Repair Of Facial Fractures Research Articles

The Role of Immunosuppression on Postoperative Outcomes in Facial Fracture Repair.

Objectives: To assess postoperative outcomes in immunosuppressed patients with facial fractures. Methods: TriNetX, a large de-identified health research database, was utilized to compare outcomes within 30 days of treatment between immunosuppressed and immunocompetent patients with facial fractures. Subgroup analysis was conducted based on use of immunosuppressive therapy, human immunodeficiency virus (HIV) status, diabetes, and chronic kidney disease (CKD). Results: Nine thousand four hundred seventy-five patients were identified. On subgroup analysis, 555 patients were on immunosuppressants, 429 patients had HIV, 619 patients had CKD, 1322 patients with liver disease, and 3133 had diabetes. Immunosuppressed patients more frequently experienced postoperative infections [odds ratio (OR) 1.37 (1.9-1.54), P < .001], thromboembolic events [OR 1.71 (1.33-2.20), P < .001], hemorrhage [OR 1.46 (1.10-1.92), P = .0087], hospital readmission [OR 1.36 (1.28-1.44), P < .001], subsequent emergency department encounters [OR 1.08 (1.01-1.15), P = .0249], and wound disruptions [OR 1.52 (1.17-1.97), P = .0017]. Analyses comparing outcomes by immunosuppression type found increased rates of infection [OR 1.59 (1.25-2.01), P < .001], thromboembolic events [OR 1.56 (1.07-2.26), P = .0196], wound disruption [OR 1.57 (1.03-2.39), P = .0357], and hospital readmission [OR 1.28 (1.16-1.42), P < .001] in diabetic patients. Patients with CKD [OR 1.7 (1-2.90), P = .0478] had higher rates of infection [OR 2.02 (1.18-3.46), P = .0092] and readmission [OR 1.43 (1.14-1.79), P = .0017]. Patients with liver disease had higher rates of infection [OR 1.54 (1.07-2.23), P = .0210], thromboembolic events [OR 2.84 (1.37-5.87), P = .0033], and readmission [OR 2.14 (1.83-2.51), P < .001]. No significant differences were seen between groups for HIV patients. Conclusions: Immunosuppressed patients with facial trauma have a higher prevalence of postoperative complications compared to immunocompetent patients. Diabetics had a higher prevalence of most complications while patients with CKD and liver disease had higher rates of infections. Surgeons may consider measures to decrease postoperative risk in these patients and to provide preoperative patient counseling.

Post-Operative Lower Eyelid Massage Versus Standard Care for Prevention of the Lower Eyelid Scar Contracture after Subciliary Approach in Traumatic Facial Fracture Repair: A Randomized Controlled Trial

Background: Subciliary incision, a common technique for traumatic facial repair, associates with lower eyelid scar contracture and malpositioning. Despite proposed management techniques like eyelid massage, the efficacy of post-operative massage remains unexplored in preventing and treating these issues. Objective: To assess the effectiveness of lower eyelid massage in preventing lower eyelid scar contracture and malposition following the subciliary approach for traumatic facial repair, compared to standard care without massage. Materials and Methods: A randomized controlled trial enrolled patients with traumatic facial fractures slated for subciliary approach repair. Patients were randomly allocated to the lower eyelid massage as the experimental group or standard care as the control group. The massage group received post-operative instructions. Data on demographics, injury profiles, lower eyelid scar contracture as graded by the grading of lower eyelid scar contracture (GLESCO) criteria, eyelid malpositioning, comfort scores, and complications were gathered over a 6-month follow-up. Results: The present study included 59 patients, with 30 in the massage group and 29 in the control group. There were no significant differences in demographic characteristics, injury profiles, or complications between the two groups. Post-operative assessments revealed the massage group exhibited a trend towards lower GLESCO grades with an average decrease of 0.72 grade per week (95% CI –1.46 to 0.02, p=0.058) and lower eyelid malpositioning grades with an average decrease of 0.49 grade per week (95% CI –1.03 to 0.05, p=0.073) compared to the control group. However, there was no significant difference in comfort scores between the two groups with an average difference of 0.18 score per week (95% CI –1.08 to 1.45, p=0.775). Conclusion: Lower eyelid massage demonstrated potential benefits in preventing lower eyelid scar contracture following traumatic facial repair. However, its impact on eyelid malpositioning and comfort scores was not statistically significant in the present study. Further study with larger sample sizes is warranted to validate these findings. Trial registration: ClinicalTrials.gov, NCT06311318 Keywords: Subciliary incision; Subciliary approach; Lower eyelid massage; Facial fracture; Scar contracture; Eyelid malposition; Ectropion

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.

