Interfacility transfers for facial trauma are common but often avoidable. However, the magnitude of these potentially avoidable interfacility transfers (PAITs), which can strain trauma systems and incur avoidable costs to the patients, remains unknown. This study aimed to quantify the burden of PAITs for isolated facial trauma in the US. A retrospective analysis using the 2022 Nationwide Emergency Department Sample was performed. Patients aged 16 years and older with isolated facial injuries were identified using ICD-10-CM codes and the Abbreviated Injury Scale. A multiple logistic regression model was developed from level I trauma center (TC) data to predict emergency department home discharge, internally validated, and applied to transfers from level III or non-TCs to identify PAITs based on high predicted discharge probabilities. Among 856,197 patients with isolated facial trauma, 661,149 were initially treated at level III or non-TCs, of whom 2.4% were transferred to higher-level facilities. Using a Youden Index-derived predicted home discharge probability of greater than or equal to 0.946, 43.2% (95% CI 40.9% to 45.4%) of these transfers were classified as potentially avoidable. These transfers were more common among younger, male individuals, White race, those with private insurance, urban residence and those injured by being struck, treated in Southern hospitals, or private not-for-profit facilities. A substantial proportion of interfacility transfers for isolated facial trauma may be avoidable when benchmarked against discharge practices at level I TCs. These findings highlight a critical opportunity to optimize secondary triage decision-making, possibly in conjunction with telehealth consultations, before patient transfer.

Outpatient follow-up after operative facial trauma is critical; however, non-compliance remains a pervasive issue. This study aims to identify factors associated with missed initial postoperative appointment. This single-institution retrospective case-control study included patients who underwent operative facial trauma intervention by an otolaryngology provider at tertiary urban hospitals between January 2020 and April 2025. Sociodemographic, clinical, and operative data were collected. Statistical analysis was performed using STATA, with significance set at p < 0.05. Of 196 patients, 30 (15.3%) missed their initial post-operative appointment. Patients were less likely to attend their appointment if they self-identified as African American (odds ratio [OR]: 0.245 (0.095, 0.64), p = 0.0024), lacked private insurance (OR: 0.20 (0.072, 0.56), p = 0.009), had a higher Area Deprivation Index (national: 80.82 ± 19.10 vs. 65.05 ± 23.79, p = 0.0011; state: 7.89 ± 2.41 vs. 5.99 ± 2.78, p = 0.008), underwent surgery on an inpatient basis (OR: 0.24 (0.11, 0.56), p = 0.0003), presented with isolated midface trauma (OR: 0.30 (0.11, 0.83, p = 0.015), or were discharged to a location other than home (OR: 0.30 (0.11, 0.82), p = 0.0098). Isolated nasal trauma (OR: 3.10 (1.31, 7.37), p = 0.0079) and having a follow-up appointment scheduled at discharge (OR: 3.61 (1.62, 8.06), p = 0.0011) were protective. After multivariate analysis, missed appointments remained independently associated with isolated midface trauma (adjusted odds ratio [aOR]: 0.17 (0.036, 0.80), p = 0.025), race (aOR: 0.24 (0.063, 0.94), p = 0.041), and follow-up scheduled at discharge (aOR: 5.27 (1.65, 18.14), p = 0.005). Missed follow-up after operative facial trauma is associated with multiple sociodemographic and clinical factors. Scheduling postoperative appointments before discharge may increase the odds of outpatient follow-up.

The infraorbital nerve (ION), a branch of the maxillary division of the trigeminal nerve, provides sensory innervation to the midface via its terminal divisions. Among these, the superior labial branch (SLb) supplies the upper lip and adjacent mucosa, regions frequently involved in oral, maxillofacial, and cosmetic procedures. Despite its clinical importance, the anatomy of the SLb has received relatively limited attention compared with other ION branches. This review synthesizes current evidence on the SLb's course, branching patterns, innervation, morphometry, and variations, with emphasis on its relevance to surgical practice. Anatomical studies demonstrate that the SLb is the largest terminal division of the ION, often exhibiting medial and lateral subdivisions that anastomose with neighboring nerves. Its distribution predominantly follows a vertical orientation, supplying both cutaneous and mucosal structures of the upper lip. Variability in origin, branching, and accessory foramina underscores the need for careful surgical planning. Injury to the SLb is a recognized complication of Le Fort I osteotomy, midfacial trauma, and periapical procedures, potentially leading to long-term sensory disturbances. A comprehensive understanding of the SLb enhances intraoperative nerve preservation and may reduce postoperative morbidity, highlighting its significance for clinicians operating in the midfacial region.

Objective To explore the clinical efficacy and safety of dexmedetomidine hydrochloride for preoperative sedation in children undergoing emergency facial trauma cosmetic suturing. Methods A total of 200 children with facial trauma admitted to the Emergency Surgery Department of our hospital from January to June 2025 were retrospectively enrolled and assigned to two groups for different sedation interventions. The study group received preoperative intranasal dexmedetomidine hydrochloride spray, while the control group received routine comfort care. The UMSS Sedation Scale was used to assess sedation level objectively, and rescue dosing protocols were implemented for sedation failure. Statistical analyses were performed using SPSS 30.0 software, with a two-tailed P -value ≤ 0.05 and 95% confidence intervals (CIs) considered statistically significant. Results A total of 100 cases were included in both the study group and the control group, with no baseline differences between the two groups ( P &amp;gt; 0.05). The sedation failure rate in the study group was 8.0% (8/100), and all 8 cases achieved effective sedation after rescue dosing with one additional spray (15 μ g for 10.7–19.4 kg, 25 μg for 19.4–28.0 kg) intranasal dexmedetomidine hydrochloride; no sedation failure was observed in the control group. No serious adverse reactions were observed in either group. Preoperative and intraoperative cooperation in the study group was significantly better than that in the control group, and the incidence of agitation was significantly lower ( P &amp;lt; 0.01), 95%CI: 0.0–0.2. No serious adverse reactions were observed in either group. Preoperative heart rate, respiratory rate, oxygen saturation, and mean arterial pressure were comparable between the two groups ( P &amp;gt; 0.05). Intraoperatively, the study group maintained more stable vital signs, with significantly lower heart rate and mean arterial pressure than the control group ( P &amp;lt; 0.05), 95%CI for heart rate: 8.2–15.7; 95%CI for mean arterial pressure: 5.1–10.3, all within normal physiological ranges. Conclusion Preoperative intranasal dexmedetomidine hydrochloride is an effective and safe regimen for improving intraoperative cooperation, stabilizing vital signs, reducing agitation, and enhancing cosmetic suture quality and family satisfaction in children with emergency facial trauma.

The Bony Facial Trauma Score (BFTS) was developed to standardize the extent of injury in facial trauma and improve communication between health care providers. To determine if BFTS scores in patients with facial trauma are correlated with the hospital's cost of treating the patient. A retrospective chart review of 1,086 patients with facial fractures from 2010 to 2021 was performed. Patient information, BFTS score, length of stay (LOS), and hospital charges were collected. Spearman's correlations and multivariable regression analysis measured the association between cost and BFTS score. The average cost of management was $13,939.04 (SD: 27,573.17) per patient and the average LOS was 4.96 (SD: 9.86) days. The average BFTS score was 5.49 (SD: 4.25). BFTS had a moderately positive correlation with total cost (r = 0.40, p < 0.001), with each additional point predicting an increase of $1,309 in cost (p = 0.017). The BFTS also had a weakly positive correlation with LOS (r = 0.29, p < 0.001). Patients managed surgically were found to have higher BFTS scores than those managed conservatively (7.0 vs. 4.3, p < 0.001). BFTS correlates with hospital cost, LOS, and need for surgery, supporting its role as a standardized tool to quantify facial trauma severity and anticipate cost and resource utilization in clinical care.

