Radiology of maxillofacial gunshot injuries.

The relative advantages and disadvantages of conventional facial radiographic techniques, facial tomography, and carotid arteriography for gunshot injury cases are discussed. The conventional series of skull, facial, or cervical spine projections forms a base line upon which the more complex procedures may be added. Five cases illustrate the radiographic principles involved in the determination of gunshot fragment localization, bone fracture, soft-tissue swelling, and maxillary sinus involvement.     

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.     

Dento-alveolar and maxillofacial injuries among different ethnic groups in Israel

Abstract –  An evaluation of dental and maxillofacial trauma in a level 1 trauma center in Israel was carried out to assess the causes of trauma and the relationship between the injuries to the patient's age, gender and ethnicity. Analysis was based on data from the Israel Trauma Registry. Patients hospitalized in a level 1 trauma center from January 1, 2000 to December 31, 2005 were analyzed according to age, gender, time, place, ethnicity and cause of injury. Files of 22 558 trauma patients were reviewed. Maxillofacial and tooth injuries were separated and further analyzed according to the above parameters. Maxillofacial or dental injuries were observed in 1668 (7.4%) of the trauma patients, caused by motor vehicle accidents (39.2%), falls (30.9%), and intentional injuries (21.2%). Most occurred on the street/road (46.5%), at home (18.8%), and in public buildings (12.4%). Arab patients suffered more from vehicle accidents while Jewish patients presented more intentional injuries. Men were hospitalized three times more than women, and young people were at greater risk. The most frequent age of trauma was 19–28 years (27.6%). Ethnic differences were particularly noticeable for intentional injuries and vehicle accidents. This emphasizes that a larger percentage of the Arab population suffered from dental and maxillofacial injuries. Further dental health education and training for primary caregivers are warranted.     

Prevalence of maxillofacial injuries by motorized two wheeler road traffic accidents in Bangalore city

Abstract – Introduction : Two wheeler users in India are the most vulnerable for road fatalities and two wheelers constitute the major portion of vehicular traffic. Objectives :  To assess the prevalence of maxillofacial injuries among the victims of motorized two wheeler road traffic accidents in Bangalore city. Materials and methods :  Medical records of cases reported during January 2006–June 2007 to hospitals were considered and data regarding age, sex, date of trauma, rider or pillion rider, alcohol consumption, site of injury on the face and associated injuries to other parts of the body were recorded. Results : The prevalence of injuries among males and females was in the ratio of 3:1. Most of them were in the age group of 21–30 years. Most of the cases were recorded on Saturdays (17.4%) and in the months of August (9%) and September (9.7%) and the least number of cases were reported in January, March and June (2.1%) of 2007. The decrease in number of cases coincides with the implementation of the Helmet Rule in the city. Conclusion :  There is a need to stress on the importance of usage of helmets and adherence to traffic rules during the high-risk periods to reduce the incidence of road traffic accidents and accompanying maxillofacial injuries.     

Occurrence and types of dental injuries among patients with maxillofacial fractures

The aim of this retrospective study was to clarify the occurrence and types of dental injuries in 389 patients who had been diagnosed with facial fractures, and to analyze whether the occurrence of dental injury correlates to gender, age, trauma mechanism and type of facial fracture. Dental injuries were observed in 62 patients (16%). The most common type of injury was a crown fracture (48%). Dental injuries were multiple in most patients (63%). Almost half (48%) of all injured teeth were severely injured. Most injured teeth (61%) were in the maxilla. The incisor region was the most prevalent site in both the mandible (45%) and the maxilla (56%). The occurrence of dental injury correlated significantly with trauma mechanism and fracture type: motor vehicle accidents and mandibular fracture were significant predictors for dental trauma. The notable rate of dental injury observed in the present study emphasizes the importance of a thorough examination of the oral cavity in all patients who have sustained facial fracture. Referral to a dental practice for further treatment and follow up as soon as possible after discharge from hospital is fundamental.     

