Management Of Facial Fractures Research Articles

Pediatric Facial Fractures: A Multi-Institutional Level 1 Trauma Center Analysis of Incidence, Interventions, and Outcomes

Study Design Retrospective chart review. Objective The management of pediatric facial fractures presents distinctive considerations compared to adults. This study aims to provide a unique perspective on the correlations between the mechanism of injury, types of facial fractures, and fracture interventions and management utilized in 2 North Carolina Level 1 Trauma Centers to determine the optimal management options for this patient population. Methods An IRB-approved retrospective chart review was performed of pediatric facial trauma patients ages <18 years old between January 2020 and December 2022 at Atrium Health Wake Forest Baptist Medical Center and Atrium Health Charlotte Medical Center. Data on patient demographics, mechanism of injury, facial fractures, interventions, and outcomes were collected. Results Of 2,977 pediatric facial trauma patients, 582 patients sustained at least 1 facial fracture at the time of injury. Adolescents were significantly less likely to be transferred from outside institutions and to be admitted for further care ( P = 0.002). Adolescents experienced higher levels of residual symptoms following initial discharge ( P = 0.001) and were less likely to have a symptom resolution within 1 year ( P < 0.0001). Neonates and infants were significantly more likely to receive conservative interventions and to sustain calvarium and skull base fractures ( P < 0.0001). Conclusions This study identifies differences in pediatric age groups related to transfers, admittance, fracture type, management, and outcomes. Our data suggests adolescent patients may experience a higher incidence of residual symptoms with lower levels of symptom resolution within 1 year. Further investigation into these differences may elicit optimized methods of fracture management in pediatric age groups and allow for effective, individualized care with improved long-term outcomes.

Intraoperative computed tomography for the management of traumatic complex facial fractures: a narrative review

Successful facial reconstruction requires accurate restoration of the concealed three-dimensional facial skeleton. The key rationale for intraoperative computed tomography (iCT) is that it facilitates the most comprehensive assessment of fracture reduction. Real-time visual feedback is now considered an essential component in hand, spine and general orthopaedic surgery. Frequently proposed as the new gold standard of care, iCT has been widely adopted in maxillofacial surgery, especially internationally. In contrast, our Australian experience is that access to iCT and therefore uptake is relatively lacking. The craniofacial skeleton is a complex structure owing to its various convexities and concavities, sinonasal elements, biomechanical buttresses, visceral and occlusal components and neurovascular structures. Classic approaches to open reduction internal fixation aim to reduce incisions to prevent complications such as ectropion, salivary leak or nerve damage. However, intraoperative assessment of fractures in minimally-invasive techniques are hindered by the limited extent of exposure, especially in the setting of complex fracture patterns or those that involve dynamic or functional endpoints. With iCT, surgeons may visualise, adjust and revise fixation without wide exposure while the patient is on the operating table. This obviates an additional operation that may be required due to an unsatisfactory fixation. iCT is cost-effective and reduces radiation exposure. Challenges in integrating iCT include competing for availability with other specialties, training staff and lack of awareness about the benefits this technology offers. This narrative review discusses the role of iCT in the modern Australian operating theatre.

Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use

Study Design Literature review. Objective This review aims to explore current opioid use trends for surgical management of facial fractures, as well as methods and alternative treatments to decrease opioid use. Methods Review of selected literature from Medline and Google Scholar. Results Despite the devastating effects of the opioid epidemic and recent policy changes aimed at reducing unnecessary opioid prescription, opioids remain commonly used for pain management after facial fracture repair. Recently, use of multimodal analgesic therapy has been suggested to decrease opioid dosage utilized for post-operative pain control. Alternatives to medication therapies have been proposed for pain management; however, standardized recommendations for pain management in facial fracture patients remain unclear. Conclusions Further research is required to establish evidence-based recommendations for pain management in craniofacial fracture repair.

Trends in Management and Cost Burden of Facial Fractures: A 14-Year Analysis.

