Facial Trauma Patients Research Articles

Premorbid Incidence of Mental Health and Substance Abuse Disorders in Facial Trauma Patients.

A retrospective study. Facial trauma is a prevalent cause of morbidity and mortality with increasing incidence over recent decades. Few studies have examined the prevalence of mental health and substance abuse disorders at the time of diagnosis. Herein we investigate the psychosocial demographics associated with facial trauma. The 2016 State Inpatient Database (SID) was used to identify patients with facial trauma from all hospitals in New York, Florida, and Maryland. A non-trauma control group undergoing elective same-day surgeries at ambulatory surgical centers in Florida, Kentucky, Nevada, North Carolina, New York, and Maryland was identified using the State Ambulatory Surgery and Services Database (SASD) from the Healthcare Cost and Utilization Project (HCUP). 777 patients were identified with facial trauma and compared to 500 patients without facial fractures. Patients with facial fractures were statistically significantly more likely to have a substance abuse disorder (OR 34.78, P < .001) or mental health disorder (OR 2.75, P < .001) compared to controls. Patients with facial fractures were significantly more likely to be black than white (OR 4.80, P < .001). Patients with facial fractures were significantly more likely to have Medicaid compared to Medicare (OR 2.12, P = .005). Patients with facial fractures are more likely to have premorbid substance abuse and mental health disorders as compared to controls.

The Impact of Socioeconomic Status on Pediatric Facial Trauma.

Retrospective chart review. Socioeconomic status (SES) greatly impacts one's health status and the type of trauma that a patient experiences due to increased risk of exposure and varying availability of resources to treat emergent conditions. There is a need for large-scale databases of pediatric facial trauma to identify discrepancies in occurrence and identify risk factors. This retrospective examination uses a multi-center database to evaluate pediatric facial trauma patients (n = 644) visiting Atrium Heath Wake Forest Baptist (AHWFB) hospital from 2020 to 2022. Data collected included demographic information, past medical and surgical history, trauma history, interventions, and long-term outcomes such as scarring, deformities, and sensory or motor deficits. The number of incidents for each zip code surrounding AHWFB was compared with SES data including unemployment rate, mean household income, and poverty level. Thirty-five percent of patients sustained a high-energy injury, and 65% sustained a low-energy injury. Within the surrounding counties of AHWFB, there were more incidents of pediatric facial trauma in areas with greater rates of poverty (P = 0.006). Additionally, there were more incidents due to high-energy injuries in areas with lower income (P = 0.044) and more poverty (P = 0.002). Specifically, motor vehicle accidents were more common in areas with lower income (P = 0.017) and more poverty (P = 0.001). These findings in the central Piedmont region of North Carolina are consistent with previous research of SES's effect on health inequalities and serve as evidence of the need to take steps to prevent pediatric facial trauma in areas of low SES.

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

Retrospective chart review. 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. 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. 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). 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.

Illicit cocaine and opioid drug-related maxillofacial trauma: a 10-year review of a state-wide database of all hospitals admissions

The aim of this study was to investigate the characteristics of illicit cocaine and opioid drug-related facial trauma and determine whether the presence of cocaine or opioid drug use in facial trauma patients influenced the cause of injury, morbidity, or management. A retrospective observational cohort study was performed using records from a state-wide database of all patients who presented to a Victorian hospital with a facial fracture between 2004 and 2014. Data collected included demographics, concomitant opioid and cocaine use, mechanism of injury, facial injuries, and management. Statistical analysis was done using chi-square test, Student's t tests, binary logistic regression analysis, and multivariable linear regression analysis. Results were considered statistically significant if P < .05. A total of 54,613 patient presentations for facial trauma were analyzed with 363 patients in the cocaine and opioid-related group, and 54,250 patients in the nondrug-related group. Patients with illicit drug use were more likely to have facial fractures caused by interpersonal violence when compared with nondrug users (47.9% vs 23.5%, OR = 2.23, P < .001). Opioid and cocaine users had 0.3 more total fractures per presentation, which included more midface and skull fractures, and more facial lacerations (P < .001). There was no statistically significant difference in the need for surgical management between the two groups. Opioid and cocaine affected patients also on average had a longer hospital stay of 3.4 days and required 0.9 more allied health inputs during their admission when compared with nondrug users (P < .05). This effect was similarly reflected when controlling for confounding variables (P < .001). Concomitant cocaine or opioid use in facial trauma patients leads to more violence-related injuries with higher morbidity and healthcare costs.

Risk Factors for Missed Follow-up Appointments among Facial Trauma Patients.

