Facial Bone Fractures Research Articles

A Refined Approach to Segmenting and Quantifying Inter-Fracture Spaces in Facial Bone CT Imaging

The human facial bone is made up of many complex structures, which makes it challenging to accurately analyze fractures. To address this, we developed advanced image analysis software which segments and quantifies spaces between fractured bones in facial CT images at the pixel level. This study used 3D CT scans from 1766 patients who had facial bone fractures at a university hospital between 2014 and 2020. Our solution included a segmentation model which focuses on identifying the gaps created by facial bone fractures. However, training this model required costly pixel-level annotations. To overcome this, we used a stepwise annotation approach. First, clinical specialists marked the bounding boxes of fracture areas. Next, trained specialists created the initial pixel-level unrefined ground truth by referencing the bounding boxes. Finally, we created a refined ground truth to correct human errors, which helped improve the segmentation accuracy. Radiomics feature analysis confirmed that the refined dataset had more consistent patterns compared with the unrefined dataset, showing improved reliability. The segmentation model showed significant improvement in the Dice similarity coefficient, increasing from 0.33 with the unrefined ground truth to 0.67 with the refined ground truth. This research introduced a new method for segmenting spaces between fractured bones, allowing for precise pixel-level identification of fracture regions. The model also helped with quantitative severity assessment and enabled the creation of 3D volume renderings, which can be used in clinical settings to develop more accurate treatment plans and improve outcomes for patients with facial bone fractures.

Efficacy of absorbable vs. non-absorbable patient-specific, 3D-printed implants for the treatment of facial bone fractures: a systematic review and meta-analysis.

This systematic review and meta-analysis compares the efficacy and complication rate of absorbable versus non-absorbable 3D-printed, patient-customized, maxillofacial implants in facial trauma patients. A comprehensive search of four databases (PubMed, Scopus, Web of Science, and Cochrane) was conducted. A systematic review and single-proportion meta-analysis was conducted employing PRISMA guidelines. A comprehensive search of four databases (PubMed, Scopus, Web of Science, and Cochrane) yielded a total of 4087 results. After removing duplicates, 16 articles underwent full-text analysis, with 13 meeting the inclusion criteria. The inclusion focused on primary clinical data involving 3D-printed, patient-specific implants for facial bone fracture restorations. Exclusion criteria removed studies without full text, ongoing studies, animal studies, and studies not utilizing CAD/CAM for their implants. A total of 114 patients underwent insertion of 3D-printed implants. Patients receiving non-absorbable implants had a success rate of 84% (95% CI: 74-91), with complications in 12 patients. Patients receiving absorbable implants achieved a 100% success rate (95% CI: 0-100), with zero complications. The study suggests absorbable 3D-printed implants provide superior results with fewer complications compared to non-absorbable 3D-printed implants for the treatment of facial fractures. Not applicable.

A Retrospective Study on Correlation of Facial Fractures and Type of Trauma in Patients Admitted in Department of Maxillofacial Surgery of Stomatology National and Specialized Hospital, Kabul, Afghanistan.

Facial bone fractures represent a significant clinical challenge due to their prevalence and the complexity of treatment required. Understanding the demographic patterns, causes, and treatment outcomes of these injuries is crucial for improving patient care and developing targeted prevention strategies. This study aims to analyze the demographic characteristics, etiological factors, anatomical distribution, and treatment modalities of patients presenting with facial bone fractures at Stomatology National and Specialized Hospital in Kabul, Afghanistan, during 2022. A retrospective analysis was conducted on 463 patients with facial bone fractures treated at the hospital. Data collected included patient demographics, causes of trauma, fracture location, and treatment methods. Statistical analysis was performed to identify patterns and correlations. The study included 463 patients (378 males and 85 females), aged between 3 and 88 years, with a mean age of 26.34 years. The primary causes of trauma were road traffic accidents (RTAs) (29.6%), interpersonal violence (26.1%), and falls (23.3%). The mandible was the most commonly fractured bone (74.1%), with the parasymphysis being the predominant site of injury. Treatment predominantly involved closed reduction (54.9%), with a significant portion of patients undergoing open reduction and internal fixation (ORIF) (45.1%). The findings highlight RTAs, interpersonal violence, and falls as the leading causes of facial bone fractures. The mandible is the most frequently affected bone. Closed reduction remains the most common treatment modality. These insights underline the need for enhanced preventive measures, including stricter enforcement of traffic regulations and targeted interventions to address interpersonal violence and fall prevention.