To discuss patient demographics and management and better understand the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center. Retrospective chart review. We identified 5088 facial fractures in 2479 patients who presented from 2008 to 2022. Patient demographics, mechanism of injury, associated injuries, treatment information, and hospital charges were collected and analyzed to determine factors associated with surgical management and increased cost burden. Our 14-year experience identified 1628 males and 851 females with a mean age of 45.7 years. Orbital fractures were most common (41.2%), followed by maxilla fractures (20.8%). The most common mechanism was fall (43.0%). Surgical management was recommended for 41% of patients. The odds of surgical management was significantly lower in female patients, patients age 65 and older, and patients who presented after the onset of the COVID-19 pandemic. The odds of surgical management was significantly higher for patients who had a mandible fracture or greater than 1 fracture. The average cost of management was highest for naso-orbito-ethmoidal fractures ($37,997.74 ± 52,850.88), followed by LeFort and frontal fractures ($29.814.41 ± 42,155.73 and $27,613.44 ± 39.178.53, respectively). The highest contributor to the total average cost of management was intensive care unit-related costs for every fracture type, except for mandible fractures for which the highest contributor was operating room (OR)-related costs. This study represents one of the largest comprehensive databases of facial fractures and one of the first to provide a descriptive cost analysis of facial trauma management. 4 Laryngoscope, 134:3120-3126, 2024.

Time-to-operation delays and in-hospital complications in operative facial trauma: A national analysis

BackgroundManagement of facial fractures is variable. Understanding how time to operative management impacts outcomes can help standardize practice. MethodsRetrospective analysis of the ACS Trauma Quality Improvement Program (TQIP) database between 2016 and 2019. Adult patients with operative facial fractures were isolated by ICD-10 procedure codes, and further stratified by fracture location, including the mandible, orbit, maxilla, zygoma, and frontal bone. Multivariable logistic regression was conducted to predict in-hospital complications (both surgical and systemic complications) adjusting for time-to-operation, comorbidities, fracture location, AIS, and demographics. Results1678 patients with operative facial fractures were identified. The median time-to-operation was 2 days (IQR 1.0–2.0 days). Most patients only had one operative fracture (95 %) and orbital fracture was the most common (44 %). The overall complication rate was higher for those operated after 2 days compared to those operated between 1 and 2 days and within 24 h (2.8 % vs 0.6 % vs 0.7 %; p < 0.001). Patients who were operated on after 48 h exhibited an increased risk of any complication (OR 4.72, 95 % CI 1.49–16.6, p = 0.010) on multivariable models. ConclusionDelays in the management of facial fractures are associated with more in-hospital complications. However, the incidence of short-term postoperative complications remains low. Injury characteristics are the primary predictor of delays in operation, however Hispanic patients independently experienced delays in care.

Comparison of Efficacy Between New Method and Conventional Arch Bar Fixation Technique in Facial Bone Fracture Management – A Randomised Clinical Trail

Introduction - In this study efficacy of new method for arch bar fixation was compared with conventional technique in facial bone fracture management Material and Methods - 20 Patients with facial bone fracture reported to the Department of Oral and maxillofacial Surgery requiring open reduction were included in the study. The clinical parameters that were evaluated are Oral hygiene and Gingival index. Results - The mean OHI-S score in new technique and conventional technique in 1st week was 1.36 ± 1.19 and 0.81±0.53 respectively. In 2nd week the mean OHI-S score in new technique was 1.22 ±0.77 and in conventional technique the mean OHI-S score was 1.39 ± 1.51.In the 3rd week the mean OHI-S scores of new technique and conventional technique were 1.8 ±0.55 and 1.6 ±1.73 respectively. The mean GI score in new technique and conventional technique in 1st week was 0.69 ± 0.5 and 0.38 ± 0.3 respectively. In 2nd week the mean GI score in new technique was 0.63 ±0.4 and in conventional technique the mean GI score was 0.36 ± 0.3. In the 3rd week the mean GI scores of new technique and conventional technique were 0.65 ±0.3 and 0.35 ± 0.3 respectively. Conclusion - In a whole we can conclude from this clinical study that both the techniques were equally effective in terms of Oral hygiene, gingival health and stability. Key Words - Erich arch bar; Intermaxillary fixation; Intermaxillary fixation screws; maxillofacial trauma; oral hygiene status.

Pediatric Mandible Fractures.

The management of pediatric facial fractures requires several considerations by the treating surgeon. Pediatric facial fractures occur less commonly than in adults. Among fracture patterns in children, studies have repeatedly demonstrated that mandible fractures are the most common facial fracture particularly the condyle. Most fractures in children are amenable to nonsurgical or closed treatment; however, certain indications exist for open treatment. The literature describing epidemiology, treatment trends, and long-term outcomes are limited in comparison with adult populations. The purpose of the article is to review the etiology, workup, and management of mandible fractures in children.