Simulation-based workshop for emergency preparedness in otolaryngology.

This study aimed to evaluate the outcomes of a hands-on simulation-based course with emphasis on procedural techniques, clinical reasoning, and communication skills developed to improve junior Otolaryngology - Head and Neck Surgery (OHNS) residents' preparedness in managing otolaryngologic emergencies. Junior OHNS residents and faculty from residency programs in California, Nevada, and Arizona participated in this workshop in 2020 and 2021. The stations featured airway management techniques, ultrasound-guided needle aspiration, nasoseptal hematoma evacuation, and facial fracture repair using various models and cadavers. Participants completed a pre-workshop survey, post-workshop survey, and 2-month follow-up survey that assessed resident anxiety and confidence in three OHNS emergency situations across knowledge, manual skills, and teamwork using a 5-point Likert scale. Pre-workshop surveys reported the least anxiety and most confidence in teamwork, but the most anxiety and least confidence in technical skills and knowledge related to foreign body retrieval and airway management. Immediately post-workshop participants reported significant reductions in anxiety and increases in confidence, largest in the manual skills domain, in foreign body retrieval (anxiety: -0.99, confidence: +0.95, p < .01) and airway management stations (anxiety: -0.68, confidence: +1.07, p < .01). Data collected for the epistaxis station showed decreasing confidence and increasing anxiety following the workshop. Our findings demonstrate the effectiveness of a workshop in preparing junior residents in potentially lifesaving otolaryngologic techniques that residents will encounter. Optimizing use of simulation centered training can inform the future of residency education, improving confidence and decreasing anxiety in residents responsible for the safety of patients. III.

Operative Facial Fracture Patterns in Cannabis Users: A Propensity Score-Matched Analysis

Introduction: Cannabis is the third most used recreational substance in the United States. Each year, more and more states pass legislation to legalize it for both medical and recreation use. As the prevalence of cannabis use increases, it is important to study the implications for patient care, not simply the potential interactions with wound healing, and perioperative analgesia. Facial fractures are among the most common traumatic presentations for the plastic surgeon. As such, the present study aims to characterize the operative facial fracture patterns in cannabis users. Methods: The IBM MarketScan Research Databases were queried from the years 2017 to 2021. Cohorts were identified in the inpatient dataset using International Classification for Disease, 10th Revision Procedure Coding System (ICD-10-PCS) codes for facial fracture repair procedures. The cannabis cohort was separated based on presence of ICD-10 codes pertaining to cannabis use diagnoses. The cohorts were propensity-score matched using an approximate 4:1 matching ratio. Baseline cohort demographics were reported and compared including age, gender, geographic region, employment status, insurance plan type, and fracture repair type. Multivariate regression analysis was used to determine the relationship between cannabis use and fracture repair patterns. Results: There were 104 patients in the cannabis cohort and 480 in the control cohort after propensity score matching. The cannabis group had a higher proportion of male patients (80.8%vs 69.0%, P = .016) and a lower proportion of the age range from 18 to 34 years (4.8%vs 15.8%, P = .035). Employment types were different between the 2 cohorts, with more patients in the control cohort working full time (82.3%vs 69.2%, P = .045). Cannabis users had significantly less maxillary fracture repairs (1.9%vs 19.4%, P &lt; .001). Cannabis users also had significantly more frontal fracture repairs (1.9%vs 0.2%, P = .027) and mandibular fracture repairs (76.9%vs 63.8%, P = .010). Multivariate regression revealed that cannabis users have 1.8 times greater odds of undergoing mandibular fracture repair ( P = .020) and significantly lower odds of undergoing maxillary (OR 0.07, P = .001). Conclusion: There are significant differences in the fracture patterns for cannabis users undergoing operative management and those who do not use cannabis. While mandibular fractures were the most common fracture repair type overall, cannabis users had significantly higher odds of undergoing mandibular fracture repair. This may indicate that cannabis users are more likely to sustain injuries that require operative intervention. Further study is needed to identify the relative incidences of facial fractures among cannabis users and its implications on operative considerations.

Incidence and Reimbursement Trends for Facial Fracture Repair in the Elderly: A Medicare Analysis.

The aim was to describe incidence and reimbursement trends of surgical repair of facial fractures among the Medicare population. The annual procedure data from the Centers for Medicare and Medicaid Service National Part B Data File from 2000 to 2019 were queried. The total number of surgically corrected facial fractures increased from 10,148 in 2000 to 19,631 in 2019 in a linear pattern (r = 0.924). Specifically, nasal bone/septum fracture repairs increased the most by 200.6% (n = 4682 to n = 14,075), whereas operations for TMJ dislocations, malar/zygoma fractures, and alveolar ridge/mandibular fractures decreased by 27.9%, 12.3%, and 3.2%, respectively, between 2000 and 2019. Correspondingly, the total Medicare reimbursement rose from $2,574,317 in 2000 to $4,129,448 in 2019 (r = 0.895). However, the mean reimbursement for all procedures decreased from $376.63 to $210.35 (44.1% fall) over the same time after adjusting for inflation, with this trend holding for individual fracture types as well. Given the population's increasing age, there has been a significant increase in the number of surgical repairs of facial fractures in Medicare patients between 2000 and 2019. However, this is largely driven by an increase in nasal bone/septum closed reductions, with stagnant and, in some cases, declining incidence among other fracture repairs. The reason is unclear and may be related to an increase in nonoperative management or poor outcomes. Nevertheless, like other subfields within otolaryngology and medicine at large, payments have lagged far behind, which may play some role. 3 Laryngoscope, 134:659-665, 2024.

Limited Efficacy of Empiric Antibiotics for Pediatric Facial Fractures

Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair. This study aims to identify factors associated with antibiotic prescribing patterns and measures the association between antibiotic exposure and postoperative infections. In this retrospective cohort study, TriNetX, a research database, was used to gather data on patients under 18years of age who underwent repair of facial fractures. The records were obtained from 2003 to 2021. Current Procedural Terminology codes for facial fracture procedures were used to identify patients. Antibiotic use, defined as a binary categorical variable of whether or not patients received perioperative antibiotics. The secondary predictor variable was timing ofantibiotic administration, categorized by pre, intra, and postoperative administration. Postoperative infection, determined by International Classification of Diseases, 9th and 10th Revision codes within patient charts. Covariates included demographic variables such as age, sex, race, ethnicity, geographic location, and fracture characteristics, such as number of fractures and location of fracture. χ2 analyses were used for categorical variables and two sample t tests for quantitative variables. Multivariable logistic regression was used to evaluate patient infection and antibiotic use with adjustment for covariates. P-values were 2-tailed and statistical significance was defined as P<.05. This cohort included 5,413 patients of which 70.4% were male, 74.4% identified as white, and 83.3% identified as non-Hispanic or Latino. There were no differences in postoperative infections in patients who received antibiotics compared to those who did not (0.9 vs 0.5%, respectively, P=.12). Nevertheless, antibiotic prescriptions have increased over the years. After controlling for relevant covariates, antibiotic use did not decrease the odds of infection (adjusted odds ratio 1.1, 95% CI 0.53 to 2.34, P=.79). There was a significant association between the timing of antibiotic use and infection (P=.044), with increased odds of infection when antibiotics were given postoperatively (adjusted odds ratio 3.8, 95% CI 1.2 to 12.07, P=.023). While antibiotic prescriptions have increased over the years, this study demonstrates there is no difference in postoperative infection rates for pediatric patients prescribed antibiotics and those where were not.

Evidence-Based Medicine for Midface/Orbit/Upper Facial Fracture Repair

The face is one of the most common areas of traumatic injury, making up approximately 25% of all injuries in 2016. Assault, motor vehicle collision (MVC), fall, sports, occupational, and gunshot wounds (GSW) are all common causes of facial fractures, with MVC and GSW leading to significantly higher severity of injuries. Most facial fractures occur in the upper two-thirds of the face. Most facial fractures require timely assessment, diagnosis, and treatment for optimal restoration of facial structures and functions. Without proper initial management, significant complications including immediate complications such as airway compromise, massive bleeding, infection, intracranial hemorrhages, or even death, and long-term complications such as poor functional outcomes and aesthetic setbacks can occur. The goal of this review is to summarize the management of fractures of the upper face, orbit, and midface and provide an update about complications and their management.

Age, ASA-status, and Changes in NSQIP Comorbidity Indices Reporting in Facial Fracture Repair.

To evaluate the impact of age and the American Society of Anesthesiologists (ASA) classification on post operative outcomes as well as the changes in the National Surgical Quality Improvement Program (NSQIP) database reporting of comorbidity index variables in patients with facial fractures. The NSQIP database was queried for facial fracture repair CPT codes between 2012 and 2019 and for modified Frailty Index (mFI) and modified Charlson Comorbidity Index (mCCI) variables between years 2006 and 2018. The predominant question analyzed two preoperative risk factors: patient and ASA classification. Chi-square analysis, Kruskal-Wallis, Mann-Whitney, Spearman correlation, and multivariable logistic regression were used to evaluate age and ASA classification with wound dehiscence, superficial surgical site infection (SSSI), deep wound infection (DWI), readmission status, and return to the OR. The reporting of indices variables was evaluated with descriptive statistics. In this large database with univariate analysis, patients with a higher ASA classification and older patients experience significantly increased risks of readmission, return to the OR, and longer hospital stays. On multivariate analyses, ASA classes II, III, and IV are independently associated with increased risk of readmission and return to the OR, while controlling for patient age. The reporting of all mFI and mCCI variables were consistent from 2006 to 2010, but after 2011, there has been inconsistent or absent reporting of variables, therefore, conclusions on the impact of comorbidities on facial fracture repair are unreliable. 4 Laryngoscope, 133:2572-2577, 2023.

New trends and insights in facial fracture treatment in the United States

Aim: Facial fractures have multiple etiologies, including motor vehicle collisions, interpersonal violence, falls, and sports-related accidents. The objectives of this study are to reassess, compare, and expand the epidemiologic analysis and postoperative complication rates of facial fracture treatment. Additionally, we sought to compare the length of stay and operative time outcomes between plastic surgeons and non-plastic surgeons. Methods: NSQIP (National Surgical Quality Improvement Program) participant databases were queried to identify all patients undergoing facial fracture operations. Epidemiological data was divided into two groups and compared by surgeon specialty: patients operated on by a plastic surgeon and patients operated on by a non-plastic surgeon. Our primary outcomes of interest were operation time and length of stay. Postoperative complications included wound complications, mortality, return to the OR, and major bleeding. Results: 3,354 patients underwent facial fracture repair (2012 to 2016). In men, the most common fracture was mandibular (40.9%); in women, the most frequent was orbital (32.4 %). 79.6% had single facial fractures and 20.4 % had multiple facial fractures. Plastic surgeons’ operating time was less than that of non-plastic surgeons (P = 0.0007). The average length of stay was higher for the plastic group (mean = 1.65 days, plastic) (P &lt; 0.00001). Postoperative complication variables showed no statistically significant differences between the plastic and non-plastic groups. Conclusion: Continuous epidemiologic analysis is vital for the proper allocation of healthcare resources to the most affected facial fracture patients in the US. Assessment of complication rates between surgical specialties allows a better understanding of the management of facial fracture patients on a national level. Our data analysis may allow surgeons to better counsel patients preoperatively and improve inter-specialty collaboration.

Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

PURPOSE: Facial fractures, often resulting from high impact trauma, necessitate surgical fixation with postoperative complications occurring in 3-30% of patients.1 Thus, risk prediction of unfavorable postoperative complications is essential for preoperative planning and postoperative management. Existing literature has linked smoking, alcohol use, age, BMI, and comorbidities to increased risk of adverse postoperative outcomes following facial fracture repair.1 More recently, frailty indices, including the Modified Five-Item Frailty Index (mFI-5) and the Modified Charlson Comorbidity Index (mCCI), have emerged as potentially more accurate predictors of surgical risk and 30-day postsurgical complications than their historical counterparts.2,3 The authors aimed to evaluate whether the mFI-5 and mCCI are stronger predictors of 30-day postoperative complications after open facial fracture reduction, versus historic risk proxies. METHODS: A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed of patients undergoing open facial fracture reduction from 2013-2019. Age, smoking, BMI, comorbidities, and American Society of Anesthesiologists (ASA) class were extracted, and mFI-5 and mCCI scores were calculated using this data. Univariate logistic regressions were performed (p<0.05). RESULTS: A total of 2,667 patients were analyzed, of which 2,131 (80%) were male. Most patients were nonfrail across both indices, with 86% (n=2,292) having an mFI-5 of 0, and 75% (n=1,994) having a mCCI of 0. Both mCCl score ≥2 (OR=2.19, p<0.001) and mFI-5 =1 (OR=1.96, p<0.001) were strong independent predictors of overall 30-day complication rate and complication severity. However, ASA class ≥3 was the strongest predictor (OR=3.60, p<0.001). Age was statically significant, but a low-impact, predictor of complications and complication severity (OR= 1.02, p<0.001). The only significant predictors of surgical site infections (SSI) were smoking (OR=1.56, p=0.042) and ASA class ≥3 (OR=2.37, p=0.013). An mFI-5 of 1 was also found to be a significant predictor of hospital readmission rates (7% vs 3% p<0.001). BMI was not associated with any increased risk. CONCLUSION: The mCCI and mFI-5 are significant independent predicators of total complications and complication severity following facial fracture repair. ASA class ≥3 was the strongest predictor of postoperative complications, likely attributable to concurrent multi-organ system trauma and its global impact on risk in facial fracture injury. An mFI-5 ≥1 was additionally predictive of increased readmission rates. Smoking increased risk of surgical site infections specifically but not overall complications. Newer frailty indices (mFI-5 and mCCI) predicted adverse postsurgical events more strongly than several historic risk proxies, offering potential utility as risk predictors during surgical planning. Further research should continue to clarify their predictive value. REFERENCES: 1. Perez D, Ellis E, 3rd. Complications of Mandibular Fracture Repair and Secondary Reconstruction. Semin Plast Surg. 2020;34(4):225-231. 2. Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work. Med Care. 2015;53(9):e65-72. 3. Lee CC, Hunter WP, Hajibandeh JT, Peacock ZS. Does the Modified Frailty Index (mFI-5) Predict Adverse Outcomes in Maxillofacial Fracture Repair? J Oral Maxillofac Surg. 2021.

30-Day Post-Operative Complications of Facial Fracture Repairs: A United States Database Study.

Cross-sectional database analysis. To define post-operative complication rates in facial fracture repair and to assess this data for patient characteristics which may be associated with post-operative complications. We performed a retrospective cohort analysis of the National Surgical Quality Improvement Program (NSQIP) database between January 1, 2015, and December 31, 2019. All patients included in this study sample must have (a) been ≥18 years old and (b) underwent surgical repair of a facial fracture during the study period by a plastic surgeon or otolaryngologist. Adverse outcomes at 30 days were characterized into four groups: superficial surgical site infection (SSI), deep SSI, organ space infection, and wound disruption. In total, 2481 patients met the primary outcome of facial fracture. Among the four fracture types assessed, 1090 fractures (43.9%) were mandibular, 721 were zygomatic (29.1%), 638 were orbital (25.7%), and 32 (1.3%) were Lefort. Of the entire cohort, 25 patients (1.01%) experienced a superficial SSI, 14 patients (.56%) presented with a deep SSI, 25 fractures (1.01%) returned with an organ space infection, and 23 patients (.93%) experienced some type of wound disruption. Smokers had a significantly higher risk of superficial SSIs (P < .05) and organ space infections (P < .05). The majority of facial fracture patients do not experience post-operative complications. However, smokers and patients with diabetes mellitus were shown to be at an elevated risk of developing complications. Future research should further investigate this relationship and focus on developing interventions to improve post-operative outcomes.

Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

The present study sought to evaluate whether the mFI-5 and modified Charlson Comorbidity Index (mCCI) are stronger predictors of 30-day postoperative complications after open reduction of facial fractures compared with historic risk proxies. A retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted to investigate patients who underwent open reduction facial fracture surgery between 2013 and 2018. Risk factors including age, smoking status, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) class were extracted for each patient. The mFI-5 score and mCCI score were calculated based on this data. Univariate logistic regressions were performed (P<0.05). A total of 2667 cases were included. Of these, 2131 (80%) were male. The strongest predictors for overall 30-day complications and complication severity were ASA class ≥3 (Odds Ratio [OR]=3.34), comorbidities ≥2 (OR=2.78), mCCl score ≥2 (OR=2.19), and mFI-5 ≥1 (OR=1.96). Smoking status and BMI were not strong predictors of total complications or complication severity. Age was found to be a statically significant, but low-impact, predictor of complications, and severity (OR=1.02, P<0.001). The only significant predictors of surgical site infections (SSI) were smoking status (OR=1.56) and ASA class ≥3 (OR=2.40). mFI-5 ≥1 was a significant predictor of hospital readmission. BMI was not associated with any increased risk. The mCCI and mFI-5 are statistically significant predictors of total complications and complication severity in open reduction of facial fracture repair, and thus provide a tool to inform decision making and improve care. Smoking status may increase risk for SSIs following facial fracture repair.

Analysis of Pediatric Facial Fracture Repair Rates and Complications Using California's Office of Statewide Health Planning and Development Database.

There exists a paucity of data on which pediatric facial fractures should be surgically repaired and when. In this study, the authors used a California state-wide database to determine the prevalence of facial fractures in the pediatric population and examine, which fractures are repaired. in addition to the timing of the repair, complications and resource utilization of the healthcare system were analyzed. Pediatric patients under the age of 18 were identified using the California Office of Statewide Health Planning and Development patient discharge database for admissions occurring between January 2015 and December 2018. International Classification of Diseases, Version 10 diagnosis codes were used to classify facial fractures. The associated diagnoses, complications, and number of subsequent repairs patients underwent were analyzed to determine the typical course of pediatric facial fractures. Of the 3058 patients diagnosed with facial fracture, 32% underwent surgical repair (N = 982). The 4 most repaired fractures were mandible (40%), nasal (16.2%), and orbital (15.1%). Surgical intervention steadily increased with age, with a peak in the 12 to 15-year-old cohort. Our analysis found that most fractures were managed nonoperatively, but those that did receive an operation did so during their index admission. In addition, the most repaired fractures were mandibular, nasal, and orbital fractures. The present study represents 1 of the largest pediatric samples to have assessed facial fractures, repair rates, and their sequelae.

ASA Physical Status Classification and Complications Following Facial Fracture Repair.

To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P < .001) and risk of overall complications (P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P = .049), postoperative bleeding (P = .036), and failure to wean off ventilator (P = .027). Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.

The Impact of Subspecialty Training on Procedural Timing in Facial Fracture Repair

The Impact of Subspecialty Training on Procedural Timing in Facial Fracture Repair

Does the Modified Frailty Index (mFI-5) Predict Adverse Outcomes in Maxillofacial Fracture Repair?

Frailty has been recognized as a predictor of postoperative adverse outcomes in many surgical subspecialties. The purpose of this study was to evaluate the relationship between frailty and complications in patients undergoing operative repair of facial fractures. The authors utilized the 2011 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases to identify patients with facial fractures undergoing operative repair. The primary predictor variable was frailty as measured by the 5-Factor Modified Frailty Index (mFI-5). The primary outcome variable was the postoperative complication rate. Descriptive, bivariate, and multiple logistic regression statistics were utilized to evaluate the relationship between frailty and complications. During the study period, 4,290 subjects underwent operative repair of a facial fracture. Of these subjects, 4,086 (83.0%) were classified as nonfrail, 626 (12.7%) as moderately frail, and 208 (4.20%) as severely frail. A total of 237 subjects experienced a complication (4.82%), and the incidence of complications increased in a stepwise manner with increasing frailty (P ≤ .001). In multivariate regression, age (P = .050, 95% CI=1.00 to 1.02), Native Hawaiian/Pacific Islander race (P = .018, 95% CI=1.23 to 8.63), classification as moderately frail (P = .010, 95% CI=1.15 to 2.66), classification as severely frail (P = .032, 95% CI=1.06 to 3.70), mandibular fractures (P = .004, 95% CI=1.24 to 2.98), and wound classification as contaminated (P ≤ .001, 95% CI=1.53 to 4.57) or dirty/infected (P = .020, 95% CI=1.16 to 5.55) were independent predictors of complications. Severely frail subjects also had greater length of hospital admission (P ≤ .001) and higher 30-day readmission rates (P ≤ .001). Frailty is an independent predictor of complications following facial fracture repair and is associated with greater length of hospital admission and 30-day readmission rates.

A Cross-Sectional Study to Assess the Risk Factors for Hypoesthesia after Repair of Facial Fractures

Background: Hypoesthesia occurs as a result of injuries resulting in injury to the nerve fibres. The causes of injury include direct harm from the needle injections, around the nerve fibres, mechanical injuries resulting in an indirect pressure into the mandibular canal, during the dental surgical procures, as well as the toxicity of the local anaesthetic agents.&#x0D; Methods: This cross-sectional research was conducted by recruiting N=79 adult individuals (&gt;18 years), who had visited the district hospital for acquiring clinical assistance and treatment of facial muscles or nerve-related complications in August 2020. Data collection for this research was carried out by using a specially designed questionnaire, which facilitated in acquiring data related to aetiology of trauma, identification of the hypoesthesia area, as well as the clinical complications experienced by the respondents. The clinical reports of the patients were also collected for analysing the hypoesthesia area. SPSS was utilised for data analysis, and statistical tests were conducted for assessing the risk factors for hypoesthesia after repair of facial fractures.&#x0D; Results: The statistical tests revealed that only a small percentage of the sample population, i.e., (N=9) or 11.8% experienced the facial bone fracture, male respondents had more exposure to the facial bone fractures, as compared to the females (Mean=1.81, SD= 0.397), and the individuals below 25 years of age had high exposure of facial bone fracture (Mean=1.78, SD= 0.428). A significant majority of hypoesthesia cases were at mandible, and orbit region.&#x0D; Conclusion: The dental treatment resulting in nerve manipulation results in nerve elongation, nerve compression, contributing to transient hypoesthesia. Hypoesthesia might also lead to other clinical complications.

New Extraocular Muscle Entrapment after Facial Fracture Repair

Extraocular muscle entrapment is a well-recognized complication of orbital fracture, wherein the inferior rectus muscle becomes lodged within the fracture fragments at the time of the initial trauma. New onset entrapment cannot occur without new force applied to the orbit, displacing the fragments and the inferior rectus. Theoretically, in complex orbital fractures, manipulation of disjunct fragments may apply pressure to the orbital contents and induce new entrapment in an otherwise non-operative orbital floor fracture. Here we present the only described case of new extraocular muscle entrapment after open reduction and fixation of a supraorbital rim and frontal sinus fractures and emphasize the need for careful assessment after repair of such a fracture to ensure that new entrapment has not occurred.

Opioid Use among Adolescents Undergoing Surgical Repair of Facial Trauma.

New persistent opioid use has been quantified among adults undergoing surgery; less is known about the risk among adolescents. The authors examine new persistent opioid use in opioid-naive adolescent patients who underwent operative repair of facial fractures. Using the IBM MarketScan Commercial Database, the authors performed a retrospective analysis of patients aged 11 to 17 years who underwent facial fracture repair between 2006 and 2015. The incidences of prolonged opioid use and potentially inappropriate opioid prescriptions were determined. Of 4892 patients, 78.5 percent filled a prescription. Among these patients, 7.9 percent had prolonged opioid use. Significant risk factors included older age (i.e., age 15 to 17 years) (OR, 1.579; 95 percent CI, 1.173 to 2.126 compared to younger patients), multiple comorbidities (OR, 3.005; 95 percent CI, 1.193 to 7.568), mandible fracture (OR, 1.614; 95 percent CI, 1.213 to 2.146), and multiple fractures (OR, 1.542; 95 percent CI, 1.002 to 2.372). Overall, 24.1 percent received a potentially inappropriate opioid prescription. Mandible fracture repair was associated with increased risk (OR, 2.753; 95 percent CI, 2.275 to 3.331) of potentially inappropriate opioid prescription. Nearly one in 12 adolescents met criteria for prolonged opioid use; nearly one in four received a potentially inappropriate opioid prescription. Significant risk factors included mandible fracture, older age, multiple comorbidities, and multiple fractures. Like adults, many adolescents are at high risk for potentially inappropriate opioid prescriptions and prolonged opioid use following surgical repair. Risk, III.