Traumatic internal carotid artery aneurysm distant from facial bone fractures treated with a flow diverter stent: A case report.

Traumatic intracranial aneurysms (TICAs) can be fatal if ruptured. We report a case of a TICA, distant from facial bone fractures, successfully treated with flow diverter (FD) before rupture. A 20-year-old woman was admitted following a car accident. Initial contrast-enhanced computed tomography revealed traumatic subarachnoid hemorrhage, a 5-mm internal carotid artery aneurysm, LeFort type I + II, and mandibular fracture. On Day 8, she developed oculomotor palsy, and digital subtraction angiography revealed the aneurysm had increased to 12 mm. She started dual antiplatelet therapy (DAPT) following facial fracture repair. On Day 17, FD was placed, resulting in contrast agent stagnation within the aneurysm. Three months postinjury, her neurological symptoms improved. Screening for cerebrovascular injury is crucial several days following severe head trauma, even without skull base fractures. Unruptured TICA can be safely treated with FD following DAPT administration.

Facial bone fracture repair using ultrasound‐aided pin fixation of resorbable plates in two horses

SummaryThis report describes the application of a resorbable implant (Resorb‐Vet) made of poly‐(DL) lactide (PDLLA) for the repair of a maxillary fracture in one horse and a nasal bone fracture in another. The horses were positioned in lateral recumbency and the fracture was reduced. An absorbable plate was moulded to the bone and fixed with PDLLA pins, which were attached to an ultrasonic device and inserted into predrilled holes by ultrasonic vibrations. Once the pins contacted the bone, the ultrasonic vibrations caused liquefication of the PDLLA, which infiltrated the bone and solidified after the ultrasonic vibrations ceased. Immediate primary stability was achieved with this technique. Both horses recovered well, were discharged without complications and returned to their previous level of activity.

Causal association between cholecystectomy and fracture: A Mendelian randomization study.

Previous observational studies have reported that cholecystectomy is associated with an increased risk of fracture. However, the causality of this association remains unclear. This study aimed to explore the causal relationship between cholecystectomy and fracture using a Mendelian randomization (MR) approach. Our primary analytical method was the comprehensive two-sample MR analysis, with inverse variable weighting (IVW) serving as the main analysis technique. In addition, we use Bayesian weighted MR analysis to further confirm the results of IVW method. To enhance the robustness of our findings, we employed multiple analytical approaches including MR-Egger, weighted mode, simple mode, and weighted median. We further conducted sensitivity analyses to validate the stability and feasibility of our dataset. The results of IVW methods showed that there had no significant causal effect of cholecystectomy on fracture (forward P value: .82, .63, .96, .60, .19, .40, .58, .38, .37, .97, and .50 for fracture of wrist and hand, fracture of femur, fracture of foot, fracture of forearm, fracture of lower leg, fracture of lumbar spine and pelvis, fracture of neck, fracture of ribs, fracture of shoulder and upper arm, fracture of skull and facial bones, and fracture of spine), the results of Bayesian weighted MR showed similar results (P > .05). In the reverse, fracture of femur (P = .01) and fracture of shoulder and upper arm (P = .01) showed increased risks of cholecystectomy. The sensitivity analysis showed that none of our analyses were horizontally pleiotropic (P > .05 for MR-Egger's intercept method). Our results do not support the causal effect of cholecystectomy on fracture, which was opposite to most previous observational studies.

Bibliometric Analysis of the Role of Artificial Intelligence in Detecting Maxillofacial Fractures.

