A review of 100 closed head injuries associated with facial fractures.

One hundred closed head injuries associated with facial fractures treated over a 78-month period at a level I trauma center in Northeast Ohio were reviewed. The incidence of closed head injury in patients with facial fractures was 17.5%. Males suffered closed head injuries four times more often than females, and sustained severe intracranial injuries eight times as often. The 16- to 30-year age group predominated (59%). Although motor vehicle accidents were the most frequent cause of injury (61%), motorcycle accidents were associated with the most severe head injury. The mandible/midface fracture ratio (1.3:1) was almost half that of the non-head-injured population (2.1:1). Facial fracture complications were found to have a similar incidence (14%) as in the non-head-injured population, but were associated with more severe intracranial injuries.     

颌面部骨折142例临床报告

目的:总结分析颌面部骨折的病因、临床特点及治疗方法。方法:对中国医科大学附属口腔医院2004年10月-2005年9月收治的142例颌面骨骨折患者,分别从其年龄、性别、病因、骨折类型、全身损伤、治疗及手术并发症等各方面,进行综合分析研究。结果:颌面部骨折好发于男性,20～50岁为好发年龄段;交通事故损伤最常见(59.15%);多见下颌骨骨折(50.00%)及颧骨复合体骨折(29.58%);常伴发全身损伤(35.21%);治疗中复位后坚固内固定术是最佳方法(81.65%);手术切口以口内为主(58.72%);术后神经损伤及感染极少见。结论:颌面部骨折以青壮年居多,最主要病因是交通事故,除复位颌间牵引保守治疗外,复位后坚固内固定是现今临床最常用的治疗方法。     

Incidence of oral and maxillofacial skiing injuries due to different injury mechanisms.

PURPOSE: This study emphasizes the significance of maxillofacial injuries in skiing accidents, correlating injury mechanisms and patterns, by evaluating a large population of maxillofacial injuries over a 6-year period. PATIENTS AND METHODS: Between 1991 and 1996, of 5,623 patients showing oral and maxillofacial injuries, 1,859 were sports-related. Records of 579 patients with 882 incidents of oral and maxillofacial injury due to skiing were reviewed and analyzed according to age, sex, type of injury, cause of accident, location, and frequency of fractures. Additionally, the five main injury mechanisms were analyzed. RESULTS: The oral and maxillofacial injuries in 10.3% of all trauma patients, or 33% of all sports-related trauma patients, were due to skiing. A total of 310 patients (53.5%) had facial bone fractures, 236 patients (40.8%) suffered from dentoalveolar trauma, and 336 patients (58%) showed soft tissue injuries. Five major causes and mechanisms of injury existed, namely, 263 falls (45%); 135 collisions with other skiers (23%); 70 individuals struck by their own ski equipment (12%); 46 collisions against stationary objects (8%); and 34 lift-track accidents (6%). Sex distribution showed an overall male-to-female ratio of 1.9:1.0, but varied depending on the injury mechanism. The age distribution ranged from 2 to 81 years. CONCLUSION: The results of this study show the high incidence of oral and maxillofacial injuries due to skiing accidents. Depending on the mechanism of injury, different patterns occur. Facial bone fractures are more likely in collisions with other persons, falls, and collisions with stationary objects, whereas dentoalveolar trauma is more common when persons are struck by their own ski equipment, or when accidents on lift-tracks occur.     

Epidemiological analysis of maxillofacial fractures treated at a university hospital,Xinjiang, China: A 5-year retrospective study

PurposeTo investigate the epidemiological characteristics of maxillofacial fractures treated at a university hospital, Xinjiang, China over a 5-year period.Patients and methodsBetween 2006 and 2010, a total of 1350 patients with maxillofacial fractures were reviewed retrospectively. The data collected included demographics, aetiology, site of fracture, time regarding injuries, presence of associated injuries, treatment modalities, and complications.ResultsA total of 1860 maxillofacial fractures were seen in 1350 patients with a male to female ratio of 4.9:1. The most common aetiology of the fractures was motor vehicle accident, followed by interpersonal violence. The age group 21–30 years accounted for the largest subgroup in both sexes. The mandible was the most common site of fracture followed by the zygoma. Associated injuries were found in 48.3% of patients, with a prevalence of intracranial injuries (37.0%). Majority of fractures were treated with open reduction (62.4%), and 7.2% of patients presented post-operative complications.ConclusionRoad traffic accident is the most common cause of maxillofacial fractures in China, which is characterized by an increasing prevalence and resulting in more associated injuries. Thus, more attention should be paid on the prevention and treatment of these injuries caused by road traffic accidents in our country.     

198例老年颌面部骨折患者临床分析

目的 了解老年颌面部骨折患者的临床特征。方法 对2010年7月—2017年10月收治的198例老年颌面部骨折手术患者的临床资料进行回顾,分析创伤原因、骨折部位、合并伤、系统性疾病、治疗方法等临床特征。结果 198例老年颌面部骨折患者,男女比3.95︰1,平均年龄66.15岁;交通事故伤（78例,39.39%）、摔伤（49例,24.75%）、高坠伤（33例,16.67%）是老年人颌面部骨折的主要原因;下颌骨是最常见的骨折部位（120例）;60例患者同时伴发颌面部以外的创伤,四肢损伤最多（28例）;66例患有系统性疾病,最常见的是心血管疾病（50例）。198例患者的治疗方法主要是小型或微型接骨板切开复位坚强内固定。结论 坠跌伤和交通事故伤是老年颌面部骨折的主要原因,应采取有效的预防和干预措施。     

Analysis of the Pattern of Maxillofacial Fracture by Five Departments in Tokyo: A Review of 674 Cases

We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6 : 1. The most frequent age group was 21–25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.     

Maxillofacial fractures in Southern Bulgaria - a retrospective study of 1706 cases.

The present retrospective study investigated various types, aetiology, complications and methods of treatment of maxillofacial fractures managed in the Department of Maxillofacial Surgery, Medical University, Plovdiv, Bulgaria. PATIENTS AND METHODS: A total of 1706 patients were studied with 2534 fractures treated between 1994 and 2003. The analysis included data on age and gender of patients, causes and types of fractures (mean number of fractures per patient - 1.48) as well as the treatments used and the associated complications. RESULTS: Most maxillofacial fractures were sustained by 574 men (age range 21-30 years). The ratio of males to females was 4.6:1. Most fractures were caused by violent assault - 1040 (61%), followed by motor vehicle accidents - 264 (15.5%), fall - 213 (12.5%) and bites from animals - 72 (4%). Fractures of the mandible were sustained by 1261 patients (74%), fractures of the maxilla by 97 (6%), fractures of the zygomatic bone by 277 (16%), nasal fractures by 63 (4%) and multiple fractures by 8 (0.5%). In 1330 (77%) patients the fractures were treated by closed reduction; in 264 patients (16%) by open reduction and fixation, and for the remaining 112 patients (7%) were managed with combined closed and open reduction. The mortality rate was 0.2%, the lethal cases being a result of a combination of severe fractures in the maxillofacial region and trauma to other organs/systems. CONCLUSION: The most common cause of traumatic injury in the maxillofacial region in this study sample was assault, predominantly affecting men. The fractures were treated using various methods but mostly by closed reduction plus fixation.     

颌面部骨折1264例临床回顾分析

目的:探讨和总结颌面部骨折的临床特点和治疗方法。方法:对我院2012年6月—2017年6月收治的1264例颌面部骨折住院病例进行回顾分析,包括年龄、性别、致伤原因、损伤部位、全身损伤及治疗方法。结果:男942例（74.53%）,女322例（25.47%）;20~50岁（59.10%）为好发年龄段;意外摔伤965例（76.35%）;276例(21.84%)伴全身损伤,颅脑损伤120例（37.62%）;1107例（87.58%）采用坚固内固定。结论:颌面部骨折中男性占大多数,意外摔伤是最主要的原因。颅脑损伤是最常见的并发症,开放复位内固定术是目前最主要的治疗方法:。     

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.     

Maxillofacial trauma due to work-related accidents

Even though numerous reports on maxillofacial trauma exist, only a few give detailed information about work-related maxillofacial injuries. The purpose of this study was to reveal the significance of maxillofacial injuries related to accidents occurring at work by evaluating a large number of patients with maxillofacial injuries over a 9-year period. Out of the 8704 trauma patients treated between 1991 and 1999 in the Department of Oral and Maxillofacial Surgery at the University of Innsbruck, Austria, 463 (5.4%) were injured at work. All charts were reviewed and analyzed according to age, gender, cause of accident, occupation, type of injury, location and frequency of fractures. The highest incidence of maxillofacial injury was found among construction workers (a total of 124 patients, 26.8%), followed by craftsmen (102 patients, 22.0%) and office employees (69 patients, 14.9%). The sex distribution showed an overall male-to-female ratio of 11.8:1 and those in the age group most affected were between 20 and 29 years of age. The most frequent cause of injury was a blow in 48.4%, followed by falls and falls over obstacles, accounting for 27.9% and 7.1%, respectively. Of all trauma, 45.4% (210 persons) sustained 423 maxillofacial fractures, 31.7% (147 patients) suffered 232 dento-alveolar injuries, and 21.2% (98 people) showed 430 soft-tissue injuries. One-fifth (20.7%) of all patients displayed concomitant injuries with cerebral and cranial trauma being the most common. The probability of sustaining maxillofacial trauma at work is correlated to the nature of the occupation. Individuals (mostly men) using tools or machines at work are exposed to a much higher risk of work-related maxillofacial trauma.     