A retrospective case-control study was performed to characterize the rate of missed follow-up appointments after facial trauma and identify associated risk factors.Follow-up appointments for facial trauma over a 3-month period at a single, safety net hospital were analyzed. Appointment-specific, sociodemographic, trauma, and management data were compared between cases (missed appointments) and controls (attended appointments). Univariate testing and multivariable logistic regression were employed.A total of 116 cases and 259 controls were identified, yielding a missed appointment rate of 30.9% (116/375). Missed appointments were significantly associated with initial clinic appointments compared to return visits (odds ratio [OR] 2.21 [1.38-3.54]), afternoon visits compared to morning (OR 3.14 [1.94-5.07]), lack of private health insurance (OR 2.91 [1.68-5.18]), and presence of midface fractures (OR 2.04 [1.28-3.27]). Missed appointments were negatively associated with mandible fractures (OR 0.56 [0.35-0.89]), surgical management (OR 0.48 [0.30-0.77]), and the presence of nonremovable hardware (OR 0.39 [0.23-0.64]). Upon multivariable logistic regression, missed appointments remained independently associated with afternoon visits (adjusted OR [aOR] 1.95 [1.12-3.4]), lack of private health insurance (aOR 2.73 [1.55-4.8]), and midface fractures (aOR 2.09 [1.21-3.59]).Nearly one-third of facial trauma patients missed follow-up appointments, with the greatest risk among those with afternoon appointments, lacking private health insurance, and with midface fractures.

Evaluating Facial Trauma in the Amish: A Study of a Unique Patient Population.

Retrospective Chart Review. The lifestyle of the Amish exposes them to unique mechanisms of injury, making them an important patient population from a facial trauma standpoint. This study analyzes the demographic and clinical risk factors of facial trauma in the Amish. This retrospective chart review identified all Amish patients presenting with facial trauma at a single institution between 2013-2023. There were 87 Amish facial trauma patients. The median age was 9 years old, and 67.8% were male. Most injuries occurred on the road (41.4%), farm (28.7%), or at home (25.3%). The most frequent mechanisms were buggies (27.6%), falls (26.4%), and animals (18.4%). Fifty-eight patients sustained facial fractures, with orbital (n = 40), maxillary (n = 25), and nasal (n = 19) fractures being the most prevalent. The most common cause of facial fractures was buggy injuries (n = 17). Facial reconstruction was performed in 54.2% of buggy injuries, 31.3% of animal injuries, and 8.7% of falls. Patients with buggy injuries presented with the lowest Glasgow Coma Scale (GCS) scores (median 13.5) and had the longest inpatient hospital stay (median 3 days). Increased injury prevention efforts, especially towards buggy injuries, are necessary.

Enophthalmos: Historical Perspective on Definitions, Measurement Devices, and Clinical Significance.

Assessing enophthalmos is critical in facial trauma patients, and there are many ways to do so. We have reviewed the various devices for measuring enophthalmos over the last 155 years. Knowing the benefits and drawbacks of each instrument is important in obtaining accurate results and interpreting them. We have reviewed the evolution of enophthalmos definitions and surgical indications. Although 2mm of enophthalmos is commonly used as a cutoff for clinical significance, one should take into account individual patient factors, measurement techniques used, symptoms and/or the patient's aesthetic concerns. The decision to operate must also be balanced with the risks of surgery, which may cause or worsen symptoms, such as diplopia, soft tissue deformities related to the surgical approach, and possibly blindness. We question whether enophthalmos greater than 2mm should be considered the main criteria for corrective surgery.

Assessment of quality of life in patients with surgically treated maxillofacial fractures.

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

Age Effects in Facial Fracture Trauma: Disparities in Multisystem Injuries in Non-Fall-Related Trauma.