Facial bone fractures are a common occurrence in trauma cases, particularly in India where road traffic accidents contribute significantly. Over the past few years, artificial intelligence (AI) has become a potent instrument to help medical professionals diagnose and treat facial fractures. This study aims to perform a bibliometric analysis, that is, a quantitative and qualitative analysis, of publications focusing on the role of AI in detecting facial bone fractures. Bibliometric analysis can be a very strong measure of research productivity and analysis of trends within a given area of research. Data were drawn from the Dimensions AI database; 58 relevant scientific articles were analyzed in this study. This bibliometric analysis aims to assess the volume of research in this area, identifying key trends, authors, institutions, and countries contributing to the literature. The Dimensions AI database was used to gather and analyze relevant data, shedding light on the research impact through indicators such as the h-index, citation counts, and publication trends. This review will depict the landscape of research work, highlighting the rising influence of the use of AI for accurate diagnostics in facial bone fractures and further detailing gaps and potential avenues of future research directed toward solutions such as standardizing datasets and clinical integration.

Facial Fractures at the Armed Forces Capital Hospital of Korea: A 10-Year Study From 2013 to 2022.

The aim of this study was to analyze facial bone fractures at the Armed Forces Capital Hospital of Korea (AFCH) from 2013 to 2022. This review included individuals who visited AFCH for treatment. The inclusion criteria for the study were fractures resulting from external trauma, specifically coded as S02.1-4 and S02.6-9. The exclusion criteria comprised fractures caused by factors other than external trauma. This retrospective study of 178 facial bone fractures included 176 males (98.9%) and 2 females (1.1%) (22.5±5.1 years). The most common causes of injury were bumps (72.5%), followed by slips (7.3%), assaults (5.6%), and falls (5.1%). The majority of facial bone fractures occurred during sports activities (33.7%), training (31.5%), or everyday activities (28.7%). Nasal bone fractures were the most prevalent (47.7%), followed by fractures of the maxilla (19.2%), orbit (18.7%), mandible (10.3%), and zygoma (3.3%). The interval between the injury and hospital arrival was 6.0±8.0 days. Among the 164 patients, 110 (67.1%) underwent surgery. The overall complication rate was 8.9%. The highest complication rate was mandibular fractures (22.7%), followed by nasal bone fractures (9.8%). Among the 208 recorded facial bone fractures, 145 patients (69.7%) received treatment at AFCH, whereas 63 (30.3%) were treated in a civilian hospital; 59 patients (28.4%) by their own choice and 4 patients (1.9%) on a consignment basis. The average follow-up period was 202.0±183.2 days. The relatively high rate (28.4%) of treatment at civilian hospitals is attributable to legislation allowing injured soldiers the option to choose between military and civilian medical facilities.

Management of Neglected Facial Fracture: A Case Report

Introduction: Neglected fracture occurs where there has been a delay of more than 30 days. The maxillofacial fracture complex is the most common fracture in traffic accidents. The most common maxillofacial fractures are Naso-Orbito-Etmoid (NOE), Lefort fracture, Zygomatic Complex (ZMC), Palate Fracture, and Parasymphysis Fracture. Neglected fractures lead to delayed treatment, worsening conditions, and even disability. Case: A 52-year-old male patient presents with complaints of facial bone fracture after being involved in a motor vehicle accident. CT scan examination showed: Multiple fractures of the bilateral nasal bones, interethmoidal septum, anterior walls of bilateral frontal sinuses, bilateral lamina papyracea of the ethmoid bone, anterior, medial, and lateral walls of bilateral maxillary bones all support Le Fort II. fracture, extending to bilateral dentoalveolar processes, bilateral zygomatic bones, and right mandibular parasymphysis. Case Management: The ORIF technique was used for the upper, middle, and lower face fractures in a preferred order. The palatal reduction and fixation step was frequently the first in this sequence. When proper occlusion was achieved, it was maintained by intermaxillary fixation. Conclusion: There was a significant result in correcting the functional, mastication, and aesthetic of the mid and lower face by using surgical management of facial fractures using ORIF. Keywords: Facial fracture, Neglected fracture, ORIF

CLINICAL EFFECTIVENESS AND FEATURES OF THE POSTOPERATIVE PERIOD IN PATIENTS AFTER OSTEOSYNTHESIS OF THE MANDIBLE USING CELL TECHNOLOGIES