Dental and maxillofacial injuries among older New Zealanders during the 1990s

Not only is the number of older people increasing in New Zealand, but a greater number of them are keeping their own teeth, with predictable consequences for the costs of treating (and rehabilitating) dental and maxillofacial trauma in that group. The aim of the study was to describe the occurrence of dental and maxillofacial trauma involving New Zealanders aged 65 and over during the 1990s. The investigation was a secondary analysis of routinely collected, national-level compensation and hospital treatment data. The analysis showed that: (1) there was an increase in the rate and absolute number of injuries among older people; (2) the dental trauma rate was highest among males in the youngest age group, while the facial fracture rate was highest among older females; and (3) there was a general increase in the contribution of falls to the occurrence of trauma. Measures which aim to reduce the occurrence of falls among older people will also reduce the oral and maxillofacial trauma rate in that age group.     

Management of sport-related maxillofacial injuries

By analyzing sports-related maxillofacial fractures, we sought to describe preventive measures and recovery times until sporting activities could be resumed. Between January 2001 and December 2006, 1241 patients were hospitalized as a result of maxillofacial fractures. The patients with sports-related maxillofacial fractures were analyzed based on age, sex, type of sport, injury mechanism, trauma site, presence of associated fractures, hospitalization, treatment method, and recovery time until the resumption of sporting activities. One hundred thirty-eight patients (11.4%) sustained sports-related maxillofacial fractures: 121 males and 17 females (ratio 8:1), aged between 11 and 72 years. The sport producing the greatest number of injuries was soccer (62.3%), followed by skiing (14.5%), and horseback riding (6.5%). The injuries involved mainly the middle third of the face (71.6%), and the mandible was the most affected site (27.2%), followed by the maxillary-zygomatic-orbital complex (25.9%). Treatment was surgery in 93.5% of the patients, with an average hospitalization period of 3.5 days. The protocol created to manage the follow-up of maxillofacial injury patients advised resuming sports activities at least 40 days after the trauma, except in the case of combat sports, when a period of 3 months was required. Although the results of this study indicate a reduction in the total incidence of sports-related maxillofacial injuries, they also show an alarming secondary increase in trauma resulting from the most popular sport in Italy-soccer. Therefore, stricter regulations are needed to discourage violent play, rather than relying on the use of protective equipment. Moreover, patients should be advised when they can resume sports activities, particularly in the case of professionals and semiprofessionals.     

Modern treatment of maxillofacial injuries

Methods and results of application of external fixation devices (EFD) in the treatment of complicated mandibular fractures are presented. The data indicate the possibility of treatment and rehabilitation by a little traumatic method, which repairs the abutment tissue defect simultaneously of repair of mandibular function.     

Frequency of maxillofacial injuries in all-terrain vehicle collisions.

PURPOSE: We sought to evaluate the frequency and distribution of maxillofacial injuries associated with all-terrain vehicle (ATV) collisions and to compare this with patients involved in motorcycle accidents over the same 5-year period at the University of Alabama at Birmingham.Patients and methods The records of all patients involved in ATV collisions who were admitted to the University of Alabama at Birmingham Trauma Center from January 1998 to January 2003 were reviewed. Age, gender, mechanism of injury, length of stay, Glasgow Coma Scale (GCS) score, maxillofacial injuries, Injury Severity Score (ISS), and maxillofacial Abbreviated Injury Scale (AIS) score were the factors considered for the study. These variables were also analyzed for patients involved in motorcycle collisions who sustained maxillofacial trauma. RESULTS: There were a total of 72 ATV collisions; 23 patients (32%) sustained maxillofacial injuries. The mean age was 31, and there were 59 males (82%) and 13 females (18%). The most common mechanism of injury was an ATV rollover. The warmer seasons and weekend days had the highest frequency of ATV trauma. Of the 23 patients who sustained maxillofacial injuries, the average maxillofacial AIS score was 2. The length of stay and GCS score were 8 days and 12, respectively, compared to 5 days and 15 in the nonmaxillofacial injury group. The most common maxillofacial fracture seen was a zygomaticomaxillary complex fracture (n = 8), followed by mandibular fractures (n = 6), and orbital floor blowout fractures (n = 5). Eighty-three percent of patients with maxillofacial injuries required an operative intervention during their hospitalization. The distribution of maxillofacial fractures in the ATV group was similar to that of an equivalent motorcycle group, but the frequency for the ATV group was higher (32% versus 8%). The length of stay for the motorcycle group was 11 days versus 8 days for the ATV group. The GCS scores, maxillofacial AIS scores, and ISS were similar between the 2 groups (12, 2, and 18, respectively). In patients who sustained maxillofacial fractures, neurologic injuries were the most frequent concomitant injury in the ATV group, whereas orthopedic injuries occurred more often in the motorcycle group. CONCLUSIONS: Maxillofacial injuries are common findings in ATV collisions. ATV patients with maxillofacial fractures have more neurologic impairment at admission and longer hospitalizations than patients sustaining motorcycle injuries. There needs to be an increase in the public health effort to educate individuals about the dangers of ATVs and to provide proper safety guidelines before the purchase of a vehicle.     

