Facial Protection Research Articles

Novel method for comparing coverage by future methods of ballistic facial protection

The wearing of eye protection by United Kingdom soldiers in Afghanistan has reduced the morbidity caused by explosive fragments. However, the remaining face remains uncovered because there is a lack of evidence to substantiate the procurement of methods to protect it. Using a new computerised tool we entered details of the entry sites of surface wounds caused by explosive fragments in all UK soldiers who were injured in the face between 1 January 2010 and 31 December 2011. We compared clinical and predicted immediate and long term outcomes (as defined by the Abbreviated Injury Score (AIS) and the Functional Capacity Index (pFCI), respectively). We also used the tool to predict how additional protection in the form of a visor and mandible guard would affect outcomes. A soldier wearing eye protection was 9 times (1.03/0.12) less likely to sustain an eye injury than one without. However, 38% of soldiers in this series were not wearing eye protection at the time of injury. There was no significant difference between the AIS and pFCI scores predicted by the tool and those found clinically. There is limited evidence to support the use of a mandible guard; its greatest asset is better protection of the nose, but a visor would be expected to reduce long-term morbidity more than eye protection alone, and we recommend future trials to assess its acceptability to users. We think that use of this novel tool can help in the selection of future methods of ballistic facial protection.

Hockey-related facial injuries: a population-based analysis.

Recognition of the potentially severe sequelae arising from inadequate facial protection has facilitated sustained efforts to increase the use of protective visors in recent decades. Our objective was to characterize nationwide trends among patients presenting to emergency departments (ED) for facial injuries sustained while playing ice hockey. The National Electronic Injury Surveillance System was searched for hockey-related facial injuries, with analysis for incidence; age and gender; and specific injury diagnoses, mechanisms, and facial locations. There were an estimated 93,444 ED visits for hockey-related facial injuries from 2003 to 2012. The number of annual ED visits declined by 43.8% from 2003 to 2012. A total of 90.6% of patients were male; and the peak age of injury was 17 years. Lacerations were the most common form of facial injury (81.5% of patients) across all age groups. Contusions/abrasions and fractures followed in frequency, with fractures increasing with advancing age. The overall incidence of ED visits due to facial injuries from ice hockey has significantly decreased over the last decade, concurrent with increased societal use of facial protective equipment. Nonetheless, facial hockey injuries facilitate a significant number of ED visits among both adults and children; thus, the knowledge of demographic-specific trends described in this analysis is relevant for physicians involved in the management of facial trauma. These findings reinforce the need to educate individuals who play hockey about the importance of appropriate facial protection.

Improving the efficacy of appearance-based sun exposure interventions with the terror management health model

The terror management health model (TMHM) suggests that when thoughts of death are accessible people become increasingly motivated to bolster their self-esteem relative to their health, because doing so offers psychological protection against mortality concerns. Two studies examined sun protection intentions as a function of mortality reminders and an appearance-based intervention. In Study 1, participants given a sun protection message that primed mortality and shown a UV-filtered photo of their face reported greater intentions to use sun protection on their face, and took more sunscreen samples than participants shown a regular photo of their face. In Study 2, reminders of mortality increased participants’ intentions to use facial sun protection when the UV photo was specifically framed as revealing appearance consequences of tanning, compared to when the photo was framed as revealing health consequences or when no photo was shown. These findings extend the TMHM, and provide preliminary evidence that appearance-based tanning interventions have a greater influence on sun protection intentions under conditions that prime thoughts of death. We discuss implications of the findings, and highlight the need for additional research examining the applicability to long-term tanning behaviour.

