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Sixty cases have been treated between 1969 and 1986. The same primary treatment's principles have left for the last twenty years. Secondary treatment only, realized between the second and the third month has much benefited by plastic surgery's progress.
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This study describes the patient profile with maxillofacial injuries attending a trauma unit at a children's hospital. A retrospective record-based analysis was carried out of children (less than 13 years of age) presenting with maxillofacial injuries from January 1991 to December 2001. Of the almost 90,000 trauma records, 13% of children presented with maxillofacial injuries. 60% were boys, with a quarter less than 3 years of age. Most presented with superficial lacerations and abrasions. The face (other than the facial bones) and the mouth/oropharnyx were most often injured. Injuries were mainly caused by falls from a variety of heights and transport-related injuries. Almost 60% of traffic-related injuries involved children as pedestrians being struck by a motor vehicle and 20% were cycle-related. Almost 70% of injuries occurred in or around their own home. Maxillofacial injuries in children are a significant cause of morbidity and its prevention especially in the home and streets needs urgent attention.
With the rise in popularity of all-terrain vehicles (ATVs), especially in rural America, injuries associated with their use are becoming more commonplace. A retrospective review was conducted of 153 patients with ATV-related injuries seen at West Virginia University Hospitals between January 1990 and June 1996. Of these patients, 33 had maxillofacial injuries. Only 2 of 21 (9.5%) patients noted to be wearing helmets had facial injuries, whereas 17 of 19 (89.5%) patients who had facial injuries were not wearing helmets. Most patients with maxillofacial injuries occurring at night had been drinking alcohol. Injury Severity Scores were worse for those patients with maxillofacial injuries, as well as for those patients who had been drinking alcohol. Patients with maxillofacial injuries were more likely to require a stay in the intensive care unit. Furthermore, children with facial injuries had higher Injury Severity Scores and longer hospital stays than the adults. To reduce these accidents and related injuries, the industry, local and federal governments, and ultimately individuals must change their attitudes regarding these potentially dangerous vehicles.
PURPOSE: To clarify the relations of the severity of oral and maxillofacial injuries from traffic accidents (TAs) to seating position and the use of restraint systems. PATIENTS AND METHODS: Hospital records were reviewed for all patients who had sustained oral or maxillofacial injuries in TAs and then were admitted to the Department of Oral and Maxillofacial Surgery, Dokkyo University School of Medicine (Tochigi, Japan), from 1994 through 2003. RESULTS: A total of 201 patients, with a mean injury severity score (ISS) of 7.9 +/- 7.6, were included in this study. Although patients with any oral or maxillofacial injury with an Abbreviated Injury Scale (AIS) score of 2 or more had extremely low ISSs, hospitalization was relatively long. The ISS and AIS score of the head or neck were significantly higher in unrestrained drivers (12.4 +/- 11.2, 1.2 +/- 1.4, respectively) than in restrained drivers (6.5 +/- 4.6, 0.4 +/- 1.0, respectively). However, AIS scores of the face were similar in unrestrained drivers (1.9 +/- 0.7) and restrained drivers (1.7 +/- 0.5). Furthermore, the incidence of maxillofacial fractures did not differ between the 2 groups. CONCLUSION: Because wearing seat belts cannot prevent all oral and maxillofacial injuries in motor vehicle occupants, both physicians and engineers must pay greater attention to the mechanisms of oral and maxillofacial injuries in TAs.
Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.
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.
A rare case of massive maxillofacial hemorrhage, which was controlled by transcatheter arterial embolization, is reported. A 23-year-old man with massive nasal and oral hemorrhage caused by maxillofacial fracture was admitted. Emergency angiography demonstrated extravasation of contrast material from the posterior superior alveolar artery, which was immediately embolized using gelatin sponge particles. This case shows that transcatheter arterial embolization is useful and effective for the treatment of massive hemorrhage resulting from severe maxillofacial injury.
Recent reports have shown an increase of oral and maxillofacial injuries caused by sports activities. In European and American countries, mouthguards are the popular measure against these injuries. The purpose of this study was to survey the rate of incidence of oral and maxillofacial injuries caused by contact sports, the diffusion and the evaluation of mouthguards and the interest in mouthguards in Japan. Questionnaires were sent to 244 Rugby football teams in Aichi prefecture and 27 American football teams in the Tokai area. We received replies from 153 Rugby football teams and 17 American football teams, and the results were as follows: 1) The rate of incidence of oral and maxillofacial injuries was 239 players out of 4721 players, which means 5.1% in Rugby football and 22 players out of 428 players, which means 5.1% in American football. 2) The diffusion of mouthguards was 20 out of 153 teams in Rugby football and 16 out of 17 teams in American football. And most of them are using commercially available mouthguards. 3) Almost all teams were not satisfied with their mouthguards and complained of speaking difficulties, discomfort and easy dislocation. 4) Almost all teams desire the improvement of mouthguards. 5) Teams with no experience of mouthguards were very much interested in the use of mouthguards but they do not have enough information about mouthguards. 6) We have to enlighten players and their instructors about mouthguards and diffuse the use of mouthguards more positively to contact sports players.