Secondary Overtriage for Isolated Facial Trauma: Current Landscape and Potential Solutions

Between 2021 and 2022, over 6.7 million CT scans were performed in England, most of which contained the orbit within the imaging (1). Emergency CT head and facial trauma radiographs are among the most frequently requested studies in acute medicine, often ordered to exclude intracranial haemorrhage or infarction. In these scans, the orbit is often also imaged but remains a bystander as the focus lies on the intracerebral contents. The orbital contents are consistently included and just as consistently underexamined.

Relevance. Timely provision of necessary emergency care prevents deterioration of visual functions, affects the treatment and rehabilitation of the patient, the duration of temporary loss of ability to work, reduces disability and blindness, and reduces the costs of treatment and prevention of complications for both the patient and the state. Purpose of the study. Assessment of the organization of medical care for the adult population with eye injuries at the prehospital stage of medical care. Material and methods. We used data extracted from 1,654 medical records, of which 1,280 patients underwent inpatient treatment in the maxillofacial surgery department of the Tashkent State Dental Institute with midface injuries from 2010 to 2019. Results and conclusion. Victims received virtually no assistance before the arrival of emergency medical services. The main reasons cited for the population’s reluctance to provide first aid were a lack of knowledge and skills (81.2%), fear of harming the victim (66.7%), and fear of legal liability (62.7%).

Social determinants of health are acknowledged as significant factors affecting trauma occurrence, severity, and outcomes. The area deprivation index (ADI) is a validated tool that combines social determinants into a single measure of "neighborhood disadvantage." We aimed to investigate whether ADI was linked to injury severity and other clinical benchmarks in orbital floor fracture patients. Patients presenting to a single Level 1 Emergency Department with acute orbital floor fracture were reviewed. Data on additional trauma, length of stay (LOS), and follow-up attendance were collected. Patients were classified into a stable, urgent, or critical condition based on initial clinical presentation. Neighborhood socioeconomic disadvantage was evaluated using national percentile and state decile ADI. Analyses were conducted using chi-squared tests, Mann-Whitney U, Spearman rank correlations, and Kruskal-Wallis tests. A total of 1255 patients with acute orbital floor fractures were analyzed. ADI was significantly higher in patients with additional facial trauma (national ADI: 55 vs. 51, p = 0.0240; state ADI: 7 vs. 6, p = 0.0119). However, ADI was not significantly associated with the incidence of bodily polytrauma, initial clinical acuity, or LOS. Follow-up attendance rates did not differ by ADI. Social disadvantage was significantly associated with differences in injury characteristics and indirectly with care utilization among orbital floor fracture patients. This may reflect different mechanisms of injury in high ADI areas and indicate that ADI may be useful as a contextual marker of injury severity. Future studies should investigate these mechanisms and other risk factors unique to high ADI areas.

There are currently no validated patient-reported outcome measures (PROMs) to specifically evaluate quality-of-life outcomes for patients who have suffered bony facial trauma. Our goals are the following: (1) Investigate functional and psychosocial concerns that are self-identified as important among patients following bony facial trauma. (2) Formalize these factors into an appropriate patient-reported outcome measurement tool that can be utilized clinically. We performed semi-structured interviews with 10 providers at the University of Virginia and other academic institutions who are experts in the field of facial trauma. Providers were asked about functional and psychosocial concerns that patients with bony facial trauma may experience. Responses were then used to create a preliminary PROM instrument, which was programmed for self-administration through the Qualtrics online survey platform. Subsequent semi-structured interviews with 15 patients affected by bony facial trauma were conducted during the cognitive debriefing portion. Patients completed the questionnaire and their responses provided focus to the finalized PROM survey. The final PROM instrument included functional concerns such as nasal obstruction, persistent facial numbness, vision issues, and limited jaw mobility. Psychosocial concerns included difficulty completing personal tasks, feeling depressed or anxious, and not wanting to spend time with family or friends. Using a standardized approach, we developed a patient-reported outcome measure specific to bony facial trauma patients by performing semi-structured interviews with content experts as well as cognitive debriefing interviews with patients. The final PROM included functional and psychosocial concerns relevant to the bony facial trauma population, such as vision issues and difficulty completing personal tasks. Future directions of the study will include a multi-institution validation phase with a larger volume of patients. 4.

Solving a cold case through scientific evidence.

Revision Surgery for Occlusal Correction in Facial Trauma

To assess dental residents' self-perceived preparedness to provide dental care and their experiences delivering care in rural communities in South Texas. This cross-sectional study evaluates advanced education in general dentistry (AEGD, n = 19) and pediatric dentistry (PD, n = 20) residents' preparation for rural dentists and experiences providing dental care in rural South Texas. Residents participated in a rural dental practice management workshop, followed by clinical rotations at rural community health centers (CHCs) in South Texas. At the conclusion of each CHC rotation, residents completed a Resident's Online Activity Report (ROAR) reflecting on their preparation for rural dental practice, ability to manage patients with complex healthcare needs, and understanding of perceived barriers to care and access issues in rural communities. Descriptive analyses were conducted to summarize residents' patient encounters, preparation to treat patients with complex healthcare needs, and evaluation of rural clinical rotation experience. Open-ended responses were summarized narratively. Primary care dentistry residents participated in 78 rural rotations and completed 74 ROARs (94.9% rate). AEGD residents self-reported (rating system: 1 = no preparation, 4 = excellent preparation) that they were best prepared to treat dental pain (3.54) and manage patients with tobacco use (3.17), while PD residents cited being well prepared to manage early childhood caries (3.76) and dental and facial trauma (3.68). Overall, PD residents (4.19) had a higher mean rating for clinical rotations at rural CHCs than AEGD (4.01). Residents indicated that the most useful parts of the rotations were the formulation of treatment plans guided by specialist faculty, using available resources to provide dental care, and understanding challenges to receiving dental care in rural areas. Didactic education in rural dental practice combined with clinical rotations at rural CHCs across South Texas, improved primary care dentistry residents' understanding of challenges faced by rural populations and enhanced their clinical and patient management skills, better preparing them to care for populations with high burden of oral disease and complex healthcare needs.

Analyze demographic and clinical factors for patients presenting with dog bites to the face, head, or neck. Retrospective cohort. Single tertiary care, level 1 trauma center. A retrospective chart review identified patients presenting for facial dog bite injuries from 2012 to 2023. There were 906 patients with facial dog bites and 2061 injuries. Patients ranged from 0 to 91 years old with a median of 7 years, and 50.6% were female. The 2 most common causes for injury were playing with the dog (32.0%) or an unprovoked attack (17.3%). Family dogs were responsible for 61.3% of injuries. Pitbulls (22.4%), Labradors (10.5%), and German Shepherds (7.0%) were the most identified breeds. The cheeks (25.9%), lips (20.8%), and nose (9.0%) were most injured. Hospital admission was required in 17.0% of patients. Regarding management, 16.9% required operative repair, 65.9% were repaired at bedside, and 17.9% were managed conservatively. There were 878 patients prescribed intravenous or oral antibiotics (96.9%) with amoxicillin-clavulanate most frequently prescribed (62.7%). Of the 138 patients bit by dogs with outdated or unknown rabies vaccination status, 35.5% (n = 49) received a rabies vaccination, and 34.8% (n = 48) received rabies immunoglobulins. Of the 254 patients not current on tetanus vaccination, 78.7% (n = 200) received a booster. Dog bites to the head and neck are common injuries, with many patients requiring hospital admission and/or repair. Understanding the demographics of these injuries is important to identify physical and socioeconomic burdens of disease, gaps in adherence to protocols/guidelines, and areas of targeted education/preventative interventions.