Multimodal Approach for Pediatric Mandibular Fractures: A Case Series

Background The management of facial fractures varies due to a variety of reasons in the pediatric age groups. The clinicians should therefore attune themselves to managing pediatric patients and the variations thereof. Every modality mentioned in the literature has its own advantages and disadvantages. The right choice of treatment by clinicians depends on their knowledge of pediatric anatomy, physiology, age-dependent bone growth, and the type and extent of fractures. Three different modalities of treatment in the form of circummandibular wiring, intermaxillary fixation and open reduction, with internal fixation were rendered to the patients, considering various factors such as the patient’s age, location of the fracture line, status of occlusion, and dentition. All three modalities showed good results in the form of adequate reduction and no post-op complications. Conclusion Pediatric trauma is a challenging entity for the surgeon. The choice of the ideal treatment modality ultimately depends on the presence of tooth buds and the maintenance of uninterrupted growth of the jaw bone. Thus, a well-thought-out and customized treatment plan should be devised for each individual case.

Craniomaxillofacial Trauma: The Past, Present and the Future.

Reconstruction of facial trauma has seen a significant evolutionary leap in the last 100 years. The current surgical management of facial fractures was made possible by the efforts and creativity of pioneer surgeons, advances in anatomic understanding, and the continued development of biomaterials and imaging technologies. Virtual surgical planning (VSP) and 3-dimensional printing (3DP) are being incorporated into the management of acute facial trauma. The integration of this technology at the point of care is rapidly expanding globally. This article reviews the history of the management of craniomaxillofacial trauma, current practices, and future directions. The use of VSP and 3DP in facial trauma care is highlighted with a description of EPPOCRATIS, a rapid point-of-care process incorporating VSP and 3DP at the trauma center.

Mandibular fracture repair techniques in cats: a dentist's perspective.

Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular fracture repair will facilitate evidence-based decision-making in clinical practice. Feline maxillofacial and oral anatomy brings unique challenges in comparison with dogs. It has been commonplace to adapt techniques and equipment that are better suited to other body regions or are species-inappropriate for use in feline maxillofacial surgery, and this has traditionally resulted in high morbidity. This review presents an overview of the diagnosis of, and decison-making for, maxillofacial trauma in cats, specifically with reference to the feline mandible. The challenges associated with the management of these injuries are presented. Techniques for repair that can be employed in general practice, as well as more advanced surgical options, are discussed, as well as the indications for invasive vs non-invasive management. Underutilised methods involving composite dental materials and their versatility for the repair of mandibular fractures in cats, and miniplates for caudal mandibular fractures in cats, are specifically covered, as well as other recent advances in the field, including three-dimensional printing and custom-printed implants. Management of feline facial fractures is an often neglected topic, with very few published studies choosing to focus on head trauma outcomes in cats. Where available, however, this review draws on the published literature, as well as the authors' own clinical experience.

Does Facial Fracture Management Require Opioids? A Pilot Trial of a Narcotic-Minimizing Analgesia Protocol for Operative Facial Trauma.

Opioid minimization in the acute postoperative phase is timely in the era of the opioid epidemic. The authors hypothesize that patients with facial trauma receiving multimodal, narcotic-minimizing pain management in the perioperative period will consume fewer morphine milligram equivalents (MMEs) while maintaining adequate pain control compared with a traditional analgesia protocol. An IRB-approved pilot study evaluating isolated facial trauma patients compared 10 consecutive prospective patients of a narcotic-minimizing pain protocol beginning in August 2020 with a retrospective, chart-reviewed cohort of 10 consecutive patients before protocol implementation. The protocol was comprised of multimodal nonopioid pharmacotherapy given preoperatively (acetaminophen, celecoxib, and pregabalin). Postoperatively, patients received intravenous (IV) ketorolac, scheduled acetaminophen, ibuprofen, and gabapentin. Oxycodone was reserved for severe uncontrolled pain. The control group had no standardized protocol, though opioids were ad libitum. Consumed MMEs and verbal Numeric Rating Scale (vNRS) pain scores (0-10) were prospectively tracked and compared with retrospective data. Descriptive and inferential statistics were run. At all recorded postoperative intervals, narcotic-minimizing subjects consumed significantly fewer MMEs than controls [0-8h, 21.5 versus 63.5 ( P = 0.002); 8-16h, 4.9 versus 20.6 ( P = 0.02); 16-24h, 3.3 versus 13.9 ( P = 0.03); total 29.5 versus 98.0 ( P = 0.003)]. At all recorded postoperative intervals, narcotic-minimizing subjects reported less pain (vNRS) than controls (0-8h, 7.7 versus 8.1; 8-16h, 4.4 versus 8.0; 16-24h 4.3 versus 6.9); significance was achieved at the 8 to 16-hour time point ( P = 0.006). A multimodal, opioid-sparing analgesia protocol significantly reduces opioid use in perioperative facial trauma management without sacrificing satisfactory pain control for patients.