Due to a signifi cant increase in the frequency and complexity of maxillofacial injuries, one of the priorities in the development of modern surgical dentistry is the search for new eff ective methods of treating facial bone fractures. In recent decades, the attention of clinicians has been focused on biological treatment methods aimed at restoring bone defects using cell technologies and biological transplants.The aim of the study was to determine the eff ect of using osteoplastic materials based on multipotent adipose- derived mesenchymal stromal cells in dental patients in the surgical treatment of mandibular fractures.Materials and methods. The clinical material included 56 patients, 13 of whom underwent mandibular osteosynthesis with hydroxyapatite bone graft substitute (subgroup 1I), 25 of whom underwent surgery with a combination of multipotent adipose tissue mesenchymal stromal cells, hydroxyapatite bone graft substitute and platelet-rich plasma (subgroup 1B), and 18 of whom underwent spontaneous healing of the fracture line (subgroup 1C). Patients were clinically evaluated on a daily basis. Clinical parameters were assessed on days 1, 3, 5, 7, 10, 14 and 28 after surgery. The postoperative pain syndrome was assessed using the Numerical Rating Scale (NRS), considering the subjective signs of pain in the operated patients.The statistical processing of the study results was performed using the statistical analysis software for biomedical research ‘Microsoft Excel 21’ and ‘Statistica’ (licence number STA862D175437Q). In the statistical processing of the results, we used the variational analysis of series – calculation of the arithmetic mean and its standard error (Mim) – and assessed the signifi cance of diff erences in the results obtained in the comparison groups using the Student’s t-test method. p<0.05 was considered a signifi cant diff erence. [17]. The study was conducted in accordance with the basic provisions of the «Rules of Ethical Principles for Scientifi c Medical Research Involving Human Subjects» approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EEC Directive 609 (24.11.1986), Orders of the Ministry of Health of Ukraine ¹ 690 of 23.09.2009, ¹ 944 of 14.12.2009, ¹ 616 of 03.08.2012. The Commission on Biomedical Ethics of the Bukovinian State Medical University found no violations of ethical and moral standards in the conduct of the research (ProtocolNo. 6, 16.03.2023). Patients signed informed consent to participate in this study and all measures were taken to ensure their anonymity.The results. The comparative analysis of the clinical eff ectiveness of the use of various osteoplastic materials in the performance of osteosynthesis surgery of the lower law confi rmed the advantages of the use of bone tissue substitute based on hydroxyapatite and its combination with multipotent adipose tissue mesenchymal stromal cells before spontaneous augmentation. It is confi rmed by the data of subjective and objective symptoms of patients during the postoperative period.Conclusions. Our data show that osteoplastic material based on multipotent mesenchymal stromal cells of adipose tissue, bone substitute based on hydroxyapatite and platelet-rich blood plasma is a promising biological material. Its application improves the regenerative and reparative properties of bone tissue, facilitates the postoperative period and shortens the duration of hospitalization, promotes the development of innovative ways of reconstructive osteogenesis in modern maxillofacial surgery.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Analysis of risk factors for patients with traumatic optic neuropathy and comparison of visual outcomes of management strategies

BackgroundTraumatic optic neuropathy (TON) is a rare complication of facial trauma that results in vision loss. Clinical diagnosis of TON is based on a history of head trauma and an ophthalmic examination; however, the risk factors for TON and the ideal treatment strategy remain undetermined. This study investigated the predictive risk factors for TON and analyzed the effectiveness of current treatments with respect to visual outcomes in patients with TON. MethodsThis study retrospectively enrolled patients with periorbital facial bone fracture between 2008 and 2019. Initial facial bone computed tomography, ophthalmic exam results, initial Glasgow Coma Scale, and Injury Severity Score (ISS) were recorded. This study classified patients into 4 intervention groups (i.e., medication, surgery, combination therapy, and observation) to compare the outcome of visual acuity. ResultsThis study enrolled 1168 patients with facial bone fractures, 93 (7.96%) of whom were diagnosed as having TON. Independent risk factors for TON included optic canal fracture, medial orbital wall fracture, retrobulbar hematoma, and head Abbreviated Injury Scale ≥ 4. Patients with TON who initially presented with no light perception tended to have poor final visual acuity (VA) outcomes. The results indicated no significant difference in VA improvement among patients receiving observation, mega-dose corticosteroid therapy, surgical decompression, or combined steroid therapy and decompression. ConclusionClinicians can achieve early prediction of TON in patients with an initial unconscious state and the determined risk factors. The results indicated that conservative observation yielded noninferior VA outcomes in patients with TON compared with those receiving medication or surgical treatment.

