Elderly patients with maxillofacial trauma: the effect of an ageing population on a maxillofacial unit's workload

The purpose of this study was to identify the aetiology and management of facial fractures in patients over 60 years old and to identify potential trends in caseload to assist with planning of resources for maxillofacial services in the coming decades. We made a prospective study over 2 years (2009–2010), during which all injured patients referred to the oral and maxillofacial surgery unit at The Canberra Hospital, Australia were recruited. The patients were classified into two groups: less than 60 years old (younger group); or 60 years old or more (older group). Factors studied included sex, age, aetiology, site of fractures, severity scored using the Maxillofacial Injury Severity Score (MFISS), and management. Based on current trends, the expected workload was extrapolated. A total of 470 patients were recruited (younger: n = 430 and older: n = 40). Falls were the most common cause of fracture in the older group (85%) and the zygoma (40%) was the bone most commonly fractured. The mean (SD) MFISS for the older group was 3.8 (2.2) (17% of these maxillofacial injuries were operated on) and 6.0 (5.0) for the younger group (72% of these were operated on). In Australia, population trends suggest that older people as a proportion of the total population will rise from about 20% of 22 million to 26% of 30 million by 2034. As the older group increases there will be a corresponding increase in the number of older people who present with trauma to maxillofacial units. The overall maxillofacial surgical workload will probably not increase much because the injuries tend to be less severe and are less likely to require operation.     

Occult maxillofacial trauma in epilepsy

Epilepsy is a relatively common neurological disorder with incidence in both developed and developing countries. Head, facial, and oral injuries can result from seizures experienced by the epileptic patient. Patients with severe epilepsy often experience other dental disease due to their inability to properly maintain their oral hygiene. This paper presents a case of a chronic mandibular fracture following an episode of seizures in a patient with epilepsy in whom the fracture was discovered when he developed a fistula in the submandibular region.     

Application of intermaxillary fixation screws in maxillofacial trauma.

PURPOSE: The use of intermaxillary fixation (IMF) in the treatment of maxillofacial trauma represents the cornerstone of fracture reduction and immobilization. Many modalities of IMF have been described; recently IMF screws have been introduced into clinical practice, however, hardware failure can occur. We performed a retrospective study evaluating hardware-associated complications for self-drilling/tapping IMF screws. MATERIALS AND METHODS: A retrospective study on 49 patients requiring IMF was performed. The diagnosis, duration of IMF, screw site, use of elastic or wire fixation, and associated complications were recorded. IMF screws were used to adjunct open reduction techniques, for definitive closed reduction, or fracture prevention following dentoalveolar surgery. Follow-up examinations were performed until fracture healing was complete (6 to 8 weeks). RESULTS: A single adverse event occurred in 19 patients (39%) while 4 patients (8%) had more than 1 complication. The most common event was screw loosening; 29% of patients had at least 1 screw dislodged in the treatment period. Of the total number of screws placed (229), 15 (6.5%) became loose, and were equally distributed among the mandible and maxilla. The remaining complications noted were root fracture, 4% (2 of 49); loosened wires, 6% (3 of 49); screw shear, 2% (1 of 49); malocclusion, 2% (1 of 49); and ingested hardware, 2% (1 of 49). CONCLUSIONS: Overall the IMF self-drilling/tapping screws have been shown to be a useful modality to establish maxillomandibular fixation. It is a safe, and time-sparing technique; however, it is not without limitations or potential consequences which the surgeon must be aware of in order to provide safe and effective treatment.     

Proforma for maxillofacial trauma

Over a three-year period we devised, developed, and implemented a simple proforma, validated by a previous audit, to improve the accuracy of data collected on maxillofacial trauma. It covers both sides of an A4 sheet and functions as an aide-memoire for junior staff and prompts the comprehensive recording of all necessary medicolegal details should further documentation be required by the police, judiciary, or compensatory body.     

Massive bleeding following maxillofacial trauma. Case report

A case is reported of massive haemorrhage following severe maxillofacial trauma. The various procedures that were used to control the bleeding are discussed with particular reference to therapeutic arterial embolization.     

Cervical spine fractures associated with maxillofacial trauma: A 3-year-long study in the Greek population

Background

Maxillofacial fractures have been recognized as high risk trauma for concomitant cervical spine or spinal cord injury.

Cervical spine injury in maxillofacial trauma

Objective—To find out the incidence of associated facial injuries and injuries to the cervical spine. Design—Retrospective study. Setting—Teaching hospital, India. Subjects-536 patients treated for maxillofacial injuries between January 1992 and November 1993. Interventions—Review of hospital case notes and radiographs. Main outcome measures—Coexisting facial and cervical spine injuries, morbidity and mortality. Results—16 patients (3%) had sustained both facial and cervical spine injuries. There were 14 men (median age 40, range 21–64) and 2 women (aged 19 and 30). In 10 of the 16 patients the cause of the injury was a road traffic accident. In 11 patients the facial injury was to the soft tissue only, in 4 it was to both hard and soft tissue, and in 1 it was to hard tissue only. Soft tissue damage to the midface was more likely to be associated with injuries in the area of C5–7 and that to the lower third of the face was more likely to be associated with damage to the upper cervical spine. 11 patients had neurological deficits as a result of their injuries and 2 died. Conclusion—If diagnosis and treatment of simultaneous facial and cervical spine injuries are to be improved, further study of the biomechanics of injury is necessary.     

Management of maxillofacial trauma in prisoners

The incidence of injuries among prisoners is much higher than in the general population, and in the UK the number of prisoners and the incidence of injuries are rising. Maxillofacial trauma is common. Based on the cases of 12 patients, we have identified eight challenges that are associated with the management of maxillofacial trauma in this group: patient-reported mechanisms of injury that are often inconsistent with the fracture pattern, complex fracture patterns, delayed presentation, high prevalence of dental disease and of smoking, complicating medical factors such as drug use and blood-borne viruses, increased risk of further violence after discharge, and problems with follow-up logistics. By actively addressing these challenges we can provide a better service to these patients.     

Computed tomography in the diagnosis of maxillofacial trauma

A study of 34 patients who were investigated for maxillofacial trauma using high resolution computed tomography (CT) scanning is presented. The areas where this increasingly available technique offers more accurate information than conventional plain radiographs are discussed.     

Tissue reactions of polypropylene mesh used in maxillofacial trauma.

Four 1-cm2 fragments of polypropylene mesh were implanted in the subcutaneous tissue of each of 10 albino rats to evaluate biocompatibility. A straight longitudinal incision was made on the back of these animals and histological analysis was carried out at 7, 15 and 30 days. At 7 days, there was a mild inflammatory reaction around the implanted material. On day 15, the inflammatory process continued being discrete. The inflammatory reaction decreased significantly by day 30, when mild inflammation with cell infiltrate was observed, as well as the formation of a layer of fibrous tissue surrounding the implanted mesh. These results show the biocompatibility of the polypropylene mesh and support its use in oral and maxillofacial surgery.     

Multidisciplinary management of trauma patients. Role of the maxillofacial surgeon

The approach of patients with multiple trauma is considered to be complicated. Many (non)medical disciplines are involved. This article describes the treatment in the early post-traumatic period and the organisation of the care in both the pre-hospital and hospital phase. Special attention is given to the treatment of patients with maxillofacial injuries. The task of the oral and maxillofacial surgeon in particular when dealing with facial injuries is described.