Etiology,distribution, treatment modalities and complications of maxillofacial fractures

Purpose: This study evaluated the trends and factors associated with maxillofacial fractures treated from 1997 to 2007 in the Oral and Maxillofacial Surgery Department of the Clermont-Ferrand University Hospital. Material and Methods: This study included 364 patients of which 82% were men and 45%, 20-29-years old. The etiology, anatomical distribution, treatment modality and complications of maxillofacial fractures were examined. Results: Overall, interpersonal violence, traffic accidents and falls were the most common mechanisms of injury. There was a decreasing trend in traffic accidents and increasing one in falls as a cause of fracture over the 11-years period of this study. Young male patients were preferentially victim of interpersonal violence and traffic accidents, while middle-aged ones were of falls and work-related accidents. Middle-aged female patients were preferentially victim of traffic accidents and interpersonal violence, while older ones were of falls. And the number of fractures per patient varied according to the mechanism of injury: low after work-related accidents and high after traffic accidents. About two-third of fractures involved the mandible. Most of these mandibular fractures were treated by osteosynthesis with or without intermaxillary fixation, with the proportion of the latter increasing over time. There were very few postoperative infections and only in mandible. Conclusions: Maxillofacial fractures predominantly occur in young men, due to interpersonal violence. There is nevertheless an increasing trend in falls as a cause of fracture, especially in female patients, consistent with the increasing trend in presentation of older people. Most maxillofacial fractures involve the mandible and there is an increasing trend in treating these fractures by osteosynthesis without intermaxillary fixation. Antibiotic prophylaxis associated with dental hygiene care can be indicated to prevent postoperative infections. Key words:Maxillofacial fractures, Epidemiology, Trends, Influencing factors, Fall, Age, Gender, Antibiotic prophylaxis.     

Cervical spine fractures associated with maxillofacial trauma: an 11-year review

Although cervical spine injury is rarely associated with maxillofacial trauma, it should be suspected when injuries above the clavicle occur, as suggested in the Advanced Trauma Life Support Manual. A retrospective study of 2482 patients with maxillofacial trauma, who were admitted to the Maxillofacial Surgical Division of Turin University between 1996 and 2006, conducted to identify concomitant fractures of the cervical spine and establish a treatment protocol. Twenty-one patients (0.8%), consisting of 17 males and four females ranging in age from 15 to 70 years, had amyelic cervical spine fractures. In 90% of the cases, the cervical spine injury was caused by a road accident. Cervical spine injuries were diagnosed using lateral x-rays in three cases and with computed tomography in the remaining patients. Although an association has been reported between mandibular fracture and cervical spine injury, we did not observe a preferential association between injuries of the upper third of the face and spinal injury. Cervical spine immobilization should never be removed until cervical spine injury has been excluded using a lateral x-ray of the cervical spine. In males with significant blunt craniomaxillofacial trauma caused by high-energy impact accidents such as car and motorcycle accidents, computed tomography is the radiologic examination of first choice to exclude cervical spine injuries. Lastly, the presence of a cervical spine injury did not result in modified or delayed treatment of maxillofacial fractures, with the exception of one patient who had a fracture of the odontoid process.     

Epidemiology and management of maxillofacial fractures treated at Muhimbili National Hospital in Dar es Salaam, Tanzania, 1998-2003

BACKGROUND: This study investigated the pattern, causes and management of maxillofacial fractures at the Muhimbili National Hospital in Dar es Salaam. METHODS: The medical records and radiographs for patients treated for maxillofacial fractures over a 5-year period (1998-2003) were retrieved. Data on the patients' age, sex, cause and type of injury, treatment modality, and post-operative complications were reviewed. RESULTS: A total of 314 patient records of 261 (83.1%) males and 53 (26.9%) females were retrieved (ratio m:f = 3:1), age range 2-70 years, with most (41.4%) in the 20-29 year age group. Most of the fractures occurred in the mandible 222 (70.7%). The distribution of maxillary fractures was Le-Fort I in 10 (66.7%). Most fractures were caused by assault 181 (57.6%) followed by falls 62 (19.7%), motor traffic accidents 43 (13.7%) and sports 25 (8%). Most of the mandibular (98.2%) and zygomatic arch fractures (62.5%) were managed by closed reduction, compared with alveolar bone fractures that were predominantly managed by open reduction. Complications occurred in 17 (5.4%) patients and were mostly infections. CONCLUSION: The causes and pattern of maxillofacial fractures reflect trauma patterns within the community and, as such, can provide a guide to the design of programmes geared toward prevention and treatment.     