Gunshot injuries of the orofacial region in Nigerian civilians.

The dearth of information from Africa on gunshot injuries to the orofacial region in a civilian population prompted this retrospective survey. Sociodemographic data, manifestations at admission, type of firearm inflicting injuries, mechanism of injury, radiographs, treatment and complications were reviewed. All injuries occurred in the civilian population. The majority of patients (95.5%) were males, involved mainly in recreational hunting expeditions. The Dane gun was mostly used (86.4%) and accidental discharge of the weapon was recorded in 59.1% of the cases, 40.9% of these being accidentally self-inflicted. Overall, the left half of the face received more of the missiles. Complications were seen in 63.6% of the patients and the most common of these was loss of sight. The mortality rate was 22.7%. Late presentation was a frequent occurrence. It is suggested that Nigerian law enforcement agencies devise strategies to monitor the sale, acquisition and use of such firearms.     

Patterns of maxillofacial injuries related to interaction with horses.

PURPOSE: Studies of trauma patients have described patterns of injuries sustained from unfortunate encounters with large animals. However, the patterns of maxillofacial injuries have yet to be reported. The goal of this investigation was to describe and report on maxillofacial injuries that are associated with interaction with horses. PATIENTS AND METHODS: Charts were selected from the trauma registry by E-code at a level 1 trauma center in Portland, OR. A retrospective review was performed on charts collected from the previous 5 years (1998-2002). Data were collected according to patient, pattern of injuries, and mechanism of injury. RESULTS: The 62 patients who were identified consisted of 15 males (24%) and 47 females (76%) and ranged in age from 1 to 83 years (average age, 32 years; most frequent age, 12 years). Most of the accidents occurred in the spring months and involved a horse known to the patient. The most common mechanism was falling from the horse. However, being kicked was correlated with a more serious injury (P =.048). The most frequent injury was abrasion/contusion (24 [39%]), second were lacerations (20 [32%]), and third were fractures (18 [29%]). Fifty (81%) were not wearing helmets. Forty-six (74%) of the patients had other associated injuries. CONCLUSIONS: In patients with facial injuries related to horses, younger females were the most frequently involved. Facial injuries were often associated with other types of injuries. Nearly a third of the facial injuries sustained were fractures. The percentage of riders without a helmet was high. However, in our patient population, wearing a helmet does not seem to add any protection to the face, and almost all of the accidents involved a horse known to the patient. More education aimed at horse owners regarding the use of helmets, proper handling and riding skills, and supervising young riders is encouraged to prevent further injuries.     

Penetrating injuries to the maxillofacial region

The cases of 37 patients who had incurred penetrating injuries to the maxillofacial region, with retention of foreign bodies, are described. Primary surgery was performed when possible. In some cases the foreign bodies were removed several years after the injuries, and in others the objects were never removed. Methods for locating and removing foreign bodies lodged within the maxillofacial region are discussed.     

Pediatric maxillofacial injuries and its management

BackgroundPediatric facial injuries are common due to children's high level of activity which gradually decreases as age advances. Main etiology in cases of pediatric age group are self-fall, sports related injuries, interpersonal violence and lastly road traffic accident. Pattern and management of facial fracture in pediatric age group is different to that of adult population.Material and methodsThis study included 87 patients who had facial injuries and who reported at dental institute RIMS, Ranchi over a period of three years from 2017 to 2020. Initial assessment diagnosis and management were given to the patients.ResultsSelf-fall accounted as the leading cause of fracture (47.1%). Most frequent age group with facial injuries were from 7 to 12 years age group (49.1%). Dentoalveolar pattern of facial fracture was most common accounting for (39.1%) followed by mandible fracture in 33.3%. Closed reduction of the fracture was the most common way of treatment. Open reduction and fixation was carried out in 3.4% patients.ConclusionSelf-fall was the main etiology in our study and younger age group patients were more involved. Conservative treatment are generally given to pediatric age group, with open reduction in few cases on the basis of displacement. Close monitoring and follow up is mandatory in these age group.     

Management of maxillofacial injuries in Iraq

These clinical studies reflect the experience of the author in managing 673 patients treated during the last 8 years. All patients were treated in the Maxillofacial Unit, Surgical Specialties Hospital, Medical City, Baghdad, and in the author's private clinic. Included patients were 530 males and 143 females; patients' age ranged between 1 year and 75 years (mean, 38 y). Distribution of injuries was as follows: fracture of the mandible, 287 (42.64%); middle third injuries, 39 (5.79%); orbital injuries, 236 (35.07%; including 12 cases with cranioorbital injuries); injuries in children, 27 (4.0%); fracture of the zygoma, 52 (7.73%); and fracture of the nose, 40 (5.94%).Maxillofacial injuries in this study were classified as follows: (1) craniomaxillofacial with head injuries and cerebrospinal fluid leak; (2) fracture of the middle third including Le Fort I, II, and III and midline split in the face; (3) fracture of the mandible as an isolated injury or as part of a facial skeleton injury; and (4) isolated complex injuries of the zygoma, the orbital skeleton, and the nasoethmoidal region.The technique used for treating middle third injuries was external fixation either by halo frame (with vertical rods and cheek wires) or by box frame (using 4 external pins connected by rods) or internal fixation by suspending the middle third with internal wires (0.5 mm stainless steel) from the zygomatic process of the frontal bone beneath the zygomatic arch down the lower arch bar. Fractures of the mandible were treated by gunning splint with intermaxillary fixation (IMF) or with open reduction and fixation by stainless steel wire with IMF or by IMF screw or by an arch bar and IMF. Other fractures such as fracture of the orbit were treated by bone graft, sialastic, or lyophilized dura with open reduction. Fractures of the zygoma were treated by open reduction and fixation with stainless steel wire and bone graft or by reduction without fixation. Fractures of the nose were treated by reduction with straightening of the septum with a splint (lead splint or polythene) or by external splint with plaster of Paris. With the techniques used, results from managing these cases were satisfactory.     

口腔颌面外科手术室护士锐器伤调查分析与预防控制

目的： 了解口腔颌面外科手术室护士锐器伤的现状,分析其原因,并制定有效的防护对策,减少锐器伤的发生。方法： 采用问卷调查方式,对上海交通大学医学院附属第九人民医院口腔颌面外科手术室102名护士在2016年1月—2017年3月间发生锐器伤的情况进行调查,对锐器伤的种类、发生原因及操作环节等进行分析;针对调查分析结果采取相应的防护措施,对各个环节进行针对性整改等。结果： 口腔颌面外科手术室护士锐器伤发生率为87.2%。工作年限≥5年发生率为57.1%,<5年为95.6%;新职工发生率为91.6%,实习生为95.6%。致伤物依次为针刺损伤、刀片、玻璃;致伤环节依次为传递器械、术后整理器械、清洗器械。结论： 口腔颌面外科手术因手术器械精细、缝针繁多、手术时间长、器械人员接触尖锐器械多,容易发生锐器伤。通过针对性地预防干预,可以有效地预防锐器伤的发生。