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Maxillofacial injuries are frequent, often dramatic, and easily divert attention from more occult injuries. Early consultation with the plastic surgeon will enable the traumatologist to formulate an integrated, definitive plan that will produce superior aesthetic and functional results.
Maxillofacial injuries account for 5% of all acute attendances at accident and emergency units, and are often seen in the multiply injured patient. A systematic method of examining and investigating these patients is required for all staff involved with trauma patients and an understanding of the principles of their management will help to prioritize treatment needs.
BACKGROUND: With the increase in the amount of medical data handled by emergency units, advances in computerisation have become necessary. New computer technology should have a major influence on accident analysis and prevention and the quality of research in the future. OBJECTIVES: To investigate the occurrence of sports related maxillofacial injuries using a newly installed relational database. To establish the first sports trauma database in Switzerland. METHODS: The Qualicare databank was used to prospectively review 57 248 case histories of patients treated in the Department of Emergency Medicine between January 2000 and December 2002. Pre-defined key words were used to collect data on sports related maxillofacial injuries. RESULTS: A total of 750 patients with maxillofacial injuries were identified. Ninety (12%) were sports related maxillofacial fractures. Most (27%) were sustained during skiing and snowboarding, 22% during team sports such as soccer or ice hockey, and 21% were from cycling accidents. Sixty eight per cent of the cyclists, 50% of the ice hockey players and soccer players, and 48% of the skiers and snowboarders had isolated fractures of the midface. Fractures of the mandible were noted predominantly in contact sports. CONCLUSIONS: Computerisation of trauma and emergency units and the introduction of customised software can significantly reduce the workload of researchers and doctors. The effective use of new computer technology should have a considerable influence on research and the quality of future prospective and retrospective studies.
AIMS: To review patients admitted with head injuries under a regional neurosurgical service, to document the incidence and features of associated maxillofacial trauma, and to assess any delay in referral to a maxillofacial surgeon for definitive management of facial injuries. METHODS: The details of all patients admitted under the neurosurgical service at Christchurch Hospital over the preceding 7 years (1995-2002) were reviewed via that department's database. The records of those patients noted to have a maxillofacial injury were requested, and the following data obtained: demographics, diagnosis, and mode of injury (including specific variables such as alcohol consumption and seatbelt usage in motor vehicle accidents). RESULTS: 2307 patients were admitted under the neurosurgical service at Christchurch Hospital over a 7-year period. Five percent of those patients had an associated maxillofacial injury. Three-quarters were men, with an average age of 27 years. Motor vehicle accidents and assaults were the most common cause of injury. Nearly one-third of those persons in motor vehicle accidents were not wearing seatbelts. Alcohol was more frequently involved in mild and moderate head injuries and these patients were more likely to have been assaulted than those admitted with severe head injuries. There were no significant delays in referring patients admitted who had an associated maxillofacial injury to a maxillofacial surgeon. CONCLUSIONS: A small but significant number of patients admitted with head injuries will have an associated maxillofacial injury.
OBJECTIVE: To test the effects of ketamine (KET) on traumatic brain injury resulting from impact maxillofacial injury. METHODS: The rat models with middle serious traumatic brain injury were obtained by falling impaction at maxillofacial region of the rats, then the animals were treated with KET in the early stage, and the alteration of the neural function in those rats was observed at the same time. RESULTS: There was obvious difference between the rats in the KET-treating groups and the control group. It took about 2 days fewer than that of the control group for rats in the KET-treating group to recover. CONCLUSION: KET can shorten the recovery time of rats with brain injury resulting from impact maxillofacial injury.
Maxillofacial injuries occur in contact and noncontact sports. Despite advancements in protective equipment and rule changes, there is still an unacceptably high rate of maxillofacial injuries. These injuries are clinically challenging. The significant morbidity, deformity, and disability associated with these injuries can be avoided by their prompt diagnosis and appropriate management. It is important for the sports medicine professional to be competent in the correct diagnosis and management of maxillofacial injuries. This article reviews some of the major maxillofacial injuries, along with their emergent examinations and treatments.
Maxillofacial injuries can produce a wide variety of airway problems. We report the case of a difficult airway situation in an intoxicated and combative patient with maxillofacial injury, for which we resorted to awake translaryngeal guided intubation (TLI).
BACKGROUND: In spite of employing numerous devices improving the safety in motor vehicles, traffic accidents are still among the main reasons of maxillofacial injuries. The maxillofacial injuries remain the serious clinical problem because of the specificity of this anatomical region. The knowledge of etiologic factors and mechanisms of injuries can be helpful in a satisfactory trauma prevention. The aim of this study was to find out the incidence and the pattern of maxillofacial injuries resulting from traffic accidents in the patients treated in the Department of Maxillofacial Surgery (Silesian Medical Academy in Katowice, Poland) from January 2001 to December 2005. METHODS: The material consisted of 1024 case records of patients with maxillofacial injuries treated in the Maxillofacial Surgery Department of Silesian Medical Academy. The detailed analysis was carried out on the case records of 198 patients in the age of 3 to 68 with maxillofacial injuries resulting from traffic accidents. On the basis of data from a history, examination on admission, consultations and radiological examinations, patients' age and gender, we obtained the information on a pattern of injury and detailed description of an accident (the date and the time of an accident, the role of the patient in an accident). RESULTS: The traffic accidents were the cause of 19.93% maxillofacial injuries in the analyzed period of time. Most of the patients had injuries to the soft tissues of the face (22.21%), followed by tooth and alveolar process injuries (20.71%) and mandibular fractures (18.69%). All the types of injuries were more common in men than in women. The majority of the patients were car drivers followed by car passengers, pedestrians, cyclists and motor cyclists. The peak age of the patients was between 18 to 25 years. The prevalent number of accidents resulting in injuries to this region took place in spring, especially between noon and 4 PM. CONCLUSION: Our results exhibit that road traffic accidents remain among the main reasons of maxillofacial injuries following the traumas resulting from assaults and interpersonal violence. This succession of etiologic factors is in accordance with the data from the most developed countries. The relatively high incidence of injuries resulting from traffic accidents indicates the necessity to reinforce legislation aimed to prevent road traffic crashes and thus to reduce maxillofacial injuries among children and adults.