PURPOSE: The purpose of this study was to report the incidence, causes, and patterns of maxillofacial injury associated with domestic violence. PATIENTS AND METHODS: A retrospective review of patients treated for domestic violence injuries at an inner-city hospital over a 5-year period was done, and data were collected on type and location of injury, mechanism of injury, alcohol involvement, and treatment. RESULTS: The sample consisted of 236 emergency room admissions. The majority (81%) of victims presented with maxillofacial injuries. The fist was a favorite means for assaults (67%). The middle third of the face was most commonly involved (69%). Soft tissue injuries were the most common type of injury (61%). Facial fractures were present in 30% of victims. The average number of mandible fractures per patient was 1.32. The majority of facial fractures (40%) were nasal fractures. Left-sided facial injuries were more common than right sided. CONCLUSIONS: These data confirm that most victims of domestic violence sustain maxillofacial injuries. Midface injuries predominate. The preponderance of facial injuries makes it very likely that oral and maxillofacial surgeons will be involved in the care of these patients.
Experience in team management of multiply injured patients with maxillofacial injuries is reported. During 1992, out of 169 patients transferred to the Royal London Hospital, UK by the Helicopter Emergency medical Service 38 (22.4%) had injuries to the maxillofacial region, 17 of whom were scored on the Abbreviated Injury Scale (AIS) as having sustained facial AIS > 2. The median Injury Severity Score (ISS) was 22, while the ISS was 17.7 for survivors and 34.5 for those who died (chi 2 = 7.3, 0.05 < P > 0.02). Facial AIS (median 4) and facial AIS contribution to ISS were found to be poor indicators of severity of injury. Revised Trauma Score (RTS) and percentage probability of survival (Ps%) were found to be useful discriminators of severity of overall injuries. RTS compared between survivors and those who died was 0.05 < P > 0.02 (chi 2), while Ps% was 0.01 < P > 0.001 (chi 2). It was concluded that the severity of maxillofacial injuries, and hence their contribution to total injury assessments, tended to be underscored. We propose that refined facial injury assessment methods be tested.
A 10-year review of 1693 maxillofacial injuries was presented with respect to age, sex, cause of injury, pattern of fracture, and associated systemic injuries. The majority of fractures in maxillofacial region were found in males, the most prevalent age ranged from 21 to 40 years. The leading cause of facial trauma was traffic accidents. Mandible fracture outranked zygomatic and maxillary fracture. Multiple fractures were more common than single fracture. The average number of fractures for each patient was 1.7. Accompanied injuries to brain and skull happened in almost half patients, which were more often than other part of the body. There was a higher incidence that midfacial fractures coincided with brain and skull damage.
In the Jordanian Society many factors contributed to the occurrence of maxillofacial injuries. Analysis of 131 cases of maxillofacial injuries indicated higher involvement of males. The most susceptible age group was 0-5 years; mandibular fractures were commoner than those of the middle third of the face. In Jordan the incidence of violence is less frequent than that of road traffic accidents. Shattered automobile glass is by far the most common cause of facial injuries. The use of seat-belts notably reduced the frequency of severe facial injuries. The findings of this study should alert the authorities to the need for the establishment of a maxillofacial unit in every city, as major problems concerning the identification and management of such cases still exist in developing countries like Jordan.
Thirty-one cases of massive bleeding due to blunt maxillofacial injuries were treated by several procedures. Blind techniques, such as nasal and/or oral packing or ligation of external carotid artery, failed to achieve hemostasis in 13 of the 18 cases (72.2%) in which they were employed before 1984. Since then, carotid angiography has documented the location of the bleeding in 12 of the 13 cases (92.3%) in which it was employed. Each of the four cases in which extravasation was visualized from the external carotid artery was successfully treated by transcatheter embolization. We conclude that selective, angiographically guided embolization can reliably achieve hemostasis in a high proportion of patients with maxillofacial injury who are in danger of exsanguination from the branches of the external carotid artery.
