Management Of Maxillofacial Fractures Research Articles

The Role of Orthodontics in the Management of Maxillofacial Fractures in Children: A Review on Contemporary Approaches.

Maxillofacial fractures present complex challenges requiring effective orthodontic management to restore function and aesthetics. This review explores various orthodontic techniques, including fixed braces, maxillomandibular fixation (MMF), functional orthodontic therapy (FOT), and acrylic splints, emphasizing their roles in stabilizing fractures and promoting healing. The management of condylar fractures is discussed, highlighting the benefits of early intervention with functional appliances to facilitate condylar remodeling in children and adolescents. Additionally, the review covers splinting methods for dental and dentoalveolar fractures and the use of open reduction internal fixation (ORIF) for maxillary fractures. It addresses the complications and challenges of fracture management, the need for a multidisciplinary approach, and the limitations of current studies. Future directions include the use of advanced technologies such as virtual surgical planning (VSP) and 3D printing to enhance treatment precision and outcomes. This review provides a comprehensive overview of orthodontic strategies for maxillofacial fractures, offering insights into clinical applications and future advancements.

Management of Maxillofacial Trauma in Pregnant Women.

Trauma during pregnancy deserves special attention as management must be directed towards both the mother and the fetus. Management of maxillofacial fractures in pregnancy can adversely affect the well-being of the fetus by impinging on normal functions such as respiration, mastication, and nutrition. Pregnancy complicates the management of facial injury due to the maintenance of the patent airway, anesthesia considerations, and imaging restraints. The purpose of this study is to use three illustrative from our own institution to further elucidate education on the management of mandible fracture in pregnancy with a focus on multidisciplinary treatment and outcomes. A retrospective chart review was performed for all cases of facial fractures admitted to Ryder Trauma Center from 2012 to 2022. During this time, 4,910 patients presented with facial fractures 1319 patients were female. Three of the patients were pregnant at the time of admission. Demographics, mechanism of injury, associated injuries, and management information were collected. Patient 1 was a 20-year-old female presented to Ryder Trauma Center following a motor vehicle collision. She was 17 weeks pregnant at the time of admission and was found to have a left mandibular angle fracture. Patient 2 was a 14-year-old female who presented to Ryder Trauma Center status post gunshot wound to the mandible after she and her brother were unknowingly playing with a loaded gun. She was 18 weeks pregnant at the time of admission, with a past medical history of domestic violence, suicidal ideation, and major depressive disorder. Patient 3 was a 20-year-old female 36 weeks pregnant at the time of admission. She presented with a right paraymphyseal fracture and left mandibular angle fracture as a result of falling on the stairs. Patients all underwent surgical repair of fractures.

"A study to assess the use of ultrasonography in detecting maxillofacial fractures"

