Cause Of Facial Injuries Research Articles

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

BackgroundThe percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED).MethodsData were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.ResultsThe study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).ConclusionsThis study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.

Incidence of Maxillofacial Injuries in the Emergency Department-Retrospective Study.

Maxillofacial injuries are a common finding among the patients reporting to the Emergency Department. This study was conducted to evaluate the occurrence and characteristics of Oral and Maxillofacial injuries among the patients who reported to the Emergency Department at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. The study was carried out retrospectively by analysing the medical records of patients who were presented with maxillofacial injuries, under the Department of Oral and Maxillofacial Surgery over a period of nine years. A total of 2831 patients were evaluated and segregated into different age groups. Standardized data was gathered on the number and location of lacerations, abrasions, fractures of facial bones, associated head injuries and treatment done. It was found that the majority of the maxillofacial injuries reported to the emergency department are soft tissue injuries comprising of 71.49% of total cases among which 55.77% cases were with single or multiple lacerations and 15.72% cases with abrasions alone. The most common cause of facial injuries is road traffic accidents 56.8% followed by self-fall (33.8%) and assault (5.837%). The most common site of occurrence of laceration was noted to be forehead laceration (13.2%) followed by chin (10.97%), supraorbital (9.44%), upper lip (8.1%) and lower lip (5.97%). Among the fracture cases, Mid-facial fracture occurred in 58.84%, followed by mandibular fractures at 20.86% being the next most common occurrence. The results and understanding obtained from this study will be utilized to develop focused treatments for reducing the severity and frequency of maxillofacial trauma. Further, we believe that public awareness campaigns about enhanced safety measures can reduce the occurrence of maxillofacial injuries.

The Impact of Traffic Law Enforcement Regulations on the Incidence and Severity of Maxillofacial Injuries.

This study aimed to assess the effectiveness of the new traffic law enforcement regulations (TLERs) on the incidence and severity of maxillofacial injuries in Oman, as road traffic accidents (RTAs) are the main cause of facial injuries in Oman. A retrospective longitudinal analytic study was conducted at three tertiary care hospitals in Muscat, Oman. All patients with RTA-related maxillofacial injuries during a five-year period from January 2005 to December 2009 (before the new TLERs) and the five-year period from January 2015 to December 2019 (after the new TLERs) were included in the study. A total of 1,127 patients were included in the study. Of these, 646 (57.3%) patients sustained RTA-related maxillofacial injuries before the implementation of the new TLERs compared to 481 (42.7%) after the introduction of TLERs. No significant gender-based difference was found between the two study periods. The incidence of injury before the implementation of the new TLERs was 22.7 per 100,000 population, which then reduced significantly to 11 per 100,000 after the TLERs were implemented. Overall, the mean facial injury severity score reduced significantly, from 3.2 to 2.3, after the implementation of the new TLERs. The findings of this study indicate that the newly introduced TLERs have resulted in a reduction in the incidence and severity of RTA-related maxillofacial injuries. Continuous improvement and reinforcement of TLERs will further help reduce the burden of these injuries to society in general and health services in particular.

Lead Airgun Projectiles Inside the Maxillary Sinuses—Therapeutic Approaches through the Years: A Systematic Review of Case Reports

Background: Shots from commonly available non-gunpowder weapons are a significant cause of facial injuries, especially in pediatric patients. A consequence of such trauma may be the placement of a projectile within the maxillary sinus, which is a therapeutic need with no guidelines for foreign body removal. The purpose of this paper is to discuss the etiology, epidemiology, diagnosis, treatment and prognosis of such cases. Materials and methods: Any cases describing the presence of airgun pellets within the maxillary sinus were included. Animal patients and non-English cases were excluded. The final search using the PubMed, BASE and Google Scholar engines was made on 13 November 2021. The JBI Critical Appraisal Checklist for Case Reports was used to assess the risk of bias. The collected data are presented in tabular form and were subjected to a comparative assessment. Results: In total, reports of seven cases of lead airgun projectiles in the maxillary sinuses were identified, qualified and analyzed. There were no cases of lead intoxication. The bullets were removed by open surgery in the form of antrostomy of the maxillary sinus or with the use of an endoscope. In none of the described cases were complications observed during surgery or postoperative observation. Discussion: This systematic review was based on case reports that differed significantly in quality. The location of the lead foreign body within the maxillary sinuses may be considered favorable over other craniofacial gunshots. The risk of lead intoxication does exist, but such a location of the bullets does not favor it. The removal of projectiles from the maxillary sinuses appears to be easily achievable and does not predispose one to complications.