548例颌面创伤患者的回顾性分析

目的：通过回顾分析本院颌面创伤住院患者的临床资料，了解西安地区颌面创伤病例的构成、发病特点和临床流行病学现状。方法：对第四军医大学口腔医学院口腔颌面外科2003年7月～2006年6月3年间548例口腔颌面创伤患者的年龄、性别、时间、致伤原因、骨折特点、好发部位、神经损伤以及合并损伤等方面进行流行病学调查分析，采用SPSS10．12软件录入、分析所有数据。结果：颌面创伤患者占本院同期住院患者的22％，男女比例为3．9：1，21～40岁为发病高峰年龄。颌面创伤患者以7月份最多，2月份最少。交通事故在致伤原因中占50．91％，居于首位。颌面损伤以多发性骨折为主，人均骨折部位数为2．3处。在颌面骨骼中，下颌骨骨折最常见，其次是上颌骨和颧弓。在颌面部神经中，眶下神经和面神经损伤最常见。颅脑伤、四肢伤和眼损伤是颌面骨折最常见的合并伤。结论：近年来颌面创伤发病率逐年上升，且伤度加重、伤情复杂，交通事故伤呈上升趋势，创伤患者有年轻化趋势，男女比率有一定下降。     

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

AimThe aim of this retrospective study was to evaluate the frequency and distribution of maxillofacial trauma patients over 80 years, with regard to type and environment of accidents as well as treatment and complications.Patients and methodsData for 94 patients (96 cases; aged 80–94 years) with maxillofacial fractures were retrospectively analysed.ResultsData of 30 male and 64 female patients with an average age of 85 years were analysed. In 90% of the study population, the cause of fractures was a fall, followed by traffic accidents (9%) and assault (1%). Seventy-two patients had fractures of the midface, 10 had factures of the mandible, 9 had fractures of both the midface and mandible and 5 had fractures of the neurocranium and midface. Surgical intervention was required in 57% of the patients. Post-operative complications were: four cases of diplopia, two cases of infected plates, four cases of lower eyelid ectropion and in one case a retrobulbar haematoma.ConclusionFacial trauma in the elderly can often be treated conservatively unless the patient complains of functional problems. Due to co-morbidities, special attention should be paid to hypertension, anticoagulant agents and the surgical approach.     

西藏地区588例颌面部创伤的临床分析

目的:回顾性分析西藏地区颌面部损伤的临床流行病学特点.方法:对西藏军区总医院口腔科2001-06-2010-06间收治的588名颌面部创伤患者的病历资料进行回顾性研究.结果:颌面部损伤患者人数占本科住院总人数的26.4％,男女比例为4.8∶1,21～50岁为发病高峰年龄段,5～10月份为高发期.交通事故在致伤原因中居首...     

An 11-year review of dental injuries associated with maxillofacial fractures in Turin, Italy

Introduction

The aim of the study was to analyze the incidence, characteristics, and correlations between maxillofacial fractures and dental injuries in patients who were treated at a first-level trauma center in a metropolitan center in northwest Italy in the last 11 years.

Material and methods

Between January 1, 2001 and December 31, 2011, 2,110 patients with maxillofacial fractures were admitted. Only dentulous patients with complete clinical records who presented with associated dental injuries were included in this study. Data on the age, gender, mechanism of injury, damaged tooth, type of dental injury, site of facial fractures, and concomitant injuries were recorded.

Results

On the whole, 267 patients (13.1 %), mainly males aged 20–29 years, presented with 759 dental injuries associated with maxillofacial fractures, especially following motor vehicle accidents. The maxillary teeth, most often the anterior elements with decreasing involvement from the incisors to the molars, were the teeth most frequently damaged overall. The main types of dental trauma in patients with maxillofacial fractures were luxations and dental fractures.

Discussion

Our findings show that patients with mandibular fractures were statistically and significantly associated with dental injury, and the teeth in the upper jaw were the most frequently injured teeth, exhibiting mainly luxations and crown fractures. Confirmation of the predominant impact site in patients with dental injuries associated with maxillofacial fractures comes from the 177 lacerations noted in the chin and lip regions in 267 patients.