Background:-Maxillofacial fractures occur most frequently as an after effect of trauma. Initially during first century, diagnosis of fracture was carried out using conventional radiographs but it has certain shortcomings which includes high radiation exposure, difficulty in detecting hair line & non dislocated fractures due to anatomical superimposition from the para-nasal air sinuses obscuring the visibility of underlying anatomical structures. At the time of this study the literature was focused more about isolated facial fracture and less about complete comprehensive evaluation of maxillofacial fractures using USG. A radiological confirmation is necessary because missed or incorrectly managed cases may encounter serious consequences. The most common causes of these fractures are road traffic accidents. The etiology and incidence of these fractures vary in different countries. The nasal bone being the most prominent bone is often prone to fracture (39% of maxillofacial fractures). The mandible and zygomatico-maxillary complex play an essential role in facial contour and mastication. A fracture in this area can affect facial appearance, function, and quality of life. To restore aesthetics, function, and quality of life, it is essential to completely diagnose these fractures for effective management. Thus we aim to add on more facts to the preexisting context which may further help to utilize ultrasonography as a first line diagnostic tool in detecting various maxillofacial fractures. Materials & Methods:-Thirty four patients who presented with clinical signs & symptoms suggestive of maxillofacial fractures having computed tomography ( GE Revolution 16 slice, 1.25mm slices) & conventional radiographs( GENORAY PAPAYA Plus DP-1S )done as a standard protocol for management of maxillofacial fractures were included in this study. These patients were subjected to ultrasonographic ( VOLUSON 730 PRO )examination using 5-7 MHz frequency linear probe by an experienced sonologist who was blinded to the findings of computed tomography and conventional radiographs. Assessment was carried out in real time. The findings of conventional radiographs & ultrasonography were then correlated with findings on computed tomography. In this study computed tomography was taken as the gold standard & sample size estimation done with “two tailed test’ in EPI INFO SOFTWEAR Results:-The data analysis was performed by diagnostic & sensitivity test. Inferentional statistics was performed using EPI INFO 1.1.1.14. In this study ultrasonography shows sensitivity 86.20%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 20.00%, accuracy of 86.66% in detecting maxillofacial fractures. When correlating the fracture detected by computed tomography & ultrasonography the results were highly significant with P = 0.001893. Conventional radiographs shows sensitivity 50.57%, specificity 66.66%, PPV 97.77%, NPV 4.44%, accuracy of 51.11% in detecting maxillofacial fractures. When correlating fractures detected by USG & CR the results are significant with P = 0.00467. Conclusion:-In the present study ultrasonography has shown better accuracy than conventional radiographs in diagnosing maxillofacial fractures. Though CT scan is the gold standard, we had observed that USG is equal to CT scan in diagnosing most of the superficial fractures. Hence with the availability of well experienced sonologist and high resolution transducer USG can be considered as the first line diagnostic procedure in suspected maxillofacial fractures.

Study of Prevalence, Clinical Pattern and Management of Maxillo-Facial Fractures in a Tertiary Care Centre

Introduction: Maxillofacial injuries are one of the most common injuries prevailing in society because of the strong reliance on road transportation. Road traffic accidents being the most common cause, affecting more than 20 million people worldwide. Multiple modality treatment is often required for the management of maxillofacial fractures, including clinical examination, radio-diagnosis and surgical intervention. 3-D CT face has helped in the reconstruction and reformation of fractures with some limitations to the same. Surgical management still holds a good approach towards the definitive management of maxillofacial fractures. Material and methods: Prospective observational study from 1st February 2021 to 31st July 2022. The parameters used were age, sex, time of incident, etiology, type of vehicle used with preventive measures, type of fractures, and treatment received. All patients underwent proper history taking, clinical examination, radiographic evaluation, and 3-D CT face reconstruction. Results: About 104 patients of maxillo-facial fractures presented to the emergency room of SRMS-IMS, Bareilly, out of which 63 patients were treated with surgical management Conclusion: The study concluded that RTAs were the major cause of maxillofacial trauma with the mandible being the most common bone fracture. ORIF with mini-plate fixation as treatment. lack of helmet and seat belt use, alcohol abuse, over-speeding and failure to follow traffic rules and regulations were the contributing factors

Pattern and management of maxillofacial fractures in Jordanian children and adolescents.

The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality.

Clinical Outcomes of ULTRA EZY Bar vs Erich Arch Bar in Conservative Management of Maxillofacial Fractures: A Randomized Controlled Trial.