E-scooter-related imaging: a new emerging high-energy trauma patient.

To quantify the volume and nature of radiological imaging performed for e-scooter related trauma presentations in a tertiary referral centre and to identify common radiological pattern of injuries. Our study received institutional review board approval. We retrospectively reviewed all anonymised radiological imaging studies performed in our institution for the term 'scooter' or 'e-scooter' between July 2020 and July 2021. The patient demographics, number of imaging studies performed and modality type as well as the nature of injuries identified were recorded. Within the study period, 147 patients with e-scooter-related injuries were referred for radiological imaging. Forty-two (29%) of those patients had positive radiological findings. The vast majority of injuries on radiographs were upper limb injuries typical of a fall on outstretched hand (FOOSH) pattern. Thirty-two patients (22%) required advanced diagnostics with CT or MRI with 11 of these patients having positive findings. Four patients suffered significant head injuries including skull fractures and/or intracranial haemorrhage. Five patients suffered facial bone fractures, and 2 suffered spinal fractures. One patient suffered a handlebar abdominal trauma with a resulting large bowel injury ultimately requiring bowel resection. E-scooter-related injuries represent a new and emerging high-energy trauma patient. These patients demonstrate injury patterns similar to other high-energy trauma such as road traffic accidents. Although the most common injuries are musculoskeletal upper limb injuries typical of FOOSH, a large proportion of these require advanced diagnostic imaging (CT, MRI) which were commonly positive for significant injuries.

The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq

Introduction: Modern emergency departments are under increasing pressure that can only be alleviated by new approaches to meeting demand. One strategy could be the adoption of radiographer preliminary image evaluations (PIEs), which would significantly reduce the time it takes emergency teams to receive critical imagery results. The aim of this study was to examine the accuracy of radiographers’ interpretations of axial radiographs and the impact a short training program had on their image interpretation skills. Methods: Forty-one radiographers volunteered to participate in the study. From 15 January to 15 April 2023 radiographers produced PIEs for 24 axial radiographs which were compared to the radiology reports for the same images. The accuracy each of the radiographers’ PIEs were categorized as true positive, true negative, false positive and false negative, with numerical scores to enable mean accuracies to be calculated. The radiographers’ accuracy was then reassessed on the same images after they had completed a two-week training program on axial skeletal radiograph interpretation. Results: The study reported that demonstrated that most (TP) radiographer PIEs (M = 5.66, SD = 1.24) were about facial bone fracture. Moreover, this study demonstrated that most (FN/TP) radiographer PIEs (M = 3.83, SD = 1.69) were that cases about inflammatory disease of the axial spine, such as ankylosing spondylitis. In contrast, the most common cases misinterpreted were about cervical spine disorders such as diffuse idiopathic skeletal hyperostosis (DISH) (M = 2.49, SD = 1.36). Years of experience in radiography showed a positive but not statistically significant influence on accuracy. Additionally, post training mean accuracy significantly improved. Conclusion: This study found radiographers provided quite accurate PIEs for facial bone fractures when compared to the full radiology reports of the same images. The findings also highlighted specific pathologies that were frequently misinterpreted. A two-week training program was found to be effective at improving radiographers’ ability to correctly identify and describe abnormalities present in axial radiographs.