Surgical Management of Facial Fractures in Geriatric Patients.

Facial fractures comprise a substantial part of traumatology. Due to aging of the population, over the last 20 years, there has been a pattern of redistribution of these fractures with a higher incidence at an older age. The aim of this study was to retrospectively analyze the epidemiology, pattern, and surgical management of facial fractures in geriatric patients presenting at a single tertiary trauma center.This study included patients aged ≥70 years who presented with facial bone fractures between 2008 and 2017 and were treated with surgical interventions. Parameters such as age, sex, American Society of Anesthesiologists classification, Glasgow Coma Scale score, fracture type, fracture mechanism, concomitant injuries, duration of hospitalization, and postoperative complications were evaluated.A total of 300 patients were included: 118 men (39.3%) and 182 women (60.7%). The mean age was 78.8 years. An orbital floor fracture was the most common injury (35.1%). The most common cause of fracture was a fall at home (67%). A total of 113 patients (37.7%) had 162 concomitant injuries, 35 patients (11.7%) suffered from polytrauma, and 7 patients developed postoperative complications. The average length of stay was 1.67 days in the intensive care unit and 5.50 days in the standard ward. Polytrauma, pre-existing medical conditions, and oral anticoagulation had a significant impact on the duration of hospitalization.Facial fractures are common in combination with other injuries. Women are more often affected than men, and falling at home is the most common cause of facial injuries. Postoperative complications are rare.

Alcohol Related Facial Injuries

Aim: Consumption of alcohol plays a key role in traumatic injuries The capacity of alcohol to distort human cognitive ability and reasoning makes it an important factor in the causation of motor vehicle and interpersonal violence-related injuries The aim of this study was to investigate the role of alcohol in severe facial injuries in settings of motor vehicular crashes and interpersonal violence.
 Study Design: A prospective study of 118 patients who suffered alcohol-related facial injuries.
 Place and Duration of Study: The study was conducted at the University of Uyo teaching hospital Uyo, Nigeria over a 5-year period, from January 2007 to January 2021.
 Methodology: The variables analyzed included socio demographics, nature of injury and sites of injuries. Alcohol Use Disturbance Identification Test (AUDIT test) was used to identify risks and damages of alcohol use and dependence. Data analysis was done using SPSS version 21.0. Multivariate analysis was carried out using binary logistic regression analysis, P = 0.05 was considered to be statistically significant.
 Results: A total of 118 patients suffered alcohol-related facial injuries in the period of the study. There were 97 males and 21 females, giving a male to female ratio of 4:1 The mean age of the patients’ population was 43 .The commonest age range involved in alcohol-related facial injuries was 29-38 years. Road traffic injuries were the commonest cause of facial injuries. Medium risk alcohol consumption and male gender were identified as risk factors for moderate and severe injuries as well as for avulsive injuries.
 Conclusion: Alcohol-related injuries often turn out severe, and the identifiable risk factors include male gender, high-risk alcohol consumption and road traffic crashes.

Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population.

To assess the prevalence and surgical treatment of facial fractures in a Swiss population aged 65 and over. The knowledge of the characteristics of geriatric trauma may help to prevent injuries and better allocate clinical resources for the management of multimorbid patients. This study retrospectively evaluated a cohort of 181 patients who presented at the Bern University Hospital in Switzerland from May 2012 to September 2016. Data on age, gender, aetiology and type of trauma, treatment and complications, co-morbidities and associated injuries were obtained. Women were most frequently affected (55.2%). Mean age was 80years. Zygomatic complex fractures were the most frequent type of fractures (37%), followed by isolated orbital fractures (27.6%). Falls were the most common cause of trauma (76.1%). Thirty-five per cent of all patients were taking anticoagulation or platelet aggregation medication. Hospitalisation was required in 88.4%, whereby 92.3% of the patients underwent surgical treatment. Surgery had to be performed immediately in three cases to treat compression of the optic nerve. Median hospital length of stay was 4days, with 68% of patients returning to a domestic environment and 32% being transferred to another institution for further treatment. The most common cause of facial injuries is a fall while standing in a domestic environment. Midface fractures were the most common type of fractures.

Effect of law enforcement system (Saher) on maxillofacial injuries caused by road traffic accidents in Riyadh

Background: Road traffic accident (RTA) is one of the major causes of facial injuries apart from other body injuries. Aims and Objectives: The aim of this study was to assess the effectiveness of law enforcement system (LES) on maxillofacial injuries caused by RTAs in Riyadh. Materials and Methods: The objective was achieved by conducting a comparison of RTA - related facial injuries before and after the introduction of Saher. A retrospective study on patients admitted to Prince Sultan Medical City Oral and maxillofacial surgery department of 10 years divided equally before and after the introduction of the LES. Data were collected from the hospital's electronic database regarding the patients' age, sex, gender, date, time, and type of injury. Results: The severity and the number of injuries from RTAs were considerably reduced with the introduction of the system. Conclusion: LES plays a huge role toward controlling how road users use the roads and consequently, the number of accidents reported.

Maxillofacial injuries in severely injured patients.

BackgroundA significant proportion of patients admitted to hospital with multiple traumas exhibit facial injuries. The aim of this study is to evaluate the incidence and cause of facial injuries in severely injured patients and to examine the role of plastic and maxillofacial surgeons in treatment of this patient collective.MethodsA total of 67 patients, who were assigned to our trauma room with maxillofacial injuries between January 2009 and December 2010, were enrolled in the present study and evaluated.ResultsThe majority of the patients were male (82 %) with a mean age of 44 years. The predominant mechanism of injury was fall from lower levels (<5 m) and occurred in 25 (37 %) cases. The median ISS was 25, with intracranial bleeding found as the most common concomitant injury in 48 cases (72 %). Thirty-one patients (46 %) required interdisciplinary management in the trauma room; maxillofacial surgeons were involved in 27 cases. A total of 35 (52 %) patients were treated surgically, 7 in emergency surgery, thereof.ConclusionMaxillofacial injuries are often associated with a risk of other serious concomitant injuries, in particular traumatic brain injuries. Even though emergency operations are only necessary in rare cases, diagnosis and treatment of such concomitant injuries have the potential to be overlooked or delayed in severely injured patients.

Pediatric Temporomandibular Joint Disorders

Submit Manuscript | http://medcraveonline.com J Dent Health Oral Disord Ther 2015, 2(3): 00047 precise etiology. The etiology of TMD in children has been related to trauma, malocclusion, and oral Para-functions habits such as bruxism, nail biting, and non-nutritive sucking. However, the relationship between oral Para-functional habits and TMD, if it exists, seems to be controversial and unclear. Falls, sports-related injuries, and road traffic accidents are the most frequent causes of facial injuries in children which can affects the TMJ. Moreover: Early TMD is a common feature especially in girls at the beginning of puberty. The etiology is not clear but it can be considered caused by factors, such as hyper mobility and hormone influence. Fracture of the condyle is often followed by remodeling and a disturbance in the development of ramus height and mandibular body length, ankylosis of the TMJ, growth disturbances can be seen in most cases and can be severe. Bruxism (Greek: Bruko, “gnashing of teeth”) the main cause of pediatric TMD widely defined as an anxiety response to environmental stress. Clinically, bruxism characterized by presence of abnormal movements and clenching which can lead to tooth grinding, attrition. According to the International Classification of Sleep Disorders, the bruxism is a movement disturb related to sleep, characterized by repeated contractions of the masticatory muscles, resulting in grinding or clenching of the teeth. Wide range of muscles can be affected by bruxism. These groups of muscles include muscles of mastication (primary muscles) and muscles of the craniofacial complex, shoulders and neck (secondary muscles). These groups of muscles have anatomical and neural links. Neural link through trigeminalcervical complex, which is formed by the upper cervical and trigeminal nerves. And anatomical link, through the axes for the eccentric mandibular movements and the cervical column which concur in the occiput. The mandibular position can influence the activity of the muscles of the craniofacial complex, shoulders and neck through these two links. If the masticatory system, neck and shoulders are anatomically and physiologically connected, then the bruxism can easily affects all the above described structures.