Maxillofacial trauma occurring shortly after orthognathic surgery has been rarely reported. The authors present a 21-year-old man with mandibular prognathism who underwent Le Fort I osteotomy combined with bilateral sagittal split ramus osteotomy (BSSO). The mandible was stabilized with two 2-hole titanium miniplates placed along the superior border on each side. Eight weeks postoperatively, he sustained high-energy facial trauma in a motorcycle accident, resulting in fractures of the mandibular symphysis, bilateral condyles, and maxilla, but notably no fractures at the osteotomy sites. Open reduction and internal fixation were performed, and his postoperative course was uneventful, with stable occlusion achieved at 6-month follow-up. This case demonstrates that appropriately designed rigid fixation can prevent refracture at osteotomy sites even after early high-energy trauma in the early postoperative period, when bone healing is still incomplete.

Approximately, 12% of trauma activations require intubation and 25% of all emergency department (ED) intubations are in trauma patients. The first-pass success rate in trauma patient intubation is 64-90%. This study aims to explore factors associated with first-pass success and adverse event rates in trauma patients in a Canadian context. We conducted a health records and registry review of a cohort of trauma patients requiring intubation at two Level 1 trauma sites in British Columbia (January 2017-March 2022). Primary outcome was first-pass success rate. Secondary outcomes were adverse events rates as well as identifying factors associated with first-pass success and adverse events. Multivariate logistic regression explored associations with key covariates and estimated adjusted odds ratios. Among 440 patients, 85% experienced first-pass success and 22% experienced adverse events. DASH-1A rates were 72%. Adjusted logistic regression revealed that video laryngoscopy was positively associated with first-pass success (OR 2.38 CI 1.13-4.99 p = 0.02). Trauma to head, face, or neck was negatively associated with first-pass success (OR 0.09 CI 0.01-0.65, p = 0.02). Intubations by junior residents and higher injury severity scores were associated with an increased odds ratio of adverse events (OR 2.12 CI 1.02-4.42 p = 0.05 and OR 1.04 CI 1.02-1.06 p = 0.001 respectively). Our project is the first to comprehensively report first-pass success, adverse events, intubation operator/equipment, and trauma characteristics for Canadian trauma patients intubated in the ED. Video laryngoscopy was associated with improved first-pass success, while head, face, or neck trauma was associated with reduced first-pass success. Further, intubations by junior residents and extensive injuries were found to be associated with a greater frequency of adverse events. Ongoing quality improvement and trauma-specific intubation training should continue in orderto improve first-pass success, reduce adverse events, and address patient-oriented outcomes.

Introduction: Intracranial arterial injury is typically associated with high-energy trauma. Early diagnosis and treatment are essential for improving patients' functional prognosis. Case Presentation: A 76-year-old woman complained of pulsatile tinnitus on the 15th day after her traffic accident, in which she got injured only a bruise to her face, while severe injuries to her torso. On the 17th day, ptosis, conjunctival congestion, and an ocular motility disorder developed in her right eye. Magnetic resonance angiography showed a direct high-flow shunt from the internal carotid artery to the cavernous sinus. On the 20th day, the same symptoms developed in her left eye. On the 23rd day, coil embolization to the fistula reduced symptoms in the left eye, but not the right eye. Discussion: This complication rarely occurs in patients with head trauma. Our case indicates that this can occur even in patients without obvious head or facial trauma, and even in the subacute phase of trauma care.

