Pediatric injuries in maxillofacial trauma: a 5 year study

Fractures of the facial skeleton in children are less frequent. This clinical retrospective study of 5 year was conducted on 95 patients aged less than 16 years who sustained maxillofacial injuries during the period 2003 to 2008. Age, sex, etiology incidence and type of fracture were studied. The ratio of boys to girls was 1.9:1. The 7–12 year age group was commonly involved and the highest incidence was at age of ten years. Falls were the most common cause of injury accounting for 41%, followed by road traffic accidents (30%). Sports related injuries, assault and child abuse were also the causes of injury in children. Dentoalveolar injuries were found to be highest incidence with 42.1% followed by mandibular fractures. The soft tissue injuries were associated the pediatric maxillofacial trauma were found to be 34.7% of all cases.     

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.     

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

BackgroundDue 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 MethodsA 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.ResultsOf 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.ConclusionsIt 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.     

Otologic injuries are frequent in pediatric patients with temporal bone fractures

This retrospective study aimed to clarify the occurrence and types of otologic injuries in children and adolescents with skull fractures.Files of all patients under 18 years of age who had been diagnosed with skull fractures at a tertiary trauma centre were included. The primary outcome variable was the presence of any otologic symptom or finding. Secondary outcome variables were clinically detected and radiologically detected otologic injuries. The primary predictor variable was a temporal bone fracture. Other study variables were sex, age, mechanism of injury, traumatic brain injury, and mortality.A total of 97 patients were identified for the study. Otologic symptoms and findings were frequent (33.9%). The most common clinical findings were bleeding from the external auditory canal (18.6%) and hemotympanum (13.4%). The prevailing radiological finding was blood and/or cerebrospinal fluid in the middle ear (30.9%). Patients with fractures of temporal bone had a 29-fold risk for otologic symptoms or findings (RR 28.9, 95% CI 4.1–202.9, p < 0.001) relative to those who did not have a temporal bone fracture. Severe otologic complications, such as permanent hearing loss (6.2%), cerebrospinal fluid leak (5.2%), or facial nerve palsy (1%), were infrequent.Within the limitations of the study it seems that there is the necessity of otoscopy in all pediatric patients with blunt head trauma. In case of positive otologic findings, the patient should undergo imaging and ENT consultation.     

Primary care management of maxillofacial injuries in sports

Injuries to the maxillofacial region sustained in sports related trauma are increasing in the United States. The pediatric (age 12 and younger) and teenage populations account for the greatest number of these injuries primarily due to increased team sports participation in these younger age groups. A severe injury to the maxillofacial region can have devastating psychological effects as well as being physically debilitating. Therefore, early treatment of soft tissue and bony injuries will minimize scarring and decrease potentially adverse psychological implications. Sports trauma is a frequent source of maxillofacial injuries especially in the younger population. Basic protective equipment, such as proper fitting helmets, mouth guards and face masks, are still not mandatory, or rules not enforced, in many youth hockey and football leagues. In addition, the increased popularity of multispeed bicycles, dirt bikes, and off-road vehicles (e.g. snowmobiles, go-carts) in the hands of unrestrained and unprotected children and adolescents has contributed to an increasing number of maxillofacial injuries in these groups.     

Equine-associated maxillofacial injuries: retrospective 5-year analysis

We explored the relation between the causes of facial injuries in equestrians and the presence or absence of associated injuries. Over a 5-year period we retrospectively reviewed all patients who presented to the John Hunter Hospital, New South Wales, with facial injuries that had resulted from activity with horses. We analysed the rates of hard and soft tissue injuries, and of associated injuries by sex and mechanism. A total of 85 patients were included (50 female and 35 male) with an age range of 2–88 years. There was a significant difference in the rate of maxillofacial and associated injuries when groups were analysed for sex and mechanism of injury. Facial injuries caused by falling from a horse were more often associated with other injuries in men than in women (p < 0.05), and men were 4 times more likely to present with associated injuries than women (OR 3.9; 95% CI 1.1 to 14) We also found significant differences in the rates of facial fracture. Women who had been kicked by a horse were more likely to sustain bony injuries than men (p < 0.05). Our data confirm the association between kicks and facial fracture, and this may provide an impetus for the development of appropriate protective equipment. Patients who sustain facial injuries when falling from a horse often present with associated injuries and this has practical implications for clinicians involved in their management.     

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.     

Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries

PURPOSE: A 10-year retrospective study was undertaken of all patients treated for facial gunshot and shrapnel wounds at our medical center to evaluate the outcomes and assess the results of simultaneous management to treat the hard and soft tissue injuries primarily. PATIENTS AND METHODS: A total of 44 patients were treated. Medical documentation of the patients was compiled. All maxillofacial gunshot, shrapnel, and warfare injuries were treated by the oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by pertinent consultant specialists. Patients ranged in age from 8 to 53 years, with a mean age of 24.7 years. Maxillofacial hard and soft tissue injuries were treated definitively in the first operation except when gross contamination, infection, extensive comminution, or general condition precluded this. RESULTS: There were 2 shotgun, 28 bullet, 10 shrapnel, 3 land mine, and 1 breech block injuries. Overall postadmission mortality in this series was 2.2%. Of the 97.7% of the patients who had an injury to the underlying craniofacial skeleton, all required surgical intervention. The soft tissue and underlying bony injuries were addressed concomitantly (in a single stage at the time of primary surgical debridement) in 86.3% of the patients. Nine percent of the patients had a tracheostomy emergently for management of the airway, 6.8% had an intracranial injury, and 2.2% of them required neurosurgery. In the series, 4.5% of the patients had neck wounds that required exploration. Comprehensive treatment was rendered in 1 to 3 major operations (average, 1.5). CONCLUSION: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary treatment of hard and soft tissue injuries of the face at the time of surgical debridement was possible in the majority of our patients. This minimized the number of admissions and did not bear a higher complication rate than other reported series that advocate multiple staged operations to treat such injuries despite the fact that, in our series, flaps were also mobilized for wound closure in the primary phase.     

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维持气道通畅是口腔颌面创伤麻醉处理的重要课题。观察显示口腔颌面部外伤容易并发呼吸道梗阻,尤其是合并颅脑外伤者、昏迷状态、颌面部大出血、各种异物、舌根后坠等。相关报道合并颅脑外伤昏迷时,呼吸道问题引起的死亡,往往高于创伤本身。随着麻醉学技术的进步和对困难气道的深入认识以及麻醉药品器械的研制,解决问题的手段也日益增多。但每种解决办法都有自身特点,即适应证或禁忌证,尚需深入研究。颌面创伤气道的安全性关键在于围术期如何避免缺氧,有防范策略;其次是如何熟练应用各种插管方法。     

Retrospective analysis of 471 surgically treated zygomaticomaxillary complex fractures

Purpose

Zygomaticomaxillary complex (ZMC) fractures are frequent in facial trauma; only fractures of the mandible are more common. Although the frequency of these fractures is geographically consistent, the aetiology differs widely among countries and even regions. Differences in socio-economic status and the ageing population seem to be two causes.This retrospective epidemiological study evaluates patients who were surgically treated for ZMC fractures at a Swiss university clinic.

颅脑等全身多器官损伤合并颌骨骨折的临床救治

目的:探讨颅脑等全身多器官损伤合并颌骨骨折患者的临床救治.方法:对56例颅脑等全身多器官损伤合并颌骨骨折患者的院前急救,入院时Glasgow昏迷评分,入院后的救治以及相关预后进行分析.结果:56例中,颅骨骨折20例,脑震荡伤2例,脑损伤54例,合并全身损伤38例,合并颌骨骨折45例.院前体征昏迷41例,出血20例,恶心呕吐15例,大小便失禁10例.院前急救处理:清创缝合16例,气管切开3例,胸腔闭式引流3例,骨折牵引3例,各种相应处理31例.入院时Glasgow昏迷评分GCS13～15者20例,GCS8～12者10例,GCS5～7者26例.入院后立即施行开颅手术或气管切开术10例,采取保守治疗46例.病情稳定后施行颅脑或全身手术11例,施行颌骨骨折切开复位 钛板内固定术41例.预后情况,本组无死亡病例,所有病例生命体征稳定,失语1例,运动障碍1例,视力丧失1例,听力下降1例,颌骨骨折复位固定术后咬合关系恢复正常及良好者40例.结论:颅脑等全身多器官损伤合并颌面部损伤者的急救应遵循①.影响生命体征时"先全身,后口腔";②.不影响生命体征时应"全身与口腔并举";③.颌面部损伤重,全身损伤轻时应"先口腔,后全身"的原则.     

Causes and incidence of maxillofacial injuries in India: 12-year retrospective study of 4437 patients in a tertiary hospital in Gujarat

Maxillofacial injuries are unique because of the anatomical complexity of the area and their associated psychological effects. An understanding of the epidemiology of these injuries is important if we are to develop preventive measures, increase the efficiency and delivery of health services, improve the skills of healthcare providers, and better distribute resources. We retrospectively evaluated data on 4455 patients (aged between 3 and 84 years) who presented with maxillofacial injuries to a tertiary referral hospital in Ahmedabad, India, between 1 January 1999 and 31 January 2010. Of these, 18 needed only rest and medication so 4437 were included. Data included patients’characteristics and the cause of injury. Details on the presentation and severity of injury, associated injuries including head injuries, the influence of alcohol and other drugs, treatment, and outcome, were also included. Around one-third were aged between 21and 30 years, and the male to female ratio was 5:1. The main causes of injury were road traffic accidents (n = 2347, 53%) and interpersonal violence (n = 1041, 23%). Most road traffic accidents involved two-wheeled vehicles. Alcohol was associated with 11% of injuries. A total of 2546 patients (57%) had mandibular fractures. To reduce the number of injuries we need better road safety laws with stringent enforcement, and the public, particularly those between 15 and 45 years of age, must be educated about road safety.     

A retrospective study of traumatic dental injuries in primary dentition: treatment outcomes of splinting

Objective: Splinting in primary dentition is limited to several traumatic dental injuries. The prognosis associated with splint use has not been fully investigated. In this study, we investigated the outcomes of traumatic injuries in primary teeth treated with splinting.

Materials and methods: We retrospectively analysed 137 children with root fractures and lateral and extrusive luxation injuries to their primary teeth who were treated with semi-rigid splints between 2010 and 2016. Treatment outcomes were analysed in patients with follow-up periods of >6 months. The outcomes of splinting were based on clinical and radiographic evaluations performed during follow-up examinations.

Results: In total, 182 primary teeth were examined, and of these, 90 teeth were treated using semi-rigid splints. In the splint group, pathological root resorption (31.1%) was the most common complication, whereas pathological tooth loss (25.0%) was found most common in the observation group. Splinting in root fractures showed a good prognosis, whereas in lateral and extrusive luxations, it did not (p?p?>?.05).

Conclusions: Depending on the type of luxation, splint therapy results in acceptable outcomes and may be a feasible treatment option.     

口腔颌面部严重损伤的控制性外科

损伤控制性外科的主要原则是:先通过简捷的手术控制出血和污染,然后至ICU进行生理性复苏,最后进行二次手术,对所有损伤实施确定性修复。口腔颌面部严重损伤常为多发伤,出血多、生理机能耗竭严重,需要采用损伤控制性外科策略。     

Evaluation of immediate phase of management of missile injuries affecting maxillofacial region in iraq

In the past two years Iraq was, and still is, subjecting to a confluence of conventional war, civil unrest, guerrilla and terrorist attacks as well as an increasing crime rates. This study evaluates the immediate phase of management of 100 patients suffering from missile injuries to the maxillofacial region. Patients were treated in the maxillofacial unit in the Specialized Surgeries Hospital Medical City, Baghdad during one year (from 2003 to 2004). We had 79 men and 21 women. Age ranged from three to 72 years (mean 37.5 years). The majority of injuries were caused by rifle bullets (49%) followed by fragments (29%), handgun bullets (15%), airgun pellets (6%), and shotgun (1%). Injuries consisted mainly of mandibular fractures found in 56 patients.Urgent airway management was needed in (27%) of patients. Nineteen patients were presented with active bleeding which would not stop without intervention. Most entrance and exit wounds as well as retained missiles were located in the cheek (54.8%, 39.4%, and 27.5% respectively). There were three mortalities due to complications related to head injury.Distribution of missiles used in any conflict reflects the type of this conflict, the prevailing local conditions, and the technological efficiency of weapons used by the opposing teams. Particularly challenging are missile injuries that involve the face, not only because of problems with reconstructing bone and soft tissue defects but also because of emergent problems with airway obstruction and neurovascular compromise.