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。     

Cervical spine fractures and maxillofacial trauma

Cervical spine fractures are a serious complication of maxillofacial trauma because of the high potential for mortality and neurologic morbidity. This study reviewed 563 patients with facial fractures treated by the Division of Oral and Maxillofacial Surgery at a level I trauma center and identified 11 concomitant cervical spine fractures (2.0%). These patients were almost exclusively male (91%), white (100%), between 20 and 35 years of age (64%), involved in a motor vehicle accident (91%), with a concomitant mandibular fracture (91%). The examination, diagnosis, and management of patients with cervical spine injuries are discussed.     

Prevalence of cervical spine injuries in patients with facial trauma

OBJECTIVE: Injuries to the spine may accompany facial trauma. By using a large computerized database the goal of this case control study was to assess the association between facial and cervical spine injuries among patients sustaining facial trauma. STUDY DESIGN: During a period of 4 years (1995 to 1998) 3083 patients, 10 years or older, with facial injuries were admitted to the University Hospital of Innsbruck's Department of Oral and Maxillofacial Surgery for facial trauma. Records were analyzed for cause of injury, age and gender distribution, frequency and type of injury, and frequency of cervical spine injuries in relation to facial trauma and concomitant injuries. Two hundred six (6.7%) of these patients had experienced a concomitant cervical spine injury (case group). All other patients (2877) were assigned to the control group of facial trauma only. RESULTS: Facial trauma patients with concomitant cervical spine injuries were significantly older (mean age, 42 vs 34 years); no difference existed for the female/male ratio of 30:70. Sports trauma was the main cause of facial trauma in the control group (37.4%), yet traffic accidents accounted for 43.7% of combined facial and cervical spine injuries in the case group. Central mid face fractures dominated in the case group and lateral mid face fractures in the control group. In the case group cervical spine fractures and dislocations occurred in 19.2%. None of them showed evidence of paralysis. Concomitant brain injuries occurred in 21.6% of the case group and 8.8% of the control group. For patients sustaining facial trauma, logistic regression analysis revealed reduced risks for additional cervical spine injuries in younger patients, female patients, absence of brain injury, and in patients with facial soft tissue lesions alone (58.2%) or dental trauma alone (77.5%). CONCLUSION: The results of this study underline the importance of proper clinical and computed tomographic evaluation in cases of facial fractures for recognition of additional cervical spine trauma. Detection of cervical spine trauma can be missed, especially when pain or symptoms from other parts of the body dominate. The typical patient with concomitant neck and facial trauma is male, 40 years old, and usually involved in a traffic accident.     

Cervical spine injuries

This article describes the anatomy of the cervical spine and the most common types of fractures associated with the cervical spine. Cervical spinal cord syndromes are also reviewed because such syndromes discovered during neurologic examinations frequently provide the first clue that there is an underlying spinal cord injury. Because most associated maxillofacial and spinal injuries occur in the setting of motor vehicle accidents, it is particularly important for the maxillofacial surgeon to be cognizant of the injuries, particularly in the context of the need for facial/cranial surgery. Appropriate measures are necessary to immobilize or fixate the spine before surgery to avoid exacerbating the spinal injury.     

1693名颌面创伤患者临床病例回顾性研究

对第四军医大学口腔医院1986-1995年10年间1693名颌面创伤住院患者进行了临床流行病学回顾性研究。颌面创伤患者人数占住院总人数的16%，并呈逐年递增趋势；男女比例为6：1，20-30岁为发病高峰年龄，交通事故在致伤原因中占47%，居地首位，颌面损伤以多发性骨折为主，人均骨折部位数为1.7个，在颌面骨骼中，下颌骨骨折最常见，其次是颧骨和上颌骨，颅脑伤是颌面骨折最常见的合并伤，面中部较面下部骨折更易造成颅脑损伤。     

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.     