Equine-associated maxillofacial injuries: retrospective 5-year analysis

We explored the relation between the causes of facial injuries in equestrians and the presence or absence of associated injuries. Over a 5-year period we retrospectively reviewed all patients who presented to the John Hunter Hospital, New South Wales, with facial injuries that had resulted from activity with horses. We analysed the rates of hard and soft tissue injuries, and of associated injuries by sex and mechanism. A total of 85 patients were included (50 female and 35 male) with an age range of 2–88 years. There was a significant difference in the rate of maxillofacial and associated injuries when groups were analysed for sex and mechanism of injury. Facial injuries caused by falling from a horse were more often associated with other injuries in men than in women (p<0.05), and men were 4 times more likely to present with associated injuries than women (OR 3.9; 95% CI 1.1 to 14) We also found significant differences in the rates of facial fracture. Women who had been kicked by a horse were more likely to sustain bony injuries than men (p<0.05). Our data confirm the association between kicks and facial fracture, and this may provide an impetus for the development of appropriate protective equipment. Patients who sustain facial injuries when falling from a horse often present with associated injuries and this has practical implications for clinicians involved in their management.

Incidence of facial soft tissue injuries among patients attending surgical casualty reception in Rojh-halat emergency hospital

Background and objective: Facial soft-tissue injuries are the most common injuries presenting to surgical causality reception. The present study aimed to provide a preliminary data base about the distribution, type, pattern and etiology of facial soft tissue injuries. Methods: In a prospective clinical study all patients with facial injury were enrolled in this study, over a ten months period (from 1st October 2010- 1st July 2011), who attended Surgical Casualty Reception in Rojh-halat Emergency Hospital. A questionnaire was used to collect patients’ database and relevant information. The wound configuration was divided as laceration, abrasion and contusion as well as the site of facial soft tissue injuries were recorded using the modified MCFONTZL system. Results: A total of 168 patients with facial soft tissue injuries were received and managed at Surgical Casualty Reception in Rojh-halat Emergency Hospital. The age of the patients were ranged from 1-80 years old. Most of the patients were within the age range of 1-10. Male patients constitute 62.5% of the cases. The most common etiology of facial soft tissue injury was falls. Regarding type of the injury, laceration was the most common type. The lips and chin region were mostly involved. Conclusion: Fall is the most common cause of facial injury. Lower third of the face is mostly involved. road traffic legislations have a role in decreasing road traffic accidents.

Poster 73: Fall-Related Oral and Maxillofacial Trauma: A Retrospective Cohort Review of Fall-Related Morbidity Mechanism and Fracture Patterns

Poster 73: Fall-Related Oral and Maxillofacial Trauma: A Retrospective Cohort Review of Fall-Related Morbidity Mechanism and Fracture Patterns

Violence-related facial trauma: analysis of multidetector computed tomography findings of 727 patients

The multidetector CT (MDCT) findings of facial trauma in victims of interpersonal violence were assessed. All MDCT requests for suspected facial injury during a 62 month period were retrieved; 727 cases met the inclusion criteria. Images were interpreted by two researchers by consensus. Of the 727 patients (aged 15-86 years old, mean 37), 583 (80.2%) were male and 144 (19.8%) female. Of all the patients, 74% had a fracture, and of these 44% had multiple non-contiguous fractures. Violence is a very common cause of facial injury. Nasal and orbital fractures predominate. Males are more often involved; they are younger, sustain fractures more often and significantly more often present with high-energy fracture patterns. LeFort fractures are often unilateral or asymmetrical, and are frequently accompanied by other, clinically significant fractures. Up to 25% of patients with fractures do not have paranasal sinus effusions.

Facial Injury in Sport

Sports are a common cause of facial injury. A wide variety of facial injuries occurs during sports. Severity of these injuries varies greatly. Understanding the diagnosis and treatment of these injuries is important to those participating in the health care of the athlete. Injuries that may threaten the airway or vision or cause bleeding are particularly crucial to understand. Dental injuries such as tooth fracture and tooth avulsion may need to be treated urgently in many cases. Facial lacerations may damage underlying structures, including the lacrimal system, facial nerve, or parotid duct. Closure of facial lacerations involves several considerations, such as cosmesis, method of wound closure, and complexity of the wound. Facial fractures occur commonly in sports, and familiarity with the various types and levels of severity is of key importance. Return-to-play guidelines after facial injury have yet to be established. Use of protective equipment can prevent facial injuries and protect athletes when returning to play after facial injury has occurred.

Factors Associated With Orofacial Injury and Willingness to Participate in Interventions Among Adolescents Treated in Trauma Centers

Assault is the most common cause of facial injuries in adolescents treated at inner-city trauma centers, yet little is known about the behavioral and environmental antecedents of these injuries or the willingness of such at-risk adolescents to participate in behavioral interventions to minimize reinjury. The purpose of this study was to identify possible risk and protective factors among adolescents with assault-related facial injury and to assess their willingness to participate in prospective observational research and behavioral interventions. Interviews were conducted with 67 adolescents (range 14 to 20 yrs) who were treated in trauma centers for facial injuries. Most of these injuries were assault-related (59%), followed by motor vehicle or other accidents (29%), gunshot wounds (9%), and sports injuries (3%). The subjects were predominantly male (86%) and of ethnic minorities (91%). The adolescents showed high rates of intentional injuries in the past 6 months (56%), unhealthy alcohol use, and in more than half (55%) problem levels of substance use. Compared with those with unintentional injuries, adolescents who experienced assault-related injuries were more likely to report using alcohol, tobacco, and other substances. Although a significant segment of the sample (55%) had been arrested previously, no differences in arrest rates or types of crimes for which adolescents were arrested were observed by injury type. Most subjects were unwilling to participate in interventions that involved multiple sessions; however, greater family cohesion predicted the likelihood of being willing to participate. Most facial injuries in inner-city adolescents result from assault. Unhealthy alcohol use, problem levels of substance use behaviors, and family history of alcohol problems are associated markers of assault-related injuries that can be useful for risk assessment and targeted intervention. Interventions need to be brief if they are to engage these at-risk youth.

Athletic injuries in mouth, jaw and facial surgery

Sport is a common cause of facial injuries. Depends on geographical distribution, 10% to 32% of all facial trauma cases are accounted to sporting activities according to the literature. In the following review article, sports-related facial injuries are classified based on their localization and on the principle of their treatment. Sports-specific mechanism underlying common injuries and state of the art concepts of diagnostics and surgical management, as currently practiced, are presented.

Surgical treatment of facial dog bite injuries in children

Although today most injuries of face and head are the result of car and motorcycle accidents, dog bites are a frequent cause of facial injuries in children. In recent years, general guidelines have been established concerning the surgical treatment of facial dog bite injuries in children. We have seen 16 children with such lesions at our hospital in the last 4 years. All children have been treated surgically, under general anaesthesia, by primary closure of the wound with interrupted sutures after having adapted the margins by subcutaneous sutures. In addition, all children have been evaluated 3 months-5 years after the accidents in order to objectify the results of our treatment. Special attention has been attached to the functional and aesthetic outcome. In all cases, we saw good-to-excellent results. Based on this experience we suggest a clinical classification of these injuries in regard to a special therapeutic regime for each stage. In this way, guidelines may be established for the surgeon dealing with these injuries.

Maxillofacial injuries at Jordan University Hospital

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.