Mandibular reconstruction with an alloplast: A case report and review of the current literature

The mandible plays a major role in definition of lower facial contour, airway protection and support for the tongue, dentition and the muscles of the floor of the mouth. Interruption of mandibular continuity, therefore, produces both cosmetic and functional derangements. The restoration of a patient, therefore, into acceptable cosmetics and satisfactory function after surgical ablation is a challenge for the oral and maxillofacial surgeon. This was a case of composite post-ablative defect which was reconstructed with a non-biological material (alloplast). The alloplast got exteriorised intraorally within a period of 1 year with resultant infection and had to be removed. It was concluded that alloplasts served only as temporary stabilisation in delayed reconstructtion of mandibular continuity defects. The reasons for delay may, however, vary. Resource development is necessary to facilitate surgical skills acquisition in free microvascular techniques of reconstruction which offers better and sustainable outcomes.

Questions linked to Bunyan D, Ritchie L, Jenkins D, Coia JE. Respiratory and facial protection: a critical review of recent literature. J Hosp Infect 2013;85:165–169.

Questions linked to Bunyan D, Ritchie L, Jenkins D, Coia JE. Respiratory and facial protection: a critical review of recent literature. J Hosp Infect 2013;85:165–169.

Answers linked to Bunyan D, Ritchie L, Jenkins D, Coia JE. Respiratory and facial protection: a critical review of recent literature. J Hosp Infect 2013;85:165–169.

Answers linked to Bunyan D, Ritchie L, Jenkins D, Coia JE. Respiratory and facial protection: a critical review of recent literature. J Hosp Infect 2013;85:165–169.

Guidance on the use of respiratory and facial protection equipment

Infectious micro-organisms may be transmitted by a variety of routes, and some may be spread by more than one route. Respiratory and facial protection is required for those organisms that are usually transmitted via the droplet/airborne route, or when airborne particles have been artificially created, such as during ‘aerosol-generating procedures’. A range of personal protective equipment that provides different degrees of facial and respiratory protection is available. It is apparent from the recent experiences with severe acute respiratory syndrome and pandemic (H1N1) 2009 influenza that healthcare workers may have difficulty in choosing the correct type of facial and respiratory protection in any given clinical situation. To address this issue, the Scientific Development Committee of the Healthcare Infection Society established a short-life working group to develop guidance. The guidance is based upon a review of the literature, which is published separately, and expert consensus.

Electrophysiological Mapping of the Temporal Branch of the Facial Nerve

Minimized frontal and frontolateral approaches have been proposed for the clipping of aneurysms and for removal of deep-seated supra- and parasellar lesions. To avoid postoperative facial nerve palsy, anatomical studies have been conducted; however, only one electrophysiological investigation has been reported. We studied the course of the facial nerve in the temporal region and identify the optimal pterional keyhole craniotomy from the perspective of facial nerve protection. We stimulated the temporal branch of the facial nerve in nine healthy volunteers and identified its course electrophysiologically. Electromyographic (EMG) responses were recorded from the superior orbicularis oculi, corrugator, and frontal muscles. The course of the temporal branch of the facial nerve was identified by tracking the stimulation points that elicited the best EMG responses. The distances from the tragus to the canthus, the tragus to the point where the facial nerve crosses over the zygomatic arch, the tragus to the first nerve bifurcation, the tragus to the second nerve bifurcation, and from the orbit to the middle rami were 80.8 ± 1.8 mm, 40.2 ± 1.6 mm, 58.1 ± 2.8 mm, 79.1 ± 3.4 mm, and 16.4 ± 0.9 mm, respectively. We found that the temporal branch of the facial nerve innervates each muscle in posterior-anterior direction. Based on these results, we prefer the pterional keyhole approach and incise the skin at a site posterior to the temporal branch of the facial nerve.

Less invasive transjugular approach with Fallopian bridge technique for facial nerve protection and hearing preservation in surgery of glomus jugulare tumors

For the past three decades, surgery of glomus jugulare tumors (GJTs) has been characterized by extensive combined head and neck, neuro-otologic, and neurosurgical approaches. In recent years, the authors have modified the operative technique to a less invasive approach for preservation of cranial nerves while achieving satisfactory tumor resection. We evaluated and compared the clinical outcomes of our current less invasive approach with our previous more extensive procedures. The clinical records of 39 cases of GJT surgically treated between 1992 and 2011 were retrospectively reviewed. The less invasive transjugular approach with Fallopian bridge technique (LI-TJ) was used for the most recent five cases. The combined transmastoid-transjugular and high cervical (TM-HC) approach was performed in 30 cases, while four cases were treated with a transmastoid-transsigmoid approach with facial nerve translocation. Operative technique, extent of tumor resection, operating time, hospital stay, and morbidity were examined through the operative records, and a comparison was made between the LI-TJ cases and the more invasive cases. No facial nerve palsy was seen in the LI-TJ group while the TM-HC group demonstrated six cases (17.6%) of facial palsy (House-Brackmann facial nerve function grading scale grade II and III). The complication rate was 0 % in the LI-TJ group and 16.7% in the more invasive group. The mean operative time and hospital stay were shorter in the LI-TJ group (6.4 h and 4.3 days, respectively) compared with the more invasive group (10.7 h and 8.0 days, respectively). The LI-TJ approach with Fallopian bridge technique provided adequate tumor resection with cranial preservation and definitive advantage over the more extensive approach.

Incidence and prevention of traumatic injuries in paediatric handball players in Istanbul, Turkey

To investigate the frequency of dental injuries in paediatric handball players. In addition, the players' habits with regard to mouthguard usage, as well as their general knowledge of the prevention of traumatic dental injuries (TDIs) were investigated. Data were collected by structured one-to-one interviews with children of 14 randomly selected handball teams in the amateur national league. The questionnaire consisted of 15 questions. The age, gender, trauma experience and league status of each interviewee was recorded. The interviews took place mainly at national championships or tournaments. A total of 212 individuals, 74 girls and 138 boys, were interviewed. Forty-one of the 212 participants (19.3%) had sustained a dental injury. The mean age of participants was 12±1.6years. Concussion was the most frequent finding and the cause of injury was a blow from another player. The number of individuals that were aware of mouthguards was only 15.6% and surprisingly no players used mouthguards. The results show that handball players need more knowledge and education considering the prevention of TDIs from their sports clubs and dentists. The importance of adequate facial protection in contact sports should be endorsed by all sports clubs, and parents advised accordingly.

Adjunctive techniques in facial paralysis

Facial paralysis continues to represent a challenging clinical problem without a single solution or approach. Multiple areas of cosmetic and functional deficits complicate a paralyzed face, and each requires a targeted approach for optimal rehabilitation. When prioritizing care in patients with facial paralysis, ocular protection, and oral competence remain the primary areas of concern. However, other accompanying problems, such nasal obstruction, lower lip asymmetry, and facial drooping also prominently contribute to the morbidity of patients with facial paralysis. This article addresses these commonly overlooked problems in facial paralysis and focuses on the surgical management of incompetent nasal valve, depressor muscle asymmetry, and facial ptosis.

Designing and Constructing a Smart Armor for Protecting Motorcyclists’ Head and Neck in the Accident Time

Background: In general, riding motorized two-wheeled vehicles carries a higher risk of being involved in a fatal accident than any other mode of transport. In some countries, the use of protective helmets while riding motorcycles is a legal requirement. That is, a helmet can be a lifesaver in an accident and can protect against severe head, brain and facial injuries, particularly integral helmets with full facial protection. The present paper introduces a newly invention of smart armor to protect motorcyclist's head and neck in an accident time and to minimize injuries. Materials & Designs: The smart armor for protecting motorcyclist's head and neck was designed innovatively. The system was constructed from boxes settled on the motorcycle, including a power source, an incident detection sensor, a transmitter circuit and a transmitter circuit antenna. In addition, the helmet parts including a mechanical operator's box, mechanical force interface cables, helmet frame, balance surface, fixed neck guard and moving neck guard were constructed. The constructed system was formally registered by the Iranian Patent Organization in 2010. Findings & Tests: The smart armor showed useful capabilities and was successfully tested by several motor cyclists in simulated accidents. The different mode of collision with obstacle ahead, back hit, and change angle more than 45 degrees from vertical mode of motorcycles were successfully tested. Conclusions: The designed smart armor presented in this article, showed a suitable performance to protect motorcyclist's head and neck simultaneously. Therefore, it can be used as a suitable protective device for motorcycle riders.

Use of Facial Protection to Prevent Reinjury During Sports Practice

The objective of the study was to report the prevention of facial reinjury of a volleyball player using a custom-made protective facial shield. A custom-made protective partial facial shield was fabricated using polymethylmethacrylate and was fitted with a soft lining material to provide additional comfort and protection to the injured area. Facial protection provides greater security against possible facial injuries and allows injured areas to recover during sports practice.

Design of Facial Impact Protection Gear for Cyclists

The concept of facial impact protection mask for cyclists is proposed in response to increased participation in cycling and the need for injury prevention. The research aims to develop an approach for design of facial impact protection gear to reduce the risk of severe injury. Impact test equipment and procedure, face surrogate and protection material performance criteria are developed. Three groups of protective materials – rigid crushable, semi rigid, and soft cushion foams are tested and assessed according to criteria. The criteria are linked to measures of the risk of facial and brain injuries: HIC (Head Injury Criterion), peak deceleration, Face-bone damage and energy absorption. The impact energy is simulated by a drop test using a 48 mm-radius-steel hemispherical impactor, with a weight of 4.63 kg similar to that of headform J specified in AS/NZS standard. The drop-height is 1500 mm, and the linear deceleration force of the impactor is recorded and used to establish the performance of the materials. The HIC is used to predict the risk of brain injury, whereas the developed face surrogate is used to assess facial bone injury. A 5.4 m/s facial impact to the unprotected-face of a cyclist can result in the risk of severe facial bone fracture and mild brain injury. The impact test results for rigid foam protection of 40 mm thickness shows no densification (bottom out) and absorbs the impact energy without damage to the Foam-bone of the face surrogate. At 20 mm thickness, rigid polyurethane foams performed best with Foam-bone damage ranging from 15.1% to 20.5%. Other materials with thicknesses of 20 to 28 mm showed Foam-bone damage between 21.8% and 35.1%. The HIC values ranged from 267 to 522, with memory foams and expanded polystyrene foam having the lowest values. Peak deceleration ranged from 71 g to 105 g for the materials tested. It is concluded that the impact energy can be dissipated by the protection material thereby reducing the risk of severe facial injury to the protected area.

Cricket Related Maxillofacial Fractures

Cricket is a popular sport in New Zealand, enjoyed both at social and competitive level. Although it is a non-contact sport and there is in place good facial protection, injury to the head and neck region is still frequently seen in the emergency department. Data were collected from departmental records between 1996 and 2006. Variables examined included incidence, demographics, site of fracture and treatment method. Of the 561 patients with sports-related maxillofacial fractures during the study period, 40 were cricket-related. Male to female ratio was 36:1. 45% of patients were in the 16-30year age group. 55% of injuries were due to impact from cricket ball. 70% of injuries occurred at midface level, while 30% at the mandible. 38% of patients required surgery and hospitalization. Maxillofacial fracture from cricket playing is a frequent injury in patients presenting with sports-related injuries. Cricket players need to be educated on the safety measures in playing the sport, including facial protection devices.

Human Performance Research in Support of Current Military Operations

Shoot, move, communicate, survive, and adapt are five of the most critical tasks that a Soldier will perform during combat. The extent to which Soldiers are successful at these tasks may ultimately determine not only their survivability, but also that of their unit. This panel, which is comprised of a mixture of human factors/ergonomics practitioners and researchers, discusses topic areas in which human performance issues play a critical role in current military operations. Topics include information overload in the visual channel, facial protection effects on shooting performance, video search techniques for widely defined targets, and the development of video training lanes for improvised explosive device detection. The underlying human performance issues and various approaches which have been taken to address them will be discussed. Understanding and predicting factors that influence human performance in these arenas is not only critical for the design of effective systems and programs of instruction, but also for overall mission effectiveness and Soldier survival. Panelists will discuss critical factors and insights that are generalizable across a wide range of products and industry sectors as well as those that warrant further investigation.

Geologic constraints on the glacial amplification of Phanerozoic climate sensitivity

With research suggesting that one in four doctors believes their personal protective equipment is unsafe, <b>Jane Feinmann</b> reports on a UK collaboration that is developing effective facial protection for clinicians

Mandibular fractures in British military personnel secondary to blast trauma sustained in Iraq and Afghanistan

Blast trauma is the primary cause of maxillofacial injury sustained by British service personnel on deployment, and the mandible is the maxillofacial structure most likely to be injured in combat, but there are few reports about the effect of blast trauma on it. The Joint Theatre Trauma Registry identified all mandibular fractures sustained by British servicemen secondary to blast injury between 1 January 2004 and 30 September 2009. These were matched to corresponding hospital notes from the Royal Centre for Defence Medicine (RCDM) for those evacuated servicemen and autopsy records for those who died of wounds. Seventy-four mandibular fractures were identified in 60 servicemen. Twenty-two soldiers were evacuated to the RCDM and the remaining 38 died from wounds. Fractures of the symphysis (39/106, 37%) and body (31/106, 29%) were more common than those of the angle (26/106, 25%) and condyle (10/106, 9%). This pattern of injury differs from that of civilian blunt trauma where the condyle is the site that is injured most often. Those fractures thought to result from the blast wave itself usually caused simple localised fractures, whereas those fractures thought to result from fragments of the blast caused comminution that affected several areas of the mandible. The pattern of fractures in personnel injured while they were inside a vehicle resembled that traditionally seen in blunt trauma, which supports the requirement for mandatory wearing of seat-belts in the rear of vehicles whenever tactically viable. All mandibular fractures in servicemen injured while in the turret of a vehicle had evidence of foreign bodies or radio-opaque fragments as a result of their exposed position. Many of these injuries could therefore be potentially prevented by the adoption of facial protection.

Changes in the spatial resolution and in the color contrast perception due to interjected face protector screens in the emergency situations in mesopic conditions

Abstract Purpose Assess the changes in the visual capabilities related to protector masks that are mandatory in emergency situations. The study was carried out in mesopic conditions. Methods 36 adults were assessed. Everyone was from both genders, ranging 18 to 49 years old, with an average age of 30 +‐ 8 years old. Face protectors screens have been utilized on Individual Protection Kits for emergency situations. Every measure was conducted by the same examiner and into the same laboratory in mesopic conditions. Visual Acuity was evaluated by means of the Sloan´s test at 100% and 5% of contrast in logarithmic units, the Contrast Sensitivity with the CSV100 test and the colour perception with Ishihara´s test (each test was accomplished by the manufacturer´s recommendations). Results The capacity for distinguishing details in the assessment carried out without a protector screen was of ‐0,05+‐0,05 logMAR, and with a protector screen was of 0,00+‐0,11 logMAR; being the difference statistically significant. Constrast Sensitivity values are lower when a protector filter is interjected, with p‐valor=0,013. Regarding colour perception, significative differences were detected after protector screen application and withdrawal. Conclusion In mesopic conditions, spatial resolution, contrast sensitivity and colour perception are significantly more decreased due to face protector screens needed for emergency situations.

A review of the prevention of head, neck and facial injuries in ice hockey

Ice hockey is one of the fastest and most physical team sports. With projectiles (pucks) travelling at over 100mph and players travelling at up to 30mph wielding sticks and skating on razor sharp blades, there is potential for significant injury. In 1961, an insurance survey reported over 100 closed head injuries, with one death. This led to research into helmets and subsequent mandatory use. Facial protection was first developed in 1972 initially for goalkeepers. By 1976 all amateur players were required to wear full facial protection.