Various techniques have been employed from time to time to achieve maxillomandibular fixation, and arch bars provide an effective and versatile means of maxillomandibular fixation, and however, some of the issues occurring with it have been eliminated with the introduction of Ultralock EZY bar. The aim of the present study is to compare the advantages and disadvantages of Ultralock Ezy bar over the Erich arch bar in mid-face fracture or maxillary fracture or mandibular fracture or both requiring conservative treatment. A total of 20 patients reported to the Department of Oral and Maxillofacial Surgery in Sudha Rustagi Dental College and Hospital, Faridabad, with mid-face fracture/maxillary fracture, mandibular fracture or both. The treatment plan required intermaxillary fixation. As a part of treatment plan, group was selected randomly divided into 20 arches in each group that is test arch group and control arch group.Test arch group included arches in which Ultralock EZY bar was done. Control arch group included arches in which Erich arch bar was done. The parameters compared in both the groups were surgical time taken, injuries due to wires, arch bar stability, oral hygiene index, patient acceptance and comfort, pulp vitality, and complication (if any). The average surgical time taken was less, and oral hygiene status and patient acceptance were better in test group. There was not much statistically significant difference in pulp vitality but number of cases with absence of pulp vitality were more in test group. This study emphasizes the use of Ultralock Ezy bar as a quick and easy method than Erich arch bar. Oral hygiene maintenance was comparatively better in patients with Ultralock Ezy bar than those with Erich arch bar. For thepatients who require long-term IMF, Ultralock Ezy bars can be a viable option. The online version contains supplementary material available at 10.1007/s12663-022-01821-3.

Pattern of Facial Fractures and Its Association with a Cervical Spine Injury in a Tertiary Hospital in Jordan.

Background Facial fractures can be accompanied by serious and life-threatening injuries such as cervical spine injury (CSI), which can lead to serious consequences if misdiagnosed. Objective To assess the patterns of maxillofacial fractures and to explore the association between these fractures and cervical spine injuries (CSIs) in patients with a traumatic facial injury. Methods A retrospective analysis was conducted on the data of the subjects who were admitted to the King Abdullah University Hospital (KAUH) and had a maxillofacial fracture in the period from January 2017 through December 2020. Stepwise binary logistic regression analysis was conducted to find the variables which are significantly and independently associated with CSIs. Results A total of 394 maxillofacial fractures were reported for a total of 221 subjects. The mandible was the most common site of the reported fractures (41.88%). The majority of the subjects had associated injuries (70.6%), of which 82.7% were CSIs. The most common type of the CSIs was the vertebral fracture (52%). Increased age (OR = 1.543, P < 0.05), having a mandibular fracture (OR = 4.382, P < 0.01), and having a maxillary fracture (OR = 3.269, P < 0.05) were significantly associated with the presence of CSI. Conclusion The current study revealed that the most common type of facial fracture occurred in the mandible area, and CSI was the most common fracture-associated injury (82.7%). Increased age and having mandibular or maxillary fracture were associated with an increased risk of developing CSI. Therefore, it is necessary to rule out the presence of concomitant CSI during the emergency management of maxillofacial fractures, particularly for elderly patients and those with mandibular or maxillary fractures.

Systemic Antibiotic Prophylaxis in Maxillofacial Trauma: A Scoping Review and Critical Appraisal

Infection after maxillofacial trauma remains an important complication, with a significant socio-economic impact. While consensus exists that systemic antibiotic prophylaxis reduces the risk of infection in the management of maxillofacial fractures, the type, and duration remain controversial. Therefore, the purpose of this scoping review was to provide an overview of the current evidence that supports the use of prophylactic antibiotics in the treatment of maxillofacial fractures. A comprehensive literature search on 1 January 2022, in PubMed, Web of Science, Embase, and Cochrane, revealed 16 articles. Most studies focused on the duration of systemic antibiotic prophylaxis and compared a one-day to a five-day regimen. Included studies showed considerable variability in design and research aims, which rendered them difficult to compare. Furthermore, a variety of antibiotic regimens were used, and most studies had a short follow-up period and unclear outcome parameters. This scoping review demonstrates the lack of well-constructed studies investigating the type and duration of systemic antibiotic prophylaxis in the treatment of maxillofacial trauma. Based on the included articles, prolonging antibiotic prophylaxis over 24 h for surgically treated fractures does not appear to be beneficial. Furthermore, there is no evidence for its use in conservatively treated fractures. These results should be interpreted with caution since all included studies had limitations.

A Multicentric Prospective Study on Maxillofacial Trauma Due to Road Traffic Accidents: The World Oral and Maxillofacