Maxillofacial haemorrhagic symptoms in emergency department patients: impact of antithrombotics

PURPOSE

To investigate the effect of antithrombotics on the occurrence of maxillofacial haemorrhagic symptoms, and to determine if these haemorrhagic symptoms are predictors of maxillofacial fractures.

METHOD

A prospective cohort study was conducted of consecutive patients with maxillofacial trauma who had been admitted to the emergency department of four hospitals in the Netherlands. This study compared five haemorrhagic symptoms (peri-orbital haematoma, raccoon eyes, epistaxis, subconjunctival ecchymosis, and intra-oral haematoma) between patients not-using (NUA) and using (UA) of antithrombotics, and whether these maxillofacial haemorrhagic symptoms served as predictors for maxillofacial fractures.

RESULTS

Out of the 1005 patients, 812 (81%) belonged to the NUA group, and 193 (19%) to the UA group. UA patients exhibited higher frequencies of peri-orbital hematoma (54% vs. 39%, p < 0.001), raccoon eyes (10% vs. 5%, p = 0.01), and subconjunctival ecchymoses (16% vs. 7%, p < 0.001). In NUA, peri-orbital hematoma (OR = 2.5, p < 0.001), epistaxis (OR = 4.1, p < 0.001), subconjunctival ecchymosis (OR = 2.3, p = 0.02), and intra-oral hematoma (OR = 7.1, p < 0.001) were significant fracture predictors. Among UA, peri-orbital hematoma (OR = 2.2, p = 0.04), epistaxis (OR = 5.4, p < 0.001), subconjunctival ecchymosis (OR = 3.7, p = 0.008), and intra-oral hematoma (OR = 22.0, p < 0.001) were significant fracture predictors.

CONCLUSION

Maxillofacial haemorrhagic symptoms were observed more frequently in the UA group than in the NUA group. However, in both groups, maxillofacial haemorrhagic symptoms appear to be predictors of maxillofacial fractures. Caution is warranted in attributing these symptoms solely to antithrombotic use during emergency department assessments.

Frequency of concomitant injuries in maxillofacial trauma in a tertiary health care centre in India: A 5-year retrospective study

PURPOSE

Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma.

METHODS

This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A p value < 0.05 was considered as a level of significance.

RESULTS

The maxillofacial injuries were significantly common in patients aged 16 - 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (p < 0.001). The RTA was the most common cause of maxillofacial injury (n = 2139, 81.7%), followed by fall (n = 206, 7.9%), other causes of injury (n = 178, 6.8%), and assaults (n = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (p < 0.001). There was a significant correlation between alcohol and RTA (p < 0.001). The head injury (n = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (n = 328, 21.5%) and other bone injuries (n = 264, 17.3%).

DISCUSSION

Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.

Epidemiological analysis of patients with isolated blowout fractures of orbital floor: Correlation between demographic characteristics and fracture area

Isolated orbital floor fractures are more frequent due to low bone thickness (2 mm). The aim of this study was to conduct a retrospective epidemiological analysis on these fractures, investigating demographic variables and fractures' features and their statistical correlation. A total of 120 patients with isolated orbital floor fracture, admitted at the Maxillofacial Surgery Unit of University of Naples Federico II, from 2010 to 2022 were enrolled in the study. Patients were evaluated for age, sex, smoke, comorbidities, post-traumatic clinical manifestation,s and defect side and size. Statistical analysis was conducted using the Pearson regression coefficient (r). The fractures were more frequent in men (male:female 2.2:1) because of road accidents (30% of cases). The average age was 48 years. Enophthalmos, diplopia and ocular motility anomalies were observed in 31%, 23% and 21% of cases, respectively. Statistical analysis revealed that age was related to fracture area; in particular, older patients showed larger fractures (p < 0.001). Interpersonal violence and traffic accidents were related to younger age (p < 0.001). Data analysis revealed that isolated orbital floor fractures are more frequent in young men (<40 years) because of road accidents or interpersonal violence. There is a statistical correlation between fracture area and patient age; in particular, older age corresponds to larger defects.

Post-traumatic Sinus Syndrome, Proposal for a New Clinical Entity (CDR Syndrome) as Variant of the Silent Sinus Syndrome: Systematic Review and Case Series

The diagnostic criteria for silent sinus syndrome (SSS) are still controversial, especially for the post-traumatic/surgery cases that are, nowadays, excluded from the diagnosis of SSS because lacking of spontaneously. We present a systematic review of the last 10 years and our case series of SSS associated to previous trauma/surgery, proposing a new interpretation of SSS. In this work, following the PRISMA guide lines for systematic reviews, we collected 86 articles published on PubMed, Cochrane Library and Medline Plus since 2013 to 2023 about SSS. We divided them in six groups forming the structure of the review: (1) epidemiology, (2) clinical presentation, (3) imaging, (4) etiopathogenesis, (5) sss and craniofacial trauma and (6) treatment. We reported two explicative clinical cases: two men of 34 and 37 years old, involved in motorcycle accident in 2020 and 2014, respectively, and underwent surgery. They came back in 2023 referring diplopia documented by Hess-Lancaster test. CT-scan reported two clear cases of SSS. Basing on what is reported in literature, and basing on our experience, the post-traumatic/surgery SSS are more frequent than the idiopathic ones. Our proposal is to considered them as two individual entities. We propose to adopt the name of Post-traumatic sinus syndrome, or CDR syndrome (Catalfamo-De Rinaldis), for all cases that respect four specific diagnostic criteria reported into the text.

Submental intubation in complex maxillofacial trauma: Pilot balloon protection

AIMS

This study aims to describe our refined technique of submental intubation to avoid the recorded intraoperative complications related to tube passage and pilot balloon rupture.

CASE SERIES

This is a retrospective case series of 21 patients with complex maxillofacial trauma who underwent submental intubation from January 2019 to January 2023. All the patients underwent to the same procedure with a new technique of pilot balloon protection: the pilot balloon was not deflated because, once the connector was removed, only the tube was curved and passed through the incision extraorally while the cuff remained inflated. The wire of the pilot balloon was passed behind the last tooth so as not to interfere with the maxillary-mandibular fixation, remaining extraorally under the anesthetist's view.

DISCUSSION

Only 2 patients (9.5%) reported complications related to submental intubation: in particular a patient (4.8%) reported oral floor infection, and in another patient (4.8%) an unesthetic skin scar was observed. No patients reported intraoperative complications related to the procedure.

CONCLUSION

The technique of pilot balloon protection that we have proposed seems to be effective in reducing the intraoperative complications related to the passage of the pilot balloon, such as rupture, damage or early extubation.

Maxillofacial Trauma in Pediatric Patients: A Retrospective Study

Objective

The study was conducted to analyze the pattern, etiology and management of maxillofacial trauma in children up to 16 years of age.

Study Design

Records of the patients who sustained maxillofacial trauma from 2013 to 2018 were retrospectively evaluated for age, gender, etiology, pattern of injuries and their management. Children were divided into three groups-primary (0-5 yrs), mixed (6-11 yrs) and permanent dentition group (12-16 yrs). Maxillofacial trauma was observed as midface fracture, mandible fractures, soft tissue injuries and associated tooth fractures. SPSS software version 19.0 was used for the data analysis.

Result

A total record of 99 children were evaluated. Gender-wise distribution was reported twice in male than females. Fall was observed as the major etiological factor (73.7%) with a significant p value of 0.012 using chi-square test. The highest frequency of maxillofacial trauma is noted in mixed dentition group (47.4%). Mandible fracture was most frequently observed followed by associated soft tissue injury. Conservative approach/closed reduction for management was executed for the majority of cases.

Conclusion

Knowledge gained from the present study would help in assessing the effectiveness of present preventive modalities and facilitate elaboration of future preventive measures and new research works as well.

Analysis of dental traumatic patterns in standing electric scooter-related accidents

BACKGROUND

There have been several studies about the increasing accident risks and injuries of standing electric scooters, but there is no study about the dental traumatic injuries related with standing electric scooter so far.

OBJECTIVES

The purpose of this study is to report the overall dental traumatic patterns, and compare the patterns of standing electric scooter-related dental trauma with other traumatic causes. Also, considerations about minimizing the risks of electric scooter-related trauma will be discussed.

METHODS

Data on patients who visited Region Trauma Center of Wonju Severance Christian Hospital with dental emergency from January 2020 to December 2022 were collected.

RESULTS

The crown-root fracture and avulsion occurred significantly higher in electric scooter-related accidents than others. Furthermore, relatively minor dental injuries including concussion and subluxation showed higher percentage to be occurred as combined injuries in electric scooter-related accidents. The prevalence of traumatized posterior teeth was significantly higher in electric scooter-related trauma than others. Most of patients were teenagers and twenties. Also, the electric scooter-related accidents mostly occurred at evening and night. Furthermore, the number of patients wearing a helmet in electric scooter accidents was 1 out of 33.

CONCLUSION

The standing electric scooter-related dental trauma resulted in an increased prevalence of relatively severe dental trauma. Supplementation and reinforcement of the related policies as well as strict enforcement of the laws on electric scooter users will be needed to prevent severe dental and craniofacial trauma.

Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score

PURPOSE

This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma.

METHODS

We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries.

RESULTS

We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004).

CONCLUSIONS

Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.

Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial

INTRODUCTION

Enhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes.

METHODOLOGY

A randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes.

RESULTS

Baseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001).

CONCLUSION

Our study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.

Cross-Sectional Study of Serum Metal Ions in Patients With Metal Implants in the Maxillofacial Region

Purpose

The purpose of the present study was to measure the serum metal ion levels (titanium, cobalt, chromium) in patients who have metal implants in the maxillofacial region.

Methods

The investigators implemented a cross sectional study on patients treated with procedures requiring metal implants for management of maxillofacial trauma, fixation for orthognathic surgery, and total temporomandibular joint replacement (TJR). Inductively coupled plasma mass spectrometry was used as an analytical method to detect metal ions in serum samples.

Results

The study comprised of 50 patients who were divided into 4 groups- group I- total TJR (n = 18), group II- orthognathic (n = 8), group III- trauma (n = 8), and group IV- control (n = 16). The mean values of metal ions level were raised than the control group.

Conclusion

The present study's results suggest a rise in serum metal ion levels after the metal implantation in maxillofacial region. None of the patients had any abnormal signs and symptoms due to raised metal levels. Further studies are warranted to correlate the serum metal ion levels and their clinical relevance.

A Retrospective Study of Maxillofacial Fractures at a Tertiary Care Centre in North India: A Review of 1674 Cases

Objective

To examine the pattern of maxillofacial fractures in patients treated at the SMS Hospital in Jaipur, India, over a two-year period.

Methods

A retrospective study was conducted from October 2019 to September 2021, which recorded various data of patients with maxillofacial fractures, including age, sex, site distribution, cause of injury, type of facial bone fractures, soft tissue injuries, dentoalveolar trauma, and type of treatment. The days spent in the hospital before and after surgery were also recorded.

Results

The study included 1674 patients, with a male-to-female ratio of 4.07:1 and males being the most affected at 80.3%. The most common cause of injury was road traffic accidents (53.5%), followed by falls (18.6%) and assaults (16.1%). Mandibular fractures accounted for 38% of all fractures, with the parasymphysis being the most common site for fractures. Open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) were the most common treatment options for mandibular fractures.

Conclusion

The study highlights the need for strict enforcement of traffic rules and road safety laws, along with education and preventive measures to reduce the incidence of maxillofacial trauma. The pattern of maxillofacial injuries can provide useful information for designing programs towards the prevention and management of maxillofacial trauma.

Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire

PURPOSE

The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire.

METHODS

A retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi'an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient's medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients.

RESULTS

Out of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed.

CONCLUSION

The treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.

Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study

AIM

The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients.

MATERIALS AND METHODS

About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months.

RESULTS

No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures.

CONCLUSION

A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures.

CLINICAL SIGNIFICANCE

In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.

Comparison of Efficacy and Safety of Hybrid Arch Bar with Erich Arch Bar in the Management of Mandibular Fractures: A Randomized Clinical Trial

Study Design

A clinical randomized control trial.

Objective

To compare the efficacy and safety of Hybrid arch bar (HAB) with Erich arch bar (EAB) in fracture management of the mandible.

Methods

In this randomized clinical trial, 44 patients were divided into 2 groups:- Group 1, N = 23 (EAB group) and Group 2, N = 21 (HAB group). The primary outcome was time taken for the application of arch bar, while the inner and outer glove puncture, operator prick, oral hygiene, arch bar stability, complications of HAB, and cost comparison were secondary outcomes.

Results

The time taken for the application of arch bar in group 2 was significantly shorter than group 1 (55.66 ± 17.869 min vs 82.04 ± 12.197 min) and the frequency of outer glove puncture was also significantly lesser for group 2 (0 punctures vs 9 punctures). Better oral hygiene was found in group 2. EAB was cost-effective than HAB (Rs 700 ± 239.79 vs Rs 1742.50 ± 257.14). The stability of the arch bar was comparable in both groups. Group 2 had associated complications of root injury in 2 out of 252 screws placed and the screw head got covered by soft tissue in 137 out of 252 screws placed.

Conclusions

Thus, HAB was better than EAB with a shorter time of application, less risk of prick injury, and improved oral hygiene.Clinical trial registry name- clinical trials registry- India, URL-http://ctri.nic.in, registration number- CTRI/2020/06/025966.

Learning from Covid 19 in a level 1 oral and maxillofacial trauma centre - Insights for the future

The coronavirus disease 2019 caused by the Severe Acute Respiratory Syndrome Coronavirus-2 has resulted in many confirmed cases around the world. Sars-CoV-2 remains viable and infectious in aerosols dispersed in air and is viable on surfaces up to several days. Symptomatic patients are the main reservoir for transmission. Evidence suggests that asymptomatic patients and patients during their incubation period can shed and transmit Sars-CoV-2. The infective potential can be reduced through the use of personal protective equipment. Healthcare professionals especially the oral maxillofacial surgeons are at increased risk of being infected by the virus. Oral maxillofacial injuries typically involve vital structures in the upper aerodigestive tract and are emergent. Facial trauma surgery cannot be delayed or deferred in a pandemic. This review focuses on precautions surgeons should adopt while managing facial trauma patients in the emergency department and whilst performing emergency surgeries on these patients during the current COVID-19 pandemic. Strict and effective infection control protocols for facial trauma management are needed to minimise this risk of transmission. This review was part of the lecture given by Professor Melvyn Yeoh at the 14th Asian congress on Oral and Maxillofacial Surgery recently held virtually in Singapore due to the pandemic.

Soft Air Bullet in the Pterygopalatine Fossa: A Minimally Invasive Endoscopic Approach for Safe Extraction

Ballistic traumas among civilians are usually from low velocity, low calibre weapons such as soft air guns. The facial skeleton is an area of high aesthetic/functional value, and therefore, this is a showcase for technical description of a minimally invasive endoscopic approach for the removal of a bullet from the pterygopalatine fossae.

Indications and complications regarding titanium osteosynthesis in pediatric maxillofacial trauma: A scoping review and critical appraisal

With the advent of biodegradable osteosynthesis material, titanium osteosynthesis for ORIF in pediatric maxillofacial trauma is not as indisputable as before. The aim of this study was to conduct a scoping review to assess the indications, complications of ORIF with titanium osteosynthesis material in pediatric maxillofacial trauma. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, gray literature (ICTRP and clinicaltrials.gov) for studies published until April 2022. 3436 studies were screened and finally 13 articles, compromising a sample of 340 pediatric patients were included after full text reading. Reported complications were infection (6.5% of population), malocclusion (5% of population) and dental maleruption (8% of population). Influence on future growth could not be assessed due to short and heterogeneous follow-up periods. Eight of the thirteen studies concluded to a positive and predictable outcome using titanium ORIF for displaced/complex pediatric maxillofacial fractures. Results of this review suggest that titanium ORIF for maxillofacial fractures in the pediatric population is a reliable treatment. The surgeon must be committed to following these patients longitudinally. Interpreting the results should, however, be done with great care, as most articles have a medium to high risk of bias and limited follow-up.

A digital workflow to predict facial aesthetics in patients with maxillofacial trauma with implant retained prostheses

PURPOSE

To introduce a digital workflow for the prediction of facial aesthetics, especially in patients with dentation deformity caused by maxillofacial trauma.

METHODS

Cone-beam computed tomography (CBCT) and three-dimensional facial scans of patients with radiographic prostheses were collected. The aforementioned data were uploaded to ProPlan CMF software and merged to generate a virtual patient with craniofacial hard tissue, realistic facial soft tissue, and remaining dentition. The radiographic prostheses were scanned to form a digital cast, which was fitted with its CBCT image to create the virtual prostheses. Postoperative facial soft tissue was simulated according to the movement of the virtual prostheses. An appropriate virtual diagnostic prosthesis plan was selected by the patient and dentist. Subsequently, prosthetically driven implant guide and restoration were designed and fabricated.

CONCLUSIONS

A virtual patient was successfully constructed. A 4-mm protrusion of the virtual prosthesis was chosen. Subsequently, implant surgery was performed, and dental prostheses were fabricated based on this location. The fusion of the postoperative facial scan and preoperative facial prediction was found to be coincident. This technique can effectively predict facial aesthetic features of patients with maxillofacial trauma, facilitate communication with patients, reduce chairside time, and guide the multidisciplinary design of implant placement and restoration fabrication.

Trends of maxillofacial and mandibular fractures in level I and II trauma patients in a tertiary hospital in Saudi Arabia

Background

Maxillofacial injury is a major health concern worldwide. Incidence of maxillofacial fractures is influenced by socio-demographic, economic, and cultural factor of the population investigated. Identifying the patterns of these fractures is crucial to establish effective treatments and prevention measures. The aim of the study was to to analyze the incidence, etiology, and types of maxillofacial fractures in a tertiary trauma center.

Methods

A retrospective analysis was conducted for all patients who were admitted with maxillofacial fractures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of of 422 patients with 978 maxillofacial fractures were enrolled over a 4-year period.

Results

Among the 422 patients, 387 (91.8%) were males, and 35 (8.2%) were females. The mean age of our population was 31.1 years old. Our study has shown that motor vehicle accidents are the leading cause of maxillofacial fractures, followed by pedestrian trauma. The most common maxillofacial fractures were orbital fractures, followed by maxillary fractures. The mandibular body was most fractured among mandibular fractures. Our data has shown that males have higher incidence of maxillofacial fractures than females.

Conclusion

Our study further validated that road traffic accidents are the most common cause of maxillofacial fractures in our region. These findings emphasized the importance of improving road safety protocols and enforcing traffic laws.

An epidemiologic retrospective study of maxillofacial traumatology in the elderly

INTRODUCTION

The elderly population, which is more active than before, is increasingly suffering from trauma (loss of reflexes and systemic pathologic conditions). Surgical management may be more controversial due to the potential consequences of general anesthesia and the sometimes negligible consequences of functional management. The main objective of this study was to analyze the causes and location of facial fractures in subjects older than 65 years. The secondary objective was to evaluate the management of these fractures (surgical or functional) according to comorbidities.

MATERIAL & METHODS

In this retrospective study (over a five-year period), we analyzed the causes and management of facial fractures in patients aged over 65 years, and the medical history of each patient was investigated.

RESULTS

One hundred and nineteen patients with 198 facial fractures were included. The main cause of fractures was a fall (50%). The zygomatic region (39.9%) and mandible (27.8%) were the sites of the most frequent fractures. Comorbidities were found in 84.9% of patients, the majority of which were cardiovascular diseases (82.3%). 75.8% of fractures were treated surgically and 4.8% of patients had complications.

DISCUSSION

This work is a help to understanding the causes and consequences of facial trauma in the elderly population. The management of these facial fractures requires a multidisciplinary assessment, taking into account the patient's medical history and evaluating the risks and benefits of a surgical procedure with general anesthesia.

Oral rehabilitation of maxillofacial trauma using fixed corticobasal implant-supported prostheses: A case series

Introduction

Maxillofacial trauma is associated with severe loss of soft and hard tissues that lead to aesthetic and functional disfigurements, adverse psychological impacts on the patient's general and oral health, and decreased quality of life. Therefore, treatment of maxillofacial trauma is challenging.

Presentation of case

We present three patients with maxillofacial trauma owing to road traffic accidents that were rehabilitated by immediate use of loaded fixed corticobasal implant-supported prostheses with follow-up periods of 6, 5, and 7 years. All treated patients had a 100 % implant survival rate, healthy peri-implant tissues, stable prosthesis with significant improvement in mastication and phonation, and high patient satisfaction.

Discussion

Rehabilitation of patients with intensive maxillofacial trauma requires a multidisciplinary approach to ensure the standard of care during treatment. The described treatment eliminates the need for bone grafting, reduces susceptibility to grafting complications, shortens treatment time, and provides the patient with a fixed prosthesis with predictable success, excellent implant survival, healthy peri-implant tissue, improved prosthetic stability, and high satisfaction rates.

Conclusion

Corticobasal implant-supported prostheses are a feasible treatment modality to rehabilitate patients with maxillofacial trauma with high success and survival rates and patient satisfaction.

•

Treatment of maxillofacial trauma requires a multidisciplinary approach.

•

Hard and soft tissue loss complicates treatment.

•

Corticobasal implants do not require bone grafting and reduce treatment time.

•

They help achieve satisfactory peri-implant health and patient satisfaction.

•

Corticobasal implant-supported prostheses are a feasible treatment modality.

Tooth aspiration in two cats following maxillofacial trauma

Case series summary

Tooth aspiration is a rare occurrence in human medicine, and even more so in veterinary medicine. This report describes two cats that aspirated a tooth (one canine tooth and one premolar tooth) following maxillofacial trauma. One cat presented with dyspnoea, while the other showed no respiratory clinical signs. In both cases diagnosis was reached by obtaining routine thoracic radiographs, and successful retrieval of the teeth was achieved by bronchoscopy. Both cats recovered uneventfully.

Relevance and novel information

To our knowledge, this is the first report in the veterinary literature of tooth aspiration into the tracheobronchial tree following maxillofacial trauma. The scope of this case series is to raise awareness that tooth aspiration can occur following maxillofacial trauma and has the potential for serious complications if not diagnosed and treated promptly. Therefore, an oral examination must be performed in every maxillofacial trauma patient and missing teeth should be accounted for, even when respiratory clinical signs are not detected.

Changing patterns of Oral & Maxillofacial injuries before and during COVID-19 pandemic: A retrospective study

Introduction

Oral and maxillofacial injuries can be defined as injuries involving soft and hard tissue structures of the facial region and oral cavity, including the teeth and vital structures of the head and neck area as a result of trauma^. The maxillofacial injuries are multifactorial and vary from one country to another and even from region to region. Despite, societal restrictions imposed by the government in the form of lockdowns and curfews, patients still experienced trauma and required significant healthcare services for management.

Methods

Patients of either gender reporting to the emergency department of Lata Mangeshkar Hospital with maxillofacial injuries, attended by residents of OMFS from October 2019 to August 2020 were included in the retrospective study. The demographic data about age, gender and status pertaining to under the influence of alcohol was recorded. The aim of this retrospective study was to evaluate the changing patterns of the maxillofacial injuries during the Covid-19 pandemic.

Results

In the present study, the road traffic accidents were 72.50% pre-lockdown which reduced to 47.37% during the alcohol ban and nationwide lockdown and gradually increased to 63.83% post-lockdown. The second most common cause of maxillofacial injury was falls which showed a significant increase from 22.50% before the lockdown to 31.58% during the lockdown and decreased to 26.6% after lockdown during the pandemic. There was an increase in the number of assaults from 2.50% pre-lockdown to 15.79% during the lockdown and again a decrease to 6.38% post-lockdown.

Discussion

Our study demonstrates the impact of nationwide lockdown in the month of April and May 2020, may have an association with the significant statistical decrease in the monthly average number of trauma admissions. There was a significant decrease in the number of road traffic collisions and falls during the "lockdown period".

Conclusion

The etiology and pattern of maxillofacial injuries reflect the trauma pattern within the community. We need more coordinated strategies of action to minimize maxillofacial injuries and its implication on physical and psychological wellbeing of patients.

Bilateral Post-Traumatic Facial Palsy: A Case Report and Literature Review

INTRODUCTION

Bilateral facial nerve (FN) palsy due to temporal bone fracture is a rare clinical entity, with few cases reported. The choice between conservative and surgical treatment is more complex than in unilateral cases.

MATERIALS AND METHODS

A thorough search of the available literature on trauma-related bilateral FN palsy revealed 22 reports. Our own experience is also described.

RESULTS

All bilateral delayed- and unknown-onset cases were treated conservatively, with a good recovery rate (70.5%). Surgery was performed on 6 sides within the immediate-onset group, with a good recovery rate (83.3%).

CONCLUSIONS

In the management of traumatic FN palsy, the main controversial issue focusses on indications for surgery as well as timing and type of approach. In bilateral cases, it is more challenging to make the right choice, due to lack of facial asymmetry and/or state of unconsciousness following severe trauma. Electro-diagnostic tests and high-resolution computed tomography are essential for decision-making.

ACR Appropriateness Criteria® Imaging of Facial Trauma Following Primary Survey

Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Historical evolution of surgical approaches to the face-part III: lower face

Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries when most of the techniques were described, mainly thanks to the advent of anesthesia and antibiotic therapy. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are the subject of textbooks and articles, most do not describe the circumstances or the historical context under which they were designed. In a series of three articles, we will provide a historical perspective of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages and modifications are provided. The purpose of the present article (3/3) is to review the approaches to the lower face.

Structural similarity analysis of midfacial fractures-a feasibility study

The structural similarity index metric is used to measure the similarity between two images. The aim here was to study the feasibility of this metric to measure the structural similarity and fracture characteristics of midfacial fractures in computed tomography (CT) datasets following radiation dose reduction, iterative reconstruction (IR) and deep learning reconstruction. Zygomaticomaxillary fractures were inflicted on four human cadaver specimen and scanned with standard and low dose CT protocols. Datasets were reconstructed using varying strengths of IR and the subsequently applying the PixelShine™ deep learning algorithm as post processing. Individual small and non-dislocated fractures were selected for the data analysis. After attenuating the osseous anatomy of interest, registration was performed to superimpose the datasets and subsequently to measure by structural image quality. Changes to the fracture characteristics were measured by comparing each fracture to the mirrored contralateral anatomy. Twelve fracture locations were included in the data analysis. The most structural image quality changes occurred with radiation dose reduction (0.980036±0.011904), whilst the effects of IR strength (0.995399±0.001059) and the deep learning algorithm (0.999996±0.000002) were small. Radiation dose reduction and IR strength tended to affect the fracture characteristics. Both the structural image quality and fracture characteristics were not affected by the use of the deep learning algorithm. In conclusion, evidence is provided for the feasibility of using the structural similarity index metric for the analysis of structural image quality and fracture characteristics.

Association between maxillofacial fractures and brain injuries in trauma patients: a cross-sectional study in the Kingdom of Saudi Arabia

Introduction

trauma is on the rise in the Kingdom of Saudi Arabia (KSA) due to rapid urbanization and motorization, posing increased risks of traumatic maxillofacial and brain injuries. Given the high morbidity and mortality associated with these injuries, this study aimed to measure the prevalence and associated factors of brain injury among head injury trauma patients.

Methods

a cross-sectional study was conducted at the King Khalid hospital and Prince Sultan Centre for Healthcare in Al-Kharj City and the Al Kharj Military Industries Corporation Hospital in Al-Kharj City in the KSA. Multivariable logistic regression modelling was performed to ascertain clinical factors associated with Traumatic Brain Injury (TBI).

Results

we included 109 participants aged median 25 and IQR (18-35) years 26.95 ± 14.73 years. Most participants were males (92.7%, n = 101) and 68% (n = 75) had Saudi nationality. About 47.7% (n = 52) had maxillofacial/skull fractures and 44% (n = 48) had TBI. Participants in the age group of 31-40 years experienced a greater risk of TBI than those in the age group of 10 or less years (aOR: 6.2, CI = 1.1p = 0.041). Participants with parietal bone fractures (aOR = 23.1, CI = 3.0 - 181.3, p = 0.003) and frontal bone fractures (aOR = 19.1, CI = 1.7 - 217.0, p = 0.017) were more likely to have TBI compared to those with other skull and facial fractures.

Conclusion

fractures of parietal and frontal bones are associated with a higher risk of TBI in the KSA. Patients with TBI following road accidents with fractures of the frontal or parietal bones, particularly those in the 31-40 age group should therefore be treated with strong suspicion of underlying traumatic brain injury.

Maxillofacial fractures surgically treated: a 3-year experience of a Cuban hospital

AIM

The aim of the study was to characterize the maxillofacial fractures surgically treated in a Cuban hospital.

MATERIALS AND METHODS

This was a descriptive and retrospective cross-sectional study based on the medical records of patients attended between January 1, 2017 and December 31, 2019 in the Maxillofacial Surgery Department of Carlos Manuel de Céspedes General University Hospital, Cuba. Age, gender, residency, municipality, etiology, month and year of trauma, number and type of fractures, and alcohol consumption at the time of trauma were recorded.

RESULTS

126 cases and 304 fractures were investigated. Males were the most affected (n = 115; 91.27%). The main etiology was interpersonal violence (IPV) (46.03%). Seventy-one (56.35%) patients had zygomatico-maxillary complex fractures. In the multivariate analysis, alcohol consumption was significantly lower as the age increased (a PR: 0.989; confidence interval [CI] 95%: 0.979-0.99; p = 0.026), as well as in those patients who lived in urban zones (a PR: 0.57; CI 95%: 0.44-0.74; p < 0.001), adjusted by the side of the fracture and the municipality.

CONCLUSIONS

The profile of the maxillofacial fractures in this Cuban hospital seems to be mixed by age, affecting young people and the elderly. IPV was the major cause of maxillofacial fractures, while zygomatico-maxillary complex bones and mandible were the most affected maxillofacial areas.

Patient Triage, First Aid Care, and Management of Oral and Maxillofacial Trauma

Maxillofacial trauma is a common presentation in veterinary medical practice. Accurate assessment, diagnostics, pain management, and finally repair are tenants to treatment. In addition to typical tenants for fracture repair, the restoration of occlusion and return to function (eating, drinking, grooming) are unique to trauma management in these patients. Options for repair include conservative management (tape muzzles), noninvasive repair techniques (interdental wiring and composite splinting), and invasive repair techniques (interfragmentary wiring and plate and screw fixation).

General Overview of the Facial Trauma Evaluation

The initial evaluation of maxillofacial trauma in athletes should first focus on the management of life-threatening injuries that require emergent care. Airway, breathing, and circulation are the 3 areas to be addressed first and foremost, as set forth by Advanced Trauma Life Support (ATLS) guidelines. Following the stabilization of the patient, a thorough physical examination and systematic review of any relevant imaging studies are imperative to ensure that injuries are not missed. Ultimately, management by the facial plastic surgeon should balance the goals of facial trauma restoration with the overall needs of the patient.

Pattern of maxillofacial fractures in a Tertiary Referral Centre in Central Kerala - A comparison between the Pre-COVID and COVID periods

Our aim was to observe if there was any appreciable difference in the etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods in Central Kerala, South India. This retrospective study was conducted with data over a period of two years from the central database registry of our hospital. Age, sex, etiology, date of injury, and site of facial fractures were recorded and compared between both the time periods. Increase in facial fractures due to fall at home (p value < 0.01) and decrease in mass casualty cases (p value < 0.01) were observed during the COVID-19 period. Pedestrians involved were significantly more in the pre-COVID-19 period (p value < 0.01) and heavy vehicle accidents producing facial fractures were significantly more in the COVID-19 period (p value < 0.01). Frontal bone (p value = 0.008), nasal bone (p value < 0.001) and zygomatico-maxillary complex fractures (p value < 0.001) occurred significantly more in the COVID-19 time period whereas naso-orbito-ethmoidal (p value = 0.003), mandibular (p value = 0.011) and dentoalveolar fractures (p value < 0.001) were seen significantly more in the pre-COVID-19 period. There was decrease in the total number of maxillofacial cases during the COVID-19 period. However, this was not significant when only the number of facial fractures were compared between the two periods. This study provided an insight on the differences in etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods. Road traffic accidents involving two wheelers predominate during the COVID-19 period also, prompting further critical exploration of the reasons behind this finding.

Football-related maxillofacial injuries

Maxillofacial injuries sustained playing sports are becoming increasingly common, and in the UK where football is the most popular team sport, associated maxillofacial injuries are a regular occurrence. This study retrospectively examined data on patients who were referred with facial injuries sustained playing football between 2007 and 2019 (n = 265). Demographics, mechanism of injury, diagnosis, and treatment received were analysed. The mean (SD) age was 25 (11.0) years (range 3-85) and there was a strong male predominance (n = 256, 97% male). Facial fractures were diagnosed in 143 (54%) patients. The most common injury was a midface fracture and the most common mechanism of injury was a clash of heads. Patients with a facial fracture were significantly more likely to have sustained a concurrent head injury (p = 0.006). Those who were elbowed or punched were significantly more likely to have a facial fracture than a soft tissue or dentoalveolar injury (p ≤ 0.05). Players who clashed heads were significantly more likely to have a midface fracture (p ≤ 0.001). In conclusion, football-related maxillofacial injuries predominantly affect young adult males following a clash of heads. An elbow or punch to the face carries a significant risk of facial fracture and concurrent head injury. Therefore, to reduce the percentage of maxillofacial injuries seen in this sport, observed intentional contact between players, using an elbow or fist to the face in particular, must continue to carry the highest sanction.

The effect of lockdown during SARS-CoV-2 pandemic on maxillofacial injuries in a level I trauma centre: a comparative study

INTRODUCTION

The SARS-CoV-2 pandemic forced many governments to impose nation-wide lockdowns. Government legislation forced limited travel on the population with restrictions on the normal way of life to limit spread of the SARS-CoV-2 virus. The aim of this study is to explore the effects of lockdown on the presentation of maxillofacial trauma in a level I trauma centre.

METHODS

Comparative analysis was carried out using prospective and retrospective review of all consecutive patients admitted with any maxillofacial fracture in the lockdown period between 15th March and 15th June 2020 with the same period in 2019 to a Regional Trauma Maxillofacial Surgery Unit. Data included basic demographics and mechanism of injury including alcohol/drug influence, polytrauma, site of injury and treatment modality including escalation of care.

RESULTS

Across both periods, there were a total of one hundred and five (n = 105) recorded episodes of traumatic fractures with fifty-three (n = 53) in the pre-lockdown cohort and fifty-two (n = 52) in the lockdown. Included patients were significantly (p = 0.024) older during lockdown (mean age 41.44 years SD 20.70, range 5-96) with no differences in gender distribution between cohorts (p = 0.270). Patients in lockdown were more likely to be involved in polytrauma (p < 0.05) and have sustained their injury by cycling/running or any outdoor related activity (p = 0.013). Lockdown saw a significant reduction in alcohol and drug related violence (p < 0.05). Significantly more patients required operative management (p = 0.038).

CONCLUSION

Local lockdowns form part of the governments public health strategy for managing future outbreaks of SARS-CoV-2. Our study showed no significant reduction in volume of trauma during lockdown. It is vital that hospitals maintain trauma capacity to ensure that patients are treated in a timely manner.

Quality of life following maxillofacial trauma in the elderly: a multicenter, prospective study

BACKGROUND/AIMS

When facial trauma involves elderly patients, the possible presence of frailty and comorbidities in victims of trauma may worsen the posttraumatic symptoms and decrease quality of life. The aim of this multicenter study was to assess the quality of life following surgical or non-operative management of maxillofacial trauma in elderly patients.

MATERIALS AND METHODS

This cohort study was based on the administration of validated self-administered questionnaires to all the geriatric patients (70 years or more) with facial fractures from the involved maxillofacial surgical units across Europe, since 1st January 2019 to 31st June 2019. The following questionnaires were administered: SF36 questionnaire; the VFQ-25 questionnaire; the Oral Health Impact Profile - 14 (OHIP14). Outcome variables were VFQ-25 and OHIP-14 results.

RESULTS

A total of 37 patients (14 male and 23 female patients) met the inclusion criteria and were included in the study. Elderly patients had an improvement in almost all the categories examined by the SF-36 questionnaire 6 months after trauma, with the only exception of a worsening as for role limitations due to physical health. An improvement was observed in almost all the categories at SF-36 test. A worsening of scores of OHIP-14 for all the considered dimensions in the whole study population was observed too.

CONCLUSIONS

Elderly patients following facial trauma experience significant emotional, social, and functional disturbances. We observed that emotional problems, energy/fatigue, social functioning, and generally social limitations played a great role in the decrease of QoL in elderly patients following maxillofacial trauma.

Pediatric maxillofacial and dental trauma: A retrospective review of pediatric emergency management in Riyadh, Kingdom of Saudi Arabia

BACKGROUND

Due to the high prevalence of oral and maxillofacial (OMF) trauma in city of Riyadh, a special focus on pediatric trauma is needed. The purpose of this audit was to assess the protocol followed by the OMF unit at King Khalid University Hospital (KKUH) on pediatric trauma patients. The trauma incidence, mechanism of injury, volume, the type of pediatric trauma operated and dental management were analyzed.

MATERIALS AND METHODS

A quantitative retrospective review of 223 patients, at pediatric emergency unit of KKUH, Riyadh, KSA from January 2017 to July 2018, was done. The data retrieved included variables such as, age, gender, and cause of injury, site of injury, type of injury, and assessment of jaws, and teeth. Data regarding the type of investigations, treatment protocol, follow up visit, and dental management, were extracted from the medical records.

RESULTS

Of the 223 pediatric patients presenting to the emergency unit, 116 (52%) were under the age of 5 years. A total of 64.4% of patients reported "self-fall" as the cause of injury. Soft-tissue injuries were common in 63 (56.8%) of patients in the form of lacerations 87 (41.2%). Involvement of the teeth in the injury was observed in 57 patients, in which 33 (57.9%) patients were reported to have tooth/teeth avulsions, 15 (26.3%) patients had luxation and 9 (15.8%) patients had crown fractures. 27 (47%) patients were referred to the pedodontist for a follow-up visit.

CONCLUSIONS

It can concluded that clinicians facing maxillofacial trauma in an emergency department need to have access to useful and practice guidelines. The study also showed the need for more manpower-oriented training such as a pedodontist and a general dentist to join the OMFS team to manage pediatric patients. The regional referral hospitals should be equipped to decentralize the management of these patients to the Dental University Hospital.

Comparative Evaluation of Drill-Free and Self-Tapping Titanium Miniscrews for Semi-Rigid Internal Fixation in Maxillofacial Trauma

Introduction

Conventional semi-rigid fixation systems in maxillofacial trauma use self-tapping titanium miniscrews (STS) that require preliminary drilling of a pilot hole. Although drill-free miniscrews (DFS) accompany these systems, they have not dominated practice despite their allure of improved screw-bone contact and holding power. The COVID-19 pandemic has brought these DFS to light as they avoid aerosol production. The present study has compared DFS to STS in patients being treated with miniplate fixation for maxillofacial trauma to understand their feasibility for maxillofacial fracture fixation.

Methodology

This prospective case–control study sampled 16 patients each with zygomaticomaxillary buttress fracture and parasymphysis fracture of the mandible and grouped alternating patients as case (DFS) and control (STS). Intraoperatively duration of fixation, incidence of screw failures and fragment stability; postoperatively occlusion, neurosensory deficits, teeth vitality and infection and removal rates were evaluated at postoperative week 1, 3, 6, 12 and 24 using Cramer's V test. A P value < 0.05 was considered significant.

Results

In the 32 patients evaluated, DFS reduced internal fixation time at zygomaticomaxillary buttress (P = 0.001) but not at parasymphysis (P = 0.206). No significant difference in screw failures or fragment stability was observed. Stable occlusion was maintained in all groups with vital teeth and intact neurosensory function, but the summative incidence of infection was significant at week 24 when STS was used at parasymphysis (P = 0.019).

Discussion

While DFS may facilitate ease of insertion with a single instrument pick-and-screw-in approach, avoiding thermal osteonecrosis and aerosol production, they fail to confer any other clinical advantage.

Patterns of Maxillofacial Injuries in the Middle East and North Africa: A Systematic Review

OBJECTIVE

The objective of this review was to investigate the epidemiological characteristics of maxillofacial fractures (MFFs), to establish the prevalence of MFFs, and to recognise the major causative factors in both males and females in the Middle East and North Africa (MENA) region.

STUDY DESIGN

The protocol of this systematic reviews was established according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P); the following databases were searched: PubMed/Medline, Scopus, Google Scholar and Web of Science. We used STROBE checklist to assess the risk of bias in all identified studies, 37 studies fulfilled the eligibility criteria, and hence were selected for analysis.

RESULTS

A total of 27,994 patients (22,965 males and 5,129 females) ranging from 0 to 97 years who experienced maxillofacial injuries during the study period were entered into this review. Road traffic accidents (RTAs) were the most common cause of MFF followed by falls. The mandible was the most common site of injury. In the MENA region, males outnumbered females in terms of maxillofacial injuries with a ratio of 4.5:1.

CONCLUSION

Maxillofacial fractures are highly prevalent in the MENA region, and they are mainly caused by RTAs, especially among young males. Therefore, the concerned authorities need to employ and implement stricter traffic rules in order to minimise the risk of maxillofacial injuries and their subsequent increased morbidity and mortality rates.

Historical evolution of surgical approaches to the face-part II: midface

Surgical approaches to the head and maxillofacial area have been described and modified by multiple authors throughout history. It was during nineteenth and twentieth century when most of the techniques evolved due to advances in anesthesia and antibiotic therapy. Currently, a myriad of surgical approaches are employed to gain access to the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are presented in numerous textbooks and articles, few texts describe the circumstances or historical context under which they were developed. In a series of three articles, we will provide a historical perspective of the evolution of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages of the approaches and modifications are also provided. The purpose of the present article (2/3) is to review the approaches to the midface.

Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions

Objective

The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature.

Study design

One thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications.

Results

The average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The average orbital wall defect size was 297.9 mm² (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma.

Conclusion

Results of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm².

Management of Traumatic Trigeminal and Facial Nerve Injuries

In the area of craniomaxillofacial trauma, neurosensory disturbances are encountered commonly, especially with regard to the trigeminal and facial nerve systems. This article reviews the specific microanatomy of both cranial nerves V and VII, and evaluates contemporary neurosensory testing, current imaging modalities, and available nerve injury classification systems. In addition, the article proposes treatment paradigms for management of trigeminal and facial nerve injuries, specifically with regard to the craniomaxillofacial trauma setting.

Prediction of mortality in severely injured patients with facial bone fractures

PURPOSE

Identify the most common concomitant injuries associated with facial trauma, and compare the efficacy of various scoring systems in estimation of mortality risks in this category of patients.

METHODS

The study evaluated patients with facial and concomitant injuries, who received the multidisciplinary treatment in a specialized trauma hospital. Values of New Injury Severity Score, Glasgow Coma Scale, Facial Injury Severity Scale, age, and length of hospital stay were statistically analysed to determine presence of relationships between these indicators and define factors that significantly associated with lethal outcome.

RESULTS

During 6-year observation period, 719 patients were treated with multiple or combined maxillofacial trauma, brain injuries and polytrauma. Mainly with isolated midface bones (49.7%), pan-facial (34.6%), mandible (12.9%), and frontal bone and walls (2.8%) fractures. Mortality was (2.2%). The mortality rates in patients with severe pan-facial fractures were higher (p = 0.008) than in single anatomical area (6% vs 1.5%). Age, GCS, and NISS were the most reliable indicator of lethal outcome.

CONCLUSION

Age, Glasgow Coma Scale and New Injury Severity Score main factors, that predicts lethal outcome with high accuracy. New Injury Severity Score value ≥ 41 is a critical level for survival prognosis and should be considered in treatment planning and management of this category of patients.

Historical evolution of surgical approaches to the face-part I: head and upper face

Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries due in large part to improvements in the delivery of anesthesia and antibiotic therapy when most of the techniques were described. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex with advantages and disadvantages for each one. Although each approach is described in many text and articles, few describe the circumstances or the historical context under which they were designed. In a series of three articles, a historical perspective will be provided on the evolution of some of the most commonly employed today. Descriptions will enumerate the advantages and disadvantages of as well as later modifications. The purpose of the present article (1/3) is to review the approaches to the head and upper face.

The role of prosthetic, orthodontic and implant-supported rehabilitation in the management of secondary malocclusion to maxillofacial trauma- A systematic review

PURPOSE

Different approaches have been proposed to treat malocclusion secondary to the treatment of maxillofacial trauma. This study aimed to investigate the efficacy of prosthodontic treatment, orthodontic treatment, and implant-supported rehabilitation for the management of secondary malocclusion after maxillofacial trauma.

STUDY SELECTION

We searched five electronic databases and hand searched eight journals. The types of studies included were randomized controlled trials, cohorts, case-controls, and case series with at least eight patients with maxillofacial trauma and postoperative malocclusion. These studies used prosthetic treatment and implant-supported rehabilitation for secondary malocclusion after maxillofacial trauma. Risk of bias of eligible studies to be included in the final analysis was assessed independently by two authors using a tool for methodological quality assessment and synthesis of case series and case reports.

RESULTS

After initial screening and identification of titles and abstracts, full text of 44 articles were found and evaluated against inclusion criteria. Of these 42 articles were excluded and remaining two were included in the review. Both the studies were case series with moderate to high risk of bias.

CONCLUSIONS

Both prosthetic treatment and implant-supported rehabilitation have the potential to restore secondary malocclusion after maxillofacial trauma. However, because less number of well-designed studies with high risk of bias were included in this systematic review, the findings should be interpreted with caution. Well-designed high-quality studies are required to draw definitive conclusions.

Maxillofacial trauma in the gulf countries: a systematic review

PURPOSE

The objective of this review was to determine the prevalence, major causative factors and the most common sites of Maxillofacial Trauma in the Gulf Cooperation Council (GCC) Countries.

METHODS

All articles that were published in the English language in the databases such as Google Scholar, EBSCO, PubMed, NCBI, Medline, COCHRANE, ELSEVIER and SCOPUS were reviewed for MFT from GCC during the last 23 years.

RESULTS

A total of 19,151 patients (16,567 males and 2584 females) (86-14%) with an age range between 0 and 97 years were included in the study. In all of the Gulf countries males outnumber females in terms of maxillofacial injuries with a ratio of 6.4:1. The mandible was the most common site of trauma followed by the maxilla. Road Traffic Accidents (RTA) was the most common cause of injury in the GCC followed by falls.

CONCLUSION

Maxillofacial injuries are highly prevalent, distributed among the Gulf countries, and is mainly caused by RTAs especially among males who are highly prone to MFT in the gulf. The reasons are due to lack of road safety culture and weak enactment of traffic legislation, other possible factors include intrinsic car safety features, high speed driving and the amount/use of highways in these societies.

An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients

Background

Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention.

Methods

A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients’ medical records. Statistical analysis was performed. A value of p < 0.05 was considered statistically significant.

Results

The incidence of maxillofacial fractures was high among patients in the 20–29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions (p = 0.001, p = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks (p = 0.001).

Conclusions

Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20–29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01503-5.

Maxillofacial trauma in children: Association between age and mandibular fracture site

PURPOSE

To describe the association between age and location of facial fractures in the pediatric population.

MATERIALS AND METHODS

A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures.

RESULTS

A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (β=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (β=-0.090, p<0.001).

CONCLUSIONS

Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.

Trends in Operative Complex Middle and Upper Maxillofacial Trauma: A 17-Year Study

OBJECTIVES/HYPOTHESIS

Over 3 million incidents of facial trauma occur each year in the United States. This study aims to determine trends in operative middle and upper maxillofacial trauma in one of the largest US cities.

STUDY DESIGN

Retrospective case-control study.

METHODS

Retrospective chart review of all operative middle and upper maxillofacial trauma from July 1993 to July 2010 presenting to Los Angeles County Hospital, a Level I Trauma Center. Data included demographics, mechanism of injury, and fracture characteristics.

RESULTS

Analysis was performed for a total of 4,299 patients and 5,549 facial fractures. Mean patient age was 34.6, and most patients were male (88%). Between the two time periods (1993-2001 and 2002-2010), there was a 42% reduction in operative maxillofacial trauma (3,510 to 2,039). Orbital floor and zygomaticomaxillary complex fractures were the most prevalent types of fractures. Panfacial fractures demonstrated the largest reduction in number of fractures (325 to 5, P<0.01). Assault and motor vehicle accidents (MVA) were the two most common mechanisms of injury. Operative fractures due to MVAs decreased (390 to 214, P = .74), whereas fractures due to assault increased (749 to 800, P<0.01). Compared to adults, pediatric facial trauma (age < 18) were caused by a higher percentage of MVAs (27% vs. 13%), auto versus pedestrian (9% vs. 5%), and gunshot wounds (8% vs. 4%) (P<0.01).

CONCLUSIONS

Operative middle and upper maxillofacial trauma decreased over a 17-year period. Assault was the most significant mechanism of trauma overall. These trends suggest that focusing future prevention strategies on curtailing interpersonal violence may more effectively address the burden of facial trauma.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:1985-1989, 2021.

Transoral approach in facial penetrating trauma - importance of multidisciplinary management and nutritional support a case report

The high incidence and prevalence of facial trauma makes it important to consider related injuries and possible complications that may arise as a result. Penetrating trauma to the face, although not common, requires a surgeon with knowledge of the anatomy and physiology of the injured area and injury patterns.

We present a case of penetrating trauma to the face that was caused by a blunt object (stake) resulting from the felling of a palm tree. We describe the transoral management that was performed and the multidisciplinary support that allowed optimal management of the injury without complications, including functional or aesthetic sequelae.

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The high incidence of facial trauma makes it crucial to consider related injuries and possible complications.

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This article may help other physicians in the emergency setting managing similar injuries.

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Transoral extraction of the foreign body may the best approach for some penetrating injuries. The surgeon must anticipate the possibility of other procedures in order to allow breathing and obtain nutritional support.