Background and objective Facial fractures represent a growing concern among an aging population prone to falls. In light of this, this study aimed to investigate differential facial fracture patterns and outcomes based on age effects. Determining the differences between the severity and type of facial fractures in populations of different ages will help guide clinical decision-making when managing patients with facial fractures. Methods This was a single-center study involving trauma registry data, from July 1, 2016, to January 31, 2022. The inclusion criteria were based on theInternational Classification of Diseases (ICD-10) diagnosis of facial fracture. A linear regression was performed to ascertain the effects of predictor variables on the likelihood that a facial fracture trauma patient would experience various age effects on injury location, mortality, and morbidity. Results A total of 1575 patients were included in the analysis. A significant regression equation was found (F(47,1476)=42.46,p<0.01), with anR2of 0.57. Older facial fracture trauma patients were more likely to be female (β=3.13, p<0.01)with fractures to their zygoma (β=2.57, p=0.02). Higher Abbreviated Injury Scale (AIS) facial region scores (β=2.21, p=0.03), longer hospital length of stay (β=0.07, p=0.02), and in-hospital mortality (β=10.47, p<0.01) were also associated with older age. Older age was additionally associated with a higher level of several morbidity markers. Younger facial fracture trauma patients were more likely to be African American (β=-5.46, p<0.01) or other, non-Caucasian race (β=-8.66, p<0.01) and to have mandible fracture patterns (β=-3.63, p<0.01). The younger patients were more likely to be fully activated (β=-3.10, p<0.01) with a higher shock index ratio (SIR) (β=-7.36, p<0.01). Injury mechanisms in younger facial fracture patients were more likely to be assault (β=-12.43, p<0.01), four-wheeler/ATV accident (β=-24.80, p<0.01), gunshot (β=-15.18, p<0.01), moped accident (β=-13.50, p<0.01), motorcycleaccident (β=-12.31, p<0.01), motor vehicleaccident (β=-16.52, p<.01), or pedestrian being struck by a motor vehicle (β=-10.69, p=0.02). Conclusions Based on our findings, age effects impact facial fracture patterns and outcomes. Younger patients are more likely to experience multisystem injuries via non-fall trauma. On the other hand, older patients are more likely to experience more severe primary facial injuries. Older patients are also at a higher risk of fall-related trauma. Disparities also exist between genders and races, with male and non-Caucasianpatients being at a higher risk of injury from facial fractures at a younger age. With an aging population, the prevalence of falls is likely to increase. Thus, facial fractures represent a growing healthcare burden and warrant future investments related to care and treatment.

Application possibilities of artificial intelligence in facial vascularized composite allotransplantation-a narrative review.

Facial vascularized composite allotransplantation (FVCA) is an emerging field of reconstructive surgery that represents a dogmatic shift in the surgical treatment of patients with severe facial disfigurements. While conventional reconstructive strategies were previously considered the goldstandard for patients with devastating facial trauma, FVCA has demonstrated promising short- and long-term outcomes. Yet, there remain several obstacles that complicate the integration of FVCA procedures into the standard workflow for facial trauma patients. Artificial intelligence (AI) has been shown to provide targeted and resource-effective solutions for persisting clinical challenges in various specialties. However, there is a paucity of studies elucidating the combination of FVCA and AI to overcome such hurdles. Here, we delineate the application possibilities of AI in the field of FVCA and discuss the use of AI technology for FVCA outcome simulation, diagnosis and prediction of rejection episodes, and malignancy screening. This line of research may serve as a fundament for future studies linking these two revolutionary biotechnologies.

Bony Facial Trauma Score Predicts Clinical Outcomes in Facial Trauma.

Background: The bony facial trauma score (BFTS) is a rubric used to assess the severity of facial trauma. Objectives: To compare the BFTS with relevant clinical outcomes while controlling for medical comorbidities and polytrauma. Methods: A retrospective review of facial trauma patients evaluated between 2017 and 2022 was conducted. While controlling for medical comorbidities and polytrauma, multivariate regression models were used to assess the relationship between BFTS and outcome variables such as length of stay (LOS) and malocclusion. Results: In total, 176 patients were included in the analysis. The average age was 36.5 years (standard deviation [SD] of 16.8), and 68.8% were male. The most common mechanism of injury was blunt force (92.6%) and the mean BFTS was 10.73 (SD of 11.05). BFTS was found to correlate with the following (p < 0.05): total LOS and ICU LOS, malocclusion, likelihood of requiring multiple surgeries, and diplopia. Conclusion: The BFTS is significantly correlated with multiple outcome variables while controlling for medical comorbidities and polytrauma.

Concussion in facial trauma patients: a retrospective analysis of 100 patients from a UK major trauma centre

Concussion is a common and potentially debilitating condition. Research has shown that one-third of patients admitted with facial trauma have concurrent concussion. This study aimed to investigate the burden and management of concussion in patients presenting with acute facial trauma, and to identify potential risk factors within this population. A retrospective observational study was conducted at a UK major trauma centre between 1 January 2019 and 1 February2020. One hundred randomly selected patients who attended the acute clinic responsible for managing facial trauma were identified. No parametric data were included. The Mann-Whitney test was used to detect differences for continuous data, the X2 test for categorical data. Clinical significance was defined as p < 0.05. Forty of 100 patients (40%) had evidence of concussion, of which only 4/40 (10%) had evidence that head injury advice had been given. There was no statistically significant difference between the non-concussed and concussed groups for age (p = 0.145), gender (p = 0.921), mechanism of injury (p = 0.158), or location of facial injury (p = 0.451). Clinical features of concussion were found in 40% of patients suffering from facial injury. Despite this, we found that head injury advice was rarely given. In addition, we identified no risk factors for concussion within this population, highlighting the need to screen all patients who present with facial injury. To improve the identification and management of concussion in these patients, future work should focus on the development of simple screening tools for use in clinic, and the signposting of patients to existing written and online concussion resources.