The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq

Introduction: Modern emergency departments are under increasing pressure that can only be alleviated by new approaches to meeting demand. One strategy could be the adoption of radiographer preliminary image evaluations (PIEs), which would significantly reduce the time it takes emergency teams to receive critical imagery results. The aim of this study was to examine the accuracy of radiographers’ interpretations of axial radiographs and the impact a short training program had on their image interpretation skills. Methods: Forty-one radiographers volunteered to participate in the study. From 15 January to 15 April 2023 radiographers produced PIEs for 24 axial radiographs which were compared to the radiology reports for the same images. The accuracy each of the radiographers’ PIEs were categorized as true positive, true negative, false positive and false negative, with numerical scores to enable mean accuracies to be calculated. The radiographers’ accuracy was then reassessed on the same images after they had completed a two-week training program on axial skeletal radiograph interpretation. Results: The study reported that demonstrated that most (TP) radiographer PIEs (M 66, SD = 1.24) were about facial bone fracture. Moreover, this study demonstrated that most (FN/TP) radiographer PIEs (M = 3.83, SD = 1.69) were that cases about inflammatory disease of the axial spine, such as ankylosing spondylitis. In contrast, the most common cases misinterpreted were about cervical spine disorders such as diffuse idiopathic skeletal hyperostosis (DISH) (M = 2.49, SD = 1.36). Years of experience in radiography showed a positive but not statistically significant influence on accuracy. Additionally, post training mean accuracy significantly improved. Conclusion: This study found radiographers provided quite accurate PIEs for facial bone fractures when compared to the full radiology reports of the same images. The findings also highlighted specific pathologies that were frequently misinterpreted. A two-week training program was found to be effective at improving radiographers’ ability to correctly identify and describe abnormalities present in axial radiographs.

Big Data Analysis of Facial Fracture Epidemiology in South Korea From 2015 to 2020: Impacts of Aging and Personal Mobility.

The epidemiology of facial fractures is continuously evolving due to various influencing factors, including social, economic, and technological advancements. Thus, an updated analysis of facial bone fractures is necessary. This study aimed to provide an updated epidemiological analysis of facial bone fractures and assess severity using multiple factors. We retrospectively reviewed patients who underwent facial bone fracture surgery at 3 teaching hospitals in South Korea between January 2015 and December 2020. Data collected included patient demographics (sex and age), trauma mechanism, alcohol intoxication status, and fracture types. Trauma mechanisms were categorized into 7 groups: assault, fall, sports, occupational injury, motor vehicle crash, bicycle, and personal mobility. Severity was assessed using the modified facial injury severity scale. A total of 5953 patients (4437 males and 1516 females) were included, with ages ranging from 1 to 92 years (mean age: 36.37±18.61y). A steady decline in the number of patients was observed from 2015 to 2020. Falls were the most common cause of facial fractures (2300 cases, 39%), and nasal bone fractures were the most frequent type (3683 cases, 46%). The number of elderly patients (> 60y) and injuries caused by personal mobility devices increased steadily. Male sex and alcohol intoxication were associated with higher severity scores. Motor vehicle crashes had the highest severity scores (2.246). While the incidence of facial bone fractures has decreased in recent years, the proportion of elderly patients and injuries caused by personal mobility devices is increasing, posing a significant burden on the health care system.

Acute hydrocephalus triggered by isolated traumatic subarachnoid hemorrhage in the posterior fossa following mandibular fracture in a toddler: a rare case report.

Facial bone fractures triggered by low-height falls are rare in toddlers, while severe intracranial injuries resulting from minor trauma are extremely rare. Herein, we report the case of a 2-year-old girl who fell from a baby chair, striking her chin, who rapidly developed impaired consciousness 3h later. The patient subsequently presented with a mandibular fracture and acute obstructive hydrocephalus due to a traumatic isolated subarachnoid hemorrhage in the posterior cranial fossa. She was successfully treated with ventricular drainage, which achieved a favorable outcome. Maxillofacial trauma and head injuries are closely associated. Even in minor cases of maxillofacial trauma, vigilant monitoring and prompt intervention are crucial to prevent fatal outcomes in toddlers.