OBJECTIVE: To determine the pattern and severity of maxillofacial injuries sustained in a motor vehicle accident (MVA) resulting from automobile restraint use. DESIGN: Retrospective database review of patients injured in a MVA who were admitted to the level I trauma center at the University of Louisville Hospital in Louisville, Kentucky. METHODS: Demographic data, drug and alcohol impairment screening, and comorbidity data were obtained from database searches of trauma records. Forty-four patients had an airbag deployed, 34 patients wore seat belts, and 94 patients were unrestrained. All maxillofacial Abbreviated Injury Scale (AIS) ratings were compared among the three groups. RESULTS: Twenty-two of the 44 patients (50%) in the airbag group sustained only facial injuries. Fifteen of them had lacerations; four others had only facial abrasions. Three of the airbag patients had moderate facial injuries (AIS = 2); none required operative management. The airbag group had a mean AIS rating of 1.13, the seat belt group a mean AIS of 1.29, and the unrestrained group a mean AIS of 1.46. Patients using either seat belts (mean age, 40.5 y) or airbags (mean age, 44.9 y) were older than the unrestrained group (mean age, 39.6 y). Drug and/or alcohol impairment was significantly greater in the unrestrained group (mean, 38%) compared with the seat belt group (mean, 26%) and the airbag group (mean 11%.). CONCLUSIONS: Use of airbags is associated with less severe maxillofacial injuries compared with either a seat belt alone or no restraint. There is an inherent risk of minor maxillofacial injuries with airbag usage, but the severity of injury is distinctly reduced.
PURPOSE: The purpose of this article is to report the pattern and frequency of maxillofacial injuries resulting from all-terrain vehicle (ATV) accidents, to evaluate the mechanisms of injury, to document the length of hospital stay, and to characterize other associated injuries in patients presenting to a level 1 trauma center. PATIENTS AND METHODS: The records of patients admitted to the University of Kentucky Medical Center from July 1, 1995 through August 1996 with an ATV-related injury were reviewed. Patients were included in the study if the events of their injury, demographic data, and the specifics of their perioperative care were sufficiently documented to provide the information pertinent to the investigation. Age, sex, mechanism of injury, facial injuries, associated injuries, and length of stay were the factors considered for the study. RESULTS: Seventy-two patients met the criteria for the study. Fifty-nine (82%) were male, and 13 (18%) were female. Forty patients required operative intervention. Twenty-five (35%) had soft tissue or bony injuries to the maxillofacial region. One mandibular and 13 midface fractures were identified. Twelve of the patients with midface injuries had multiple facial fractures. Orbital floor fractures occurred in seven patients. Two patients required unilateral enucleation of the globe. Ten soft tissue injuries were diagnosed. Extremity fractures (n = 16) and closed head injuries (n = 17) were the most commonly associated injuries. The length of hospital stay for all the subjects identified in the study averaged 4.7 days. ATV rollover and being thrown from a moving ATV were the most common mechanisms of injury. CONCLUSIONS: Head and maxillofacial injuries, particularly midface injuries, are common findings after ATV accidents. Orbital trauma with serious globe injury was a striking feature of this study. Multiple systems injuries should always be anticipated and identified. The public should be alerted to the hazards of imprudent recreational vehicle use.
PURPOSE: Motor vehicle collisions (MVCs) are the leading cause of maxillofacial fractures. Additionally, maxillofacial injuries are the most common injury related to air bag deployment. We sought to characterize the occupant restraint system (seat belt and air bag) and collision characteristics associated with MVC-related maxillofacial injuries. MATERIALS AND METHODS: The 1991-2000 National (United States) Automotive Sampling System Crashworthiness Data System (CDS) data files were used. The CDS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Analysis was limited to front seat occupants involved in frontal collisions of delta-V (estimated change in velocity) of greater than 15 km/hr. The risk of facial injury was calculated according to occupants' restraint use (unrestrained, seat belt only, air bag only, and seat belt and air bag combined) and compared using risk ratios (RRs) and associated 95% confidence intervals (CIs). RESULTS: Occupants restrained with a seat belt only (RR, 0.48; 95% CI, 0.40 to 0.57) or a seat belt and an air bag (RR, 0.83; 95% CI, 0.73 to 0.94) had a significantly reduced risk of any facial injury compared with completely unrestrained occupants. There was no association for those restrained with an air bag only (RR, 1.19; 95% CI, 0.82 to 1.73). A similar pattern of results was observed for moderate to severe facial injuries and for facial fractures. CONCLUSION: Seat belt use significantly reduces the risk of facial injury in frontal MVCs. Air bag use was not associated with the risk of facial injury.