Assessment of quality of life in patients with surgically treated maxillofacial fractures

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the ‘Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty–point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p&lt; 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p&lt;0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

Mandible fracture patterns in an urban level 1 trauma center: Older, more female, lower kinetic energy

ObjectiveThe objective of this study was to complete a comprehensive retrospective chart review of the mandible fracture patterns amongst trauma patients in an urban level 1 trauma hospital. The authors propose that an urban environment influences these patterns. MethodsWe reviewed 1914 patient charts treated for 3946 facial fractures between 2008 and 2017. Those with mandibular fractures were studied in detail by collecting demographics, injury mechanism, location of injury, and treatment information. Wilcoxon-rank sum tests were used for comparing groups with continuous outcomes while Chi-square/Fisher’s exact test was used for comparing groups with categorical outcomes of interest. Results19.9% (382) of the 1914 patients who suffered facial trauma in this study suffered a mandible fracture. 382 (20%) of these patients suffered at least one mandible fracture, and of these 163 suffered fratures at multiple sites, totaling 577 fractures overall. 69% of the mandible fractures occurred in men and 31% in women. The median age of patients who sustained a mandible fracture was 33. The median age among males was 29, and females, 54. The most common site of mandible fracture was the ramus/angle of the mandible (30.3%). The most common mechanism of injury was a result of activities of daily living, such as falls. 73.9% (176) of all mandible fractures were treated with a combination of open reduction internal fixation and closed reduction maxillomandibular fixation. ConclusionIn an urban population, significant mandibular fractures may occur more frequently after non-classic low kinetic energy events, such as falls. Compared to other studies, our study more frequently included older, female patients, which may be reflective of urban demographics. It is important to maintain a high degree of suspicion for mandibular injuries in all urban facial trauma patients, regardless of mechanism.

Mandibular fractures at a tertiary health care facility: a pilot study

Background: Facial trauma patients were analyzed to determine the incidence, type, presentation, management, and outcome of fractures of the mandible. Methods: The 61 patients admitted in the trauma units of Dayanand medical college Ludhiana were analyzed prospectively during a period of two years (January 2010-December 2012). Results: In patients with multiple fractures, the common combination included zygoma and mandible (35.2%) and Le Fort II, mandible and nasoethmoid (41.2%). Out of 35 patients with mandible fractures, 8 had bilateral and 27 had single fractures making a total of 43 fractures. The body of mandible. 46.5% followed by the angle 34.8%, symphysis 9.3%, and parasymphysis 4.6% ramus and condoyle in 2.3% each were seen. Of the single mandibular fractures, the body and angle were almost equally affected in 48% and 44% cases, respectively. Isolated fracture of symphysis and parasymphysis was seen in 3.7% cases each. Isolated fracture of the ramus or condyle was not seen in any case. Half of the angle fractures were treated by wiring while shown in 1/4th each, plating and external fixation was used for treatment. Almost half (6/13) of fractures of the body were treated with external fixation. All bilateral fractures were treated with bone plating. Conclusions: Road traffic accidents are the major cause of these fractures. Mandibular fractures are commonly associated with fractures of other facial bones. The fracture line commonly seen is in the body of mandible, followed by the angle.

Psychosocial Burden of Pediatric and Adult Patients With Congenital Versus Traumatic Facial Differences: Assessment of Psychiatric Distress and Healthcare Utilization in the United States From 2004 to 2012.