Retrospective Analysis of Etiology, Pattern, and Determinants of Pediatric Maxillofacial Injuries

Abstract Context: Children sustain facial skeletal and soft-tissue injuries, which are often seen in the preschool age; however, severe facial injuries involving facial bones occur in ages above 11 years. There have been several postulated reasons for the reduction in the incidence of skeletal fractures in children. These include sutural pliability of pediatric facial bones, increased subcutaneous fat, and a greater ratio of cranial to facial bones. Aims: The study aimed to report our institutional experience of the pattern of presentation in pediatric maxillofacial trauma and report its main etiologies. Methods and Materials: Clinical and demographic information was retrieved from the maxillofacial registers, day clinics, and pathology registers. The etiology of the trauma and associated injuries were also noted. Statistical Analysis: Descriptive statistics were performed on demographic variables such as age, gender, and location of trauma. Categorical variables were analyzed in frequencies and proportions. Association analyses across variables were done using student t-test, ANOVA, and Pearson’s Chi-square after normality test had been conducted. Dunn’s test and Tukey’s post-hoc analysis were conducted after significant observations. Results: The mean age observed in the study was 7.3 years ± 5.3 SD (range: 2.6 months–16 years). There was a slight male predilection with 58.6%. Falls were the most common etiology in the ≤5-years group. RTC accounted for most injuries in children above 11 years. Soft-tissue-only injuries were observed in 51.4% of all cases. In facial bone fractures, mandibular fractures accounted for 40% of all cases. Conclusion: Male children experienced the greatest impact from maxillofacial trauma. The primary factor contributing to this was falls among preschool children. Soft-tissue injuries were found to be more prevalent among preschool children, whereas the incidence of facial fractures increased as age advanced.

Management of Le Fort I Fractures.

A retrospective study. This retrospective study aims to analyze the results of Le Fort I fracture treatment, with a focus on addressing malocclusion related to the fractures. The study included 43 patients diagnosed with Le Fort I fractures who underwent open reduction and internal fixation. Demographic data, causes of trauma, accompanying facial bone fractures, treatment methods, and complications were analyzed. Fisher's exact test was employed to assess the association between fractures and malocclusion. Postoperative complications included occlusal disorder (6 cases), sensory disturbance (4 cases), and facial deformation (6 cases). Condylar fractures showed a statistically significant association with occlusal disorders (P = 0.044). Surgeon variability did not significantly impact occlusal outcomes (P = 0.25). Proper management of Le Fort I fractures requires a thorough understanding of surgical principles and consideration of concomitant fractures. Achieving anatomical reduction based on occlusion is crucial for successful outcomes, and additional Le Fort I osteotomy may be considered in challenging cases.

Very fast, high-resolution aggregation 3D detection CAM to quickly and accurately find facial fracture areas

Background and objective:The incidence of facial fractures is on the rise globally, yet limited studies are addressing the diverse forms of facial fractures present in 3D images. In particular, due to the nature of the facial fracture, the direction in which the bone fractures vary, and there is no clear outline, it is difficult to determine the exact location of the fracture in 2D images. Thus, 3D image analysis is required to find the exact fracture area, but it needs heavy computational complexity and expensive pixel-wise labeling for supervised learning. In this study, we tackle the problem of reducing the computational burden and increasing the accuracy of fracture localization by using a weakly-supervised object localization without pixel-wise labeling in a 3D image space. Methods:We propose a Very Fast, High-Resolution Aggregation 3D Detection CAM (VFHA-CAM) model, which can detect various facial fractures. To better detect tiny fractures, our model uses high-resolution feature maps and employs Ablation CAM to find an exact fracture location without pixel-wise labeling, where we use a rough fracture image detected with 3D box-wise labeling. To this end, we extract important features and use only essential features to reduce the computational complexity in 3D image space. Results:Experimental findings demonstrate that VFHA-CAM surpasses state-of-the-art 2D detection methods by up to 20% in sensitivity/person and specificity/person, achieving sensitivity/person and specificity/person scores of 87% and 85%, respectively. In addition, Our VFHA-CAM reduces location analysis time to 76 s without performance degradation compared to a simple Ablation CAM method that takes more than 20 min. Conclusion:This study introduces a novel weakly-supervised object localization approach for bone fracture detection in 3D facial images. The proposed method employs a 3D detection model, which helps detect various forms of facial bone fractures accurately. The CAM algorithm adopted for fracture area segmentation within a 3D fracture detection box is key in quickly informing medical staff of the exact location of a facial bone fracture in a weakly-supervised object localization. In addition, we provide 3D visualization so that even non-experts unfamiliar with 3D CT images can identify the fracture status and location.