Although maxillofacial injuries account for a large number of hospital admissions, there appear to be only a few reports detailing the etiology and pattern of facial injuries in women. To delineate this problem, we performed a retrospective chart review of all women admitted to University of California, Davis Medical Center with traumatic facial injuries from July 1, 1990, to June 30, 1992. Motor vehicle accidents were the primary etiology, followed by assaults. The mandible was the most commonly injured facial bone. In a closer evaluation of female patients injured by assault, we found inadequate documentation describing the circumstances surrounding their facial injuries. This indicates that domestic violence and other forms of assaults against women may be severely underreported and has important implications for health care professionals who must always suspect physical abuse in any woman who presents with maxillofacial injuries without an obvious, known etiology.
BACKGROUND: The etiology of maxillofacial injuries varies from one country to another and even within the same country depending on the prevailing socioeconomic, cultural and environmental factors. Periodic verification of the etiology of maxillofacial injuries helps to recommend ways in which maxillofacial injuries can be averted. The aim of the present study is therefore to analyse the characteristics and trends of maxillofacial injuries in Nigeria based on a systematic review of the literature. METHODS: A literature search using MEDLINE was conducted for publications on maxillofacial injuries in Nigeria. The relevant references in these publications were manually searched for additional non-Medline articles or abstracts. Forty-two studies met the inclusion criteria and the full-texts of these articles were thoroughly examined. Due to lack of uniformity and consistency in assessment and measurement variables, and treatment modalities in most of the studies, it was impossible to apply the traditional methods of a systematic review. Therefore, a narrative approach was conducted to report the findings of the included studies. RESULTS: Although, other causes like assaults, sport injuries, and industrial accidents increased in numbers, throughout the period between 1965 and 2003, road traffic crashes remained the major etiological factor of maxillofacial injuries in all regions, except northeastern region where assault was the major cause. A significant increase in motorcycles related maxillofacial injuries was observed in most urban and suburban centres of the country. Animal attacks were not an unusual cause of maxillofacial injuries in most parts of northern Nigeria. Patients in the age group of 21-30 years were mostly involved. A strong tendency toward an equal male-to-female ratio was observed between earlier and later periods. CONCLUSION: Road traffic crashes remain the major cause of maxillofacial injuries in Nigeria, unlike in most developed countries where assaults/interpersonal violence has replaced road traffic crashes as the major cause of the injuries. There is a need to reinforce legislation aimed to prevent road traffic crashes and the total enforcement of existing laws to reduce maxillofacial injuries among children and adults. Special attention should also be paid by the authority to improve the socioeconomic conditions of Nigerian populace.
In this study a new injury severity score system, the Maxillofacial Injury Severity Score (MFISS), was developed to evaluate the characteristics of injury from maxillofacial trauma. Nine hundred and two cases of maxillofacial trauma were included in this study to evaluate injury severity using the MFISS, which was designed on the basis of Abbreviated Injury Scale, 1990 revision (AIS-90), and defined as the product of the sum of the three highest maxillofacial AIS scores and the sum of the injury severity scores for three maxillofacial functional parameters, malocclusion (MO), limited mouth opening (LMO), and facial deformity (FD). The correlation analysis was undertaken with the dependent factor of cost and number of days of stay in hospital. The results demonstrated a significant difference (P < 0.01) between bone and soft-tissue injuries and among various regional fractures. There was correlation (P < 0.01) between the MFISS and the cost of treatment and days of stay in hospital. The newly established MFISS thus characterizes maxillofacial injury severity while reflecting the management costs and treatment complexity.
Facial contact with the steering wheel was the most common source of maxillofacial injuries sustained by vehicle occupants. Maxillofacial injuries to non-restrained occupants, especially children, most commonly resulted from contact with the vehicle's seats. In contrast to previous studies, contact with the windscreen by non-restrained occupants produced only a small number of minor facial injuries. Serious fractures of the facial skeleton were rare and no maxillofacial injury was fatal. A relationship between impact speed and the severity of facial injury sustained was demonstrable. Total compliance with seat belt legislation could be expected to save the National Health Service in excess of 5 pounds million/year from the reduction in maxillofacial injuries alone.
Maxillofacial injury is common in war or in the routine life. Always accompanying trauma of other sites of the body, it has its own characters and leads to serious outcome. This article made a clinical analysis of 284 cases of maxillofacial injury from following aspects: onset of wounded, characters and chief complications of maxillofacial soft and hard tissues injury and foreign bodies left in place. The authors also discussed their experiences at emergency management.
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.
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