most and followed by metabolic diseases and musculoskeletal conditions. Furthermore, the study indicated a relationship between maxillofacial fractures and musculoskeletal conditions. Only 13 patients (10.32%) sustained local infections, of whom had other medical conditions. Most of the facial injuries (85.71%) in older people were operated including debridement, fixing loose teeth, reduction, intermaxillary fixation and open reduction and internal fixation (ORIF).

Conclusions

Our analysis of the characteristics of maxillofacial injuries in the elder patents may help to promote clinical research to develop more effective treatment and possibly prevent such injuries.

Key words: Maxillofacial, trauma, elderly, characteristics, treatment.

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.

Traumatology of the facial skeleton in octogenarian patients: a retrospective analysis of 96 cases

AIM

The aim of this retrospective study was to evaluate the frequency and distribution of maxillofacial trauma patients over 80 years, with regard to type and environment of accidents as well as treatment and complications.

PATIENTS AND METHODS

Data for 94 patients (96 cases; aged 80-94 years) with maxillofacial fractures were retrospectively analysed.

RESULTS

Data of 30 male and 64 female patients with an average age of 85 years were analysed. In 90% of the study population, the cause of fractures was a fall, followed by traffic accidents (9%) and assault (1%). Seventy-two patients had fractures of the midface, 10 had factures of the mandible, 9 had fractures of both the midface and mandible and 5 had fractures of the neurocranium and midface. Surgical intervention was required in 57% of the patients. Post-operative complications were: four cases of diplopia, two cases of infected plates, four cases of lower eyelid ectropion and in one case a retrobulbar haematoma.

CONCLUSION

Facial trauma in the elderly can often be treated conservatively unless the patient complains of functional problems. Due to co-morbidities, special attention should be paid to hypertension, anticoagulant agents and the surgical approach.

Factors influencing the incidence of maxillofacial fractures

PURPOSE

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed.

METHODS

An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures.

RESULTS

From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma.

CONCLUSIONS

Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial fractures will be seen.

Orbital Fracture: Significance of lateral wall

The lateral orbital wall is the strongest among other orbital walls. However, it is commonly fractured in the setting of severe facial trauma. The fracture usually occurs at the sphenozygomatic suture line. In general, patients with lateral wall fractures are commonly young male who may present with mid facial swelling and some degree of deformity. In some cases, lateral orbital wall fracture may be associated with visual loss or change in mental status due to associated intracranial injury. Imaging studies with computed tomography is important in the proper diagnosis and planning of the surgical intervention. Management of intracranial or eye injuries should be undertaken on emergent basis. Thereafter, significantly displaced lateral wall fractures need to be repaired on timely basis. Proper realignment of the plane of the lateral orbital wall at the sphenozygomatic suture along with the other complex articulations of the zygomatic bone is necessary for proper functional and aesthetic outcome.

Influence of musculoskeletal conditions on oral health among older adults

Both musculoskeletal disorders and diseases of the oral cavity are common and potentially serious problems among older persons, yet little attention has been given to the links between them. Several musculoskeletal diseases, including osteoporosis, Paget's disease, and arthritic disorders, may directly involve the oral cavity and contiguous structures. Drugs used to treat musculoskeletal diseases, including corticosteroids and bisphosphonates, increase the risk of suppression of the immune system and osteonecrosis of the jaw, respectively. Many people with disabling osteoarthritis, rheumatoid arthritis, and other conditions have difficulty practicing good oral hygiene and traveling to dental offices for professional help. Various inexpensive measures can help such individuals, including education of their caregivers and provision of antimicrobial mouthwashes and special toothbrushes.

Falls in elderly people that result in facial injuries

Falls in elderly people are increasing. Injuries of the upper limb that result from a fall usually suggest that an outstretched hand was used to curb the fall. Conversely, maxillofacial injuries in elderly people may result from alterations in consciousness as a result of a pre-existing medical condition. We investigated the nature of falls in an elderly population and compared two cohorts of patients-those presenting with maxillofacial injuries, and those with isolated upper limb injuries, and there were 25 patients in each cohort. Comprehensive personal data and medical history were recorded together with details of the fall. We found a significant correlation between the nature of the injury and recollection of the event (P <0.01). Patients who sustain facial injuries are less likely to recall the event. This may be the result of the injury itself, but an underlying medical condition may have been responsible for the fall and should be excluded.