Summary:Facial fracture repairs are often performed as add-on cases to work around elective schedules and emergent cases. This practice pattern can lead to delays in care and after-hours operations, longer hospital stays, operating room (OR) inefficiencies, and increased provider and staff burnout. To address this, we implemented a dedicated facial trauma OR model at our level 1 trauma center. A dedicated OR is available twice weekly and managed by the attending facial trauma surgeon on call. Any facial trauma case can be scheduled until 6 am on the same day, after which any unused OR time is then released to accommodate add-on cases. Pearson χ2 tests, Fisher exact tests, and t tests were performed for statistical analysis. Analysis of mandibular fracture repairs after 1 year of implementation identified several important benefits compared with the previous add-on surgery model. After-hours operations, defined as operations after 5 pm, were reduced by 26.5% (P = 0.02). Several other variables showed improvement but did not reach statistical significance, including inpatient hospital length of stay (34.3% reduction), time from injury to surgery for inpatients (38.5% decrease), and the proportion of patients managed as outpatients (13.6% increase). Analysis of nasal fracture reductions during the period found a 24.8% reduction in OR time (P = 0.03). These results suggest that the dedicated facial trauma OR model has the potential to improve efficiency and should be further examined as a model for delivery of facial trauma care at major trauma centers.

To report a rare presentation of periocular necrotizing fasciitis (NF) following a surgical site infection after aesthetic rhinoplasty. We present two otherwise healthy patients who developed periocular swelling, erythema, and pain extending to the temporal region and nasal bridge, accompanied by areas of periocular necrosis. Neither patient had a history of trauma. One patient underwent an uneventful aesthetic rhinoplasty more than one month earlier, followed by a recent postoperative nasal hump shaving performed in an outpatient setting at the surgeon's office. The second patient had a similar history of uneventful aesthetic rhinoplasty two weeks earlier. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scores were 6 and 7, suggesting a high likelihood of the disease. Orbital computed tomography (CT) revealed severe preseptal soft tissue swelling extending to adjacent areas with no evidence of intraorbital involvement. A clinical diagnosis of periocular NF was established, and both patients were treated with intravenous broad-spectrum antibiotics, followed by prompt surgical debridement of necrotic tissue. Bacterial cultures revealed growth of Streptococcus viridans and Staphylococcus species. Both patients achieved complete recovery without recurrence or significant complications. Although periocular NF is rare, a high index of suspicion is essential for early diagnosis, particularly in patients with a recent history of facial surgery or trauma. Prompt recognition and management can prevent catastrophic outcomes, including orbital involvement and vision-threatening complications.

Background: Facial trauma remains a major public health issue, with causes that vary by region. National statistics often overlook local trends, which highlights the need for region-specific studies to create targeted prevention and treatment plans. Methods: This retrospective review included 801 patients with facial fractures at a Level 2 urban trauma center, which serves the Tulsa metropolitan area with a population exceeding 1,000,000 residents. Data from patient records and the trauma registry between 2021 and 2024 were analyzed for demographics, injury mechanisms, fracture details, Injury Severity Score (ISS), comorbidities, treatments, and geographic origin (Tulsa versus other areas). χ 2 tests examined categorical variables, while nonparametric tests evaluated continuous variables. Results: Most patients were male (73.8%) with an average age of 47.9 years. The main causes of injury were falls (23.4% overall; 51.0% in females versus 21.8% in males, P &lt;0.001) and assaults (22.5% overall; 28.9% in males versus 13.8% in females, P &lt;0.001). Firearm injuries were uncommon but more frequent among men (4.4% versus 0.5%, P &lt;0.05). Falls made up 90.3% of injuries in patients over 85 years old ( P &lt;0.001). Major trauma (ISS &gt;15) was seen in 25.6% of cases. Orbital floor fractures (16.1%) were more common than Le Fort fractures (8.4%). Comorbidities included substance use disorder (17.1%) and mental or psychiatric illnesses (12.2%). Patients from Tulsa had lower median ISS (9 versus 11, P =0.005) but higher rates of assault (31.9% versus 20.3%) and firearm injuries (5.0% versus 2.3%; P &lt;0.05). Conclusion: In this urban Midwestern population, falls were more common in females and older adults, while intentional violence was higher among males and Tulsa residents. These findings underscore the need for tailored interventions: fall prevention for older adults and women, violence screening for men, and integrated approaches to substance use and mental health treatment.