Management of panfacial and complex facial fractures: A Belgaum perspective – Case series

Management of panfacial and complex facial fractures: A Belgaum perspective – Case series

Outpatient management of facial fractures in France: Current state

Maxillofacial trauma is still very common in France with possible involvement of all face bones. Outpatient surgery is an axis strongly put forward by the public authorities. The aim of this study is to establish a current state in the outpatient management of facial fractures in France in 2019 before COVID infection. A closed and semi-open-ended questionnaire was sent to French hospitals treating facial fractures in order to evaluate current and possible future practices in terms of outpatient and perioperative management. Data extracted from the Program for giving Medical significance to Information Systems (PMSI) thanks to the Agency for Information on Hospital Care (ATIH) were also studied to obtain proportions of outpatient care by department. About the questionnaire 43 replies were received. Nasal fractures were the only type of fracture having a minimum average length of stay below 24hours (12.00±16.65) as well as an actual average length of stay (14.22±24.24). Concerning data extracted from the PMSI, 14510 stays were found. Currently only nasal fractures and zygomatic arch fractures requiring simple reduction without osteosynthesis are performed on an outpatient basis. Mandibular fractures could be performed as an outpatient procedure. Access to the operating room and organizational problems specific to each center are factors that limit the development of outpatient management of these facial fractures. Some incompressible parameters such as the monitoring required following the management of these fractures as well as the patients' comorbidities must be taken into account.

Characteristics of Facial Fractures in Critically Injured Children

Background: Treatment of facial fractures in pediatric patients requiring intensive care unit (ICU) care has not been well categorized. The purpose of this study is to describe a single-institution experience with the management of pediatric facial fractures in patients requiring ICU-level care. Methods: We performed a retrospective review of patients under 18 years old who presented to a level I trauma center with facial fractures between 2006 and 2021. Types of facial fractures, mechanisms of injury, operative treatment, GCS score, and associated injuries were evaluated in ICU patients compared to patients who were admitted to the hospital, but not ICU. Results: Facial fractures were diagnosed in 3334 patients. Of them, 1080 were admitted to the hospital and 207 patients (19.2%) required ICU-level care. Among these patients, the average age was 9.7 ± 4.9 years. The average length of stay was 9.2 ± 10.9 days and the average lowest GCS score was 10.3 ± 4.6. The most common mechanism of injury was a motor vehicle accident (n = 122, 59.5%). Compared to non-ICU admitted patients, patients admitted to the ICU were significantly more likely to present with skull (n = 124, 60.5%, P &lt; .001), orbital (n = 140, 68.3%, P &lt; .001), and maxillary fractures (n = 96, 46.8%, P &lt; .001) and significantly less likely to present with mandibular fractures (n = 47, 22.9%, P = .020). ICU patients had significantly more associated injuries, particularly neurological injuries (91.2% vs 47.8%, P &lt; .001). ICU patients underwent operative treatment at the same rate as non-ICU admitted patients (OR, 0.7 [95% CI, 0.5-1.0]). Conclusions: Pediatric facial fracture patients requiring ICU-level care are a poorly characterized population. Our data suggest that high impact mechanisms of injury and specific fracture patterns are associated with ICU admission as these patients require particular attention and management.

Feasibility of Laterocaudal Approach in Comparison with Subtarsal Approach in the Management of Orbital Rim Fractures in Indian Population: A Prospective Study.

A balance between surgical access and aesthetics, with lesser post-op sequelae, is inevitable in the management of facial fractures. Even though various approaches are widely practised, further modifications and revisions are encouraged for better outcomes. We performed a prospective cross-sectional study on 30 patients with Zygomatico-Maxillary Complex (ZMC) fracture with inferior orbital rim involvement. Surgical management was performed using subtarsal (Group A) or laterocaudal (Group B) approach, during which the time taken to expose fracture and the ease of access was documented. Scar evaluation was performed using SCAR Scale on the 15th day and after one-month and three-month follow-up, and the post-op complications including ectropion, infections, edema, etc., were documented. There was a significant reduction in the time taken (p < 0.001) in group B than in group A. The ease of access did not demonstrate any significant difference. The SCAR scale score was significantly reduced at 3rd-month follow-up in group B compared to the other group (p = 0.009). Laterocaudal approach demonstrated lesser time-taken and better access to the inferolateral rim, with superior aesthetics and fewer complications. This approach can be employed in clinical practice, especially with inferolateral rim involvement in ZMC fractures.