Psychiatric distress and its effects on healthcare utilization in pediatric patients with congenital and traumatic facial differences remain poorly understood. This study analyzes the psychosocial burden along with mental health and reconstructive surgery services utilization of this patient population in comparison with adult patients with such facial differences. The 2004-2012 Medical Expenditures Panel Survey was queried for all patients with facial differences. Socioeconomic variables, Patient Health Questionnaire 2 and Kessler 6 scores, responses from validated screening surveys, and utilization of mental health and reconstructive surgery (ie, plastic surgery and otolaryngology) services were compared between pediatric and adult patients with congenital and traumatic facial differences. Children ages 5 to 12 years were more likely to be affected by facial trauma, whereas adolescents aged 13 to 17 years were more affected by congenital facial conditions. Pediatric patients with congenital facial conditions had higher rates of medical care, education, and special therapy utilization ( P < 0.0001), although their facial trauma counterparts used mental health services more often ( P < 0.0001). In adults, more facial trauma patients reported poorer perceived mental health status ( P = 0.01). Among patients with any facial difference, distressed adult patients were less likely to see a reconstructive surgeon even when controlling for socioeconomic variables (0.55 [0.31-0.97], P = 0.04). In the pediatric population, psychosocial considerations should include both age and etiology of facial differences to best optimize care. Among adults with facial trauma, poor mental health may contribute to lower rates of surgical follow-up, highlighting a potential benefit for provision of mental health services earlier for these patient populations.

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.

Application of Orthognathic Surgery Principles and Techniques in the Management of Craniomaxillofacial Trauma.

Posttraumatic secondary deformities of facial skeleton may occur because of nonmanagement or ill management of primary injuries, whereas some unexpectedly occur even after dedicated management attempts. Orthognathic surgery (OGS) principles and techniques can be used as an efficient tool to correct posttraumatic craniomaxillofacial deformities or skeletal developmental deformities during trauma management. The aims of this study were to describe the different types of posttraumatic secondary deformity and address how to use the principles of orthognathic techniques to correct them. Patients with orthognathic surgical osteotomies during primary or secondary management of facial trauma (referred to as trauma-OGS) during the period of 2010 to 2018 were retrospectively reviewed. Variables pertaining to patients and surgery were collected, including trauma diagnosis, etiology, duration between trauma/primary surgery and secondary presentation, suggested reason for secondary deformity, intervention undertaken to address, and the surgical outcome. Twenty-seven patients were eligible and extensively reviewed. Etiological categorization of trauma-OGS could be done into posttraumatic deformities (18) and developmental deformities (9). The former group was further categorized as OGS done as primary procedure (8) that included immobile Le Fort fractures and delayed initial treatment, and OGS done as secondary procedure (10) that included complex fractures and condylar fractures. The developmental deformity group was categorized into OGS done simultaneously during trauma management (5) or done as a secondary procedure after trauma management (4). Application of principles and techniques of OGS in indicated primary or secondary management of facial trauma patients should always be considered. The categorization of scenarios presented in this article relating facial trauma and OGS may further help to understand the application.

A national survey of oral maxillofacial surgeons' and trainees' awareness and practice regarding psychological problems associated with facial trauma.

The psychological problems associated with facial trauma may sometimes pose additional health concerns for the injured patient. Understanding the gaps in the Oral and Maxillofacial surgeons' (OMFS) awareness of patient in need of specialist mental health intervention is important in ensuring holistic care for the trauma patient. To determine the knowledge, practices and self-assessed level of competence of Nigerian Oral maxillofacial surgeons/trainees regarding psychological problems associated with facial trauma and to determine their perceived need for training in assessment of psychological consequences following facial trauma. A cross-sectional study was conducted in which a web-based structured questionnaire was sent to Oral and maxillofacial surgeons and trainees. Majority of respondents (85.2%) had encountered psychological problems in patients who have sustained facial trauma. Half (50.6%) of OMFS / trainees had high level of knowledge regarding psychological problems associated with facial trauma; depression, anxiety, post-traumatic stress disorder, body image disorder and acute stress syndrome were the five most common trauma related psychological problems mentioned. More respondents reported low level of competence in conducting mental state examination when compared to other skill sets. In-unit counselling was reported as the method of intervention by majority (69.1 %), followed by referral to the mental health specialists (17.3%). More than one third (40.7%) of OMFS were extremely interested in undergoing additional training in the psychological assessment of patients who have sustained facial trauma. Nigerian Oral and maxillofacial surgeons frequently encounter psychological problems in patients with traumatic facial injuries. Notwithstanding their perceived self-assessed low level of competence in psychological assessment of trauma patients, objective assessment revealed a relatively high level of knowledge of psychological problems that can affect the facial trauma patient with many indicating a high perceived need for additional training in the psychological assessment of facial trauma patient. There is a need for incorporating psychological assessment into the management to ensure holistic care of trauma patients.

When to Perform Maxillofacial Computed Tomography: Evaluation of over 9,000 Facial Trauma Patients

When to Perform Maxillofacial Computed Tomography: Evaluation of over 9,000 Facial Trauma Patients