Patterns and etiology of maxillofacial fractures in Riyadh City,Saudi Arabia

ObjectiveThe aim of the present study was to study the etiologies and patterns of maxillofacial fractures in patients treated in Riyadh City, Saudi Arabia, between 2007 and 2011.Patients and methodsData were obtained through a retrospective review of 237 patients admitted to the King Saud Medical City Dental Department with a diagnosis of maxillofacial trauma. After excluding patient files with incomplete or unclear records, and cases in which computed tomography showed no evidence of fracture, the files of 200 patients with a diagnosis of maxillofacial fracture were included in the study. For each case, patient’s sex and age, pattern of facial fractures, and cause of injury were recorded on a data sheet. The data were transferred to an SPSS (ver. 16.0; SPSS Inc., Chicago, IL, USA) spreadsheet for statistical analysis. The chi-square test was used to test the association between two categorical variables or factors (age group, cause) with p value set at p<0.05, and t-test value at <0.05 and independent.ResultsMotor vehicle accidents were the most common cause of maxillofacial fractures in most age groups, especially in males. Within the study sample, mandibular fractures were significantly more common than middle-third facial fractures (56.4% vs. 43.6%; p=0.006). Among mandibular fractures, parasymphyseal fractures were most common (47%), followed by condylar fractures (35.3%). Most (77.2%) middle-third facial fractures involved the zygomatic complex, and the incidence of such fractures differed significantly between male and female patients. p=0.72, not significant.ConclusionMales were more prone to maxillofacial fractures, perhaps as a result of the conservative nature of Saudi society, as the rules of Saudi Arabia do not allow the females to drive. Motor vehicle accidents were the most common cause of maxillofacial fractures in patients aged 10–29 years, indicating the high demand for the application of stricter traffic rules to reduce the rate of such accidents.     

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.     

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.     

Diagnosis of traumatic internal carotid artery injury: the role of craniofacial fracture

Optimally, internal carotid artery (ICA) injury associated with craniofacial trauma should be treated soon after diagnosis. However, diagnosis is difficult and often delayed. The typical symptoms and signs for diagnosis of traumatic ICA injuries are sometimes easily neglected. Clinically, some patients were initially diagnosed by craniofacial fracture nearby the course of ICA. This investigation retrospectively reviews clinical experience in patients with traumatic ICA injury with a focus on the importance of craniofacial fracture nearby the course of ICA observed on brain or facial bone computed tomography. Eighteen patients with traumatic ICA injury were diagnosed at Chang Gung Memorial Hospital, Taiwan, from June 1998 to April 2004, including 10 patients with pseudoaneurysm formation, seven patients with occlusion, and one patient with laceration. Brain or facial bone computed tomography was reviewed retrospectively. The sample included 14 (78%) patients with skull base fractures involving the intracranial course of ICA and three (17%) patients with mandibular and cervical spine fractures near the course of extracranial ICA. Only one (5%) patient did not have evident fracture. Fractures involving the carotid canal were noted in three (17%) patients. Eight patients received interventional treatments. No further interventional treatments for traumatic ICA occlusion were performed as a result of good collateral flow from contralateral ICA or large infarction noted when diagnosed. Three patients with pseudoaneurysm received expectant management. One patient with arterial laceration with extravasation received no further management. Through meticulously evaluating routine brain and facial bone computed tomography, craniofacial fracture involving intracranial or extracranial course of ICA may be an adjuvant indicator of traumatic ICA injury for early diagnosis.     

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.     

A review of paediatric cervical spinal trauma

Significant spinal trauma in the paediatric population is uncommon. Cervical spine injuries account for approximately 1.5% of injuries. In paediatric patients a far higher proportion of injuries which affect the spinal column occur in the cervical spine in comparison with adults. The assessment of paediatric spinal injuries and radiographs can be challenging even for experts. This is due to a combination of the evolving osseous anatomy and the increase in ligamentous injury. This article looks at the initial assessment and management of injuries. It also presents some of the common radiographic measurements which can be used to assess spinal injuries, paediatric specific injuries of the spine and common variants confused with fractures.     

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.

The relationship between head injury and facial trauma: a case–control study

Introduction

In spite of anatomic proximity of the facial skeleton and cranium, there is paucity of information in the literature regarding the relationship between head injuries and facial trauma. The objective of our investigation was to evaluate the pattern of head injuries in patients with maxillofacial trauma, and to study their relationship.

Material and methods

We evaluated 2,692 patients with maxillofacial trauma admitted to the Besat hospital, Hamedan, Iran between 2007 and 2010. Patients with associated head injury (302 cases; study group) were compared with those without head injury (2,390 cases; control group).

Results

In our cohort, the rate of head injuries associated with facial bone fractures was 23.3 %. The most common associated head injury was concussion, followed by cerebral contusion and skull fractures. In the unadjusted analysis, motorcycle and car accidents were significantly more frequent in the study group, while stumbling, sports injuries, and work-related injuries were significantly more common in the control group (p?<?0.001). Except for Lefort III fractures which was not significantly different between groups, all facial fractures occurred more frequently in the study group (p?<?0.001). Logistic regression analysis demonstrated that motorcycle accidents (211-fold), car accidents (139-fold), violence (69-fold), falls (66-fold), frontal sinus fractures (84.5-fold), and Lefort II fractures (27-fold) were the strongest predictors of head injuries.

Discussion

Present study revealed that fracture of facial bones, especially bones that are in anatomic proximity to the cranium and need a high magnitude of trauma energy to be fractured, was marker for an increased risk of head injuries.     

Mountainbiking--a dangerous sport: comparison with bicycling on oral and maxillofacial trauma.

The popularity of bicycling is reflected in the number of cycling-related oral and maxillofacial injuries. Five hundred and sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, between 1991 and 1996, accounting for 31% of all sports-related accidents and 48.4% of all traffic accidents. A review of the patient records revealed more severe injury profiles in sixty mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma and 23% soft tissue injuries, compared to 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures and 14% soft tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% LeFort I, II and III fractures. Condyle fractures were more common in bicyclists, with 18.8% compared to 10.8% in mountainbikers. Reduction of facial injuries due to cycling-related accidents needs appropriate design of helmets with faceguards and compulsory helmet use for all cyclists, and particularly mountainbikers.     

Aetiology and incidence of maxillofacial trauma in Amsterdam: a retrospective analysis of 579 patients

INTRODUCTION: The incidence of maxillofacial fractures varies widely between different countries. The large variability in reported incidence and aetiology is due to a variety of contributing factors, including environmental, cultural and socioeconomic factors. This retrospective report presents a study investigating the aetiology and incidence of patients with maxillofacial fractures in Amsterdam over a period of 10 years. RESULTS: The study population consisted of 408 males and 171 females with a mean age of 35.9 (SD: ±16.3) years. The age group 20-29 years accounted for the largest subgroup in both sexes. The most common cause of the fractures was traffic related, followed by violence. There were mainly mandibular and zygomatic bone fractures in both males and females, accounting for approximately 80% of all fractures. The main fracture site of the mandible was the combination of mandibular body with mandibular condyle (66 patients; 26.8%), followed by the combination of bilateral condylar fracture and fracture of the symphysis (43 patients; 17.5%). In fractures of the upper 2/3 of the face, zygomatic bone fractures were most common. In patients with alcohol consumption the injury was mostly the result of violence. In conclusion, this report provides important data for the design of plans for injury prevention, as compared with previous studies. Violence related injuries are increasing whereas fractures caused by traffic accidents are decreasing.     

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。     

A ten-year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: Incidence and aetiology

In the literature it is questioned if the presence of maxillofacial trauma is associated with the presence of brain injury. The aim of this study is to present a 10-year retrospective study of the incidence and aetiology of maxillofacial trauma associated with brain injury that required both oral and maxillofacial and neurosurgical intervention during the same hospital stay. Forty-seven patients from a population of 579 trauma patients undergoing maxillofacial surgery were identified. The main cause of injury was road traffic collision, followed by falls. Interpersonal violence correlated less well with traumatic brain injury. Most of the patients were males, aged 20–39 years. Frontal sinus fractures were the most common maxillofacial fractures (21.9%) associated with neurosurgical input, followed by mandibular fractures and zygomatic complex fractures. In the general maxillofacial trauma population, frontal sinus fractures were only found in 2.2% of the cases.At presentation to the Emergency Department the majority of the patients were diagnosed with severe traumatic brain injury and a Marshall CT class 2. Intracranial pressure monitoring was the most common neurosurgical intervention, followed by reconstruction of a bone defect and haematoma evacuation.Although it is a small population, our data suggest that maxillofacial trauma does have an association with traumatic brain injury that requires neurosurgical intervention (8.1%). In comparison with the overall maxillofacial trauma population, our results demonstrate that frontal sinus fractures are more commonly diagnosed in association with brain injury, most likely owing to the location of the impact of the trauma. In these cases the frontal sinus seems not specifically to act as a barrier to protect the brain.This report provides useful data concerning the joint management of oral and maxillofacial surgeons and neurosurgeons for the treatment of cranio-maxillofacial trauma and brain injury patients in Amsterdam.     

An analysis of 2,067 cases of zygomatico-orbital fracture

A ten-year review of 2,067 cases of zygomatico-orbital fractures is presented. The age and sex distribution, anatomical types of fractures, associated maxillofacial and nonmaxillofacial trauma, and causes of the injuries are described. The majority of fractures were sustained by males and resulted from trauma inflicted in altercations. The most common associated facial fractures were mandibular; the most common associated nonmaxillofacial trauma was extremity fractures. Motorcycle accidents caused the most significant amount of associated trauma, followed by motor vehicle accidents in which no seat restraint was used by the victim. Treatment, when indicated, consisted of elevation via a temporal approach followed by fixation where necessary. The fixation methods used are presented and discussed.