Comparisons in the treatment of facial trauma

Abstract

In 1980 a survey was conducted of the methods employed by OMF surgeons in the United Kingdom on the treatment of facial injuries. In 1986 a similar questionnaire was circulated in the UK with the addition of questions about clinical management. Towards the end of 1986 at a meeting in Amsterdam, arrangements were made for similar questionnaires to be circulated in The Netherlands, the USA and later in India and Hong Kong. The results recorded were as follows: UK: 164; The Netherlands: 94; USA: 1999; India: 20; Hong Kong: 5. This survey has revealed differences in the treatment of maxillofacial injuries in the countries concerned. There were differences in the means of fixation of fractured mandibles and in the types of anaesthesia used. The Americans were more likely to use extra oral surgical approaches for their lower border wirings or platings and were liable to operate on fractured mandibular condyles. The acceptability of patients being sent from the operating room with jaws wired together is confirmed by the fact that 95% of British and American OMF surgeons do this. The British OMF surgeons are much more likely to use fixation other than IMF in middle third injuries and are likely to use extra oral cranial fixation. Both the Dutch and the Americans are not so concerned about maxillary mobility and when they do employ fixation almost always use internal skeletal fixation. The approach to the reduction of a fractured malar is markedly different. The British are mainly using the Gillies approach, whereas the Dutch use the facial hook and the Americans a lower lid or brow approach. The Americans too are inclined to explore the orbital floor more than the Europeans. The treatment of facial trauma is more firmly in the hands of the OMF surgeons in Britain and The Netherlands with more specialists being in charge of basic treatment in the USA. The survey shows that the incidence of facial injuries has fallen; on the whole they are less severe and are now more frequently caused by personal violence than RTA's. The average age of OMF surgeons in the USA and The Netherlands is a decade younger than in Britain.