Factors associated with delays in medical and surgical open facial fracture management

ObjectivesOpen fractures are at risk of infection because of exposure of bone and tissue to the environment. Facial fractures are often accompanied by other severe injuries, and therefore fracture management...

An epidemiologic retrospective study of maxillofacial traumatology in the elderly

Introduction: The elderly population, which is more active than before, is increasingly suffering from trauma (loss of reflexes and systemic pathologic conditions). Surgical management may be more controversial due to the potential consequences of general anesthesia and the sometimes negligible consequences of functional management. The main objective of this study was to analyze the causes and location of facial fractures in subjects older than 65 years. The secondary objective was to evaluate the management of these fractures (surgical or functional) according to comorbidities.Material & methods: In this retrospective study (over a five-year period), we analyzed the causes and management of facial fractures in patients aged over 65 years, and the medical history of each patient was investigated.Results: One hundred and nineteen patients with 198 facial fractures were included. The main cause of fractures was a fall (50%). The zygomatic region (39.9%) and mandible (27.8%) were the sites of the most frequent fractures. Comorbidities were found in 84.9% of patients, the majority of which were cardiovascular diseases (82.3%). 75.8% of fractures were treated surgically and 4.8% of patients had complications.Discussion: This work is a help to understanding the causes and consequences of facial trauma in the elderly population. The management of these facial fractures requires a multidisciplinary assessment, taking into account the patient's medical history and evaluating the risks and benefits of a surgical procedure with general anesthesia.

El informe estructurado del traumatismo maxilofacial

Facial trauma is common, usually occurring in traffic accidents, work-related accidents, assault, or accidental falls. These lesions represent a diagnostic challenge due to the complexity of the anatomy and the limitations of physical examination, due in part to associated soft-tissue lesions. Multidetector computed tomography (MDCT) is the diagnostic technique of choice because it enables rapid image acquisition and multiplanar and volumetric reconstructions that are fundamental for the diagnosis and surgical management of facial fractures and the complications associated with them. This paper aims to describe the radiologic anatomy of facial fractures based on the buttresses and beams and taking into account the division of the facial region into three parts, as well as to consider how to write a practical structured report to optimize communication with the rest of the multidisciplinary team.

Pan Facial Trauma Fracture Management: Case Report &amp; Literature Review

Pan facial fractures involve the mandible, maxilla, and zygomatic complex at the same time, and are frequently associated with NOE and frontal bone fractures. Reconstruction of multiple facial fractures including the top and lower face should be handled as a jigsaw. To accomplish this, two common management sequences for Pan facial fractures have been proposed: "Bottom up and inside out" and "Top down and outside in." There are more sequences, but these two major ways are the most common. The proximity of the maxillofacial region to important features or senses such as vision (diplopia), olfaction, respiration (airway management), chewing or mastication (occlusion), deglutition, and aesthetics makes the scenario a little more complex for the surgeon operating in this region than in any other part of the body.&#x0D; It's difficult to stick to a tried-and-true procedure for treating pan face fractures. Despite rigorous therapy, most patients with pan facial trauma may have some residual deformity, which may necessitate more surgery in the future. The care and easy procedures utilized to decrease and fix a case of pan facial trauma in a 26-year-old are described in this article.

Associated Injuries Related to Patients With Facial Fractures.

Study Design: Retrospective Study. Objective: To find out the incidence, type, and severity of injuries in other parts of the body in patients diagnosed with facial fractures. The study also analyzed any correlation between these injuries and facial fractures. Methods: A retrospective study of 991 patients with facial fractures during the period of 2006-2016. Results: 111 patients reported associated injuries (11.1%). The most common type of injury was limb injury (33.33%), followed by head injury (22.5%), clavicle fracture (14.7%), rib fracture (10.9%), cervical spine injury (5.4%), and other injuries constituted (13.2%). Multiple associated injuries were observed in 14% of patients. Conclusion: The findings show that facial fracture management is a multidisciplinary approach. Prompt diagnosis and proper management are important to reduce the mortality rate and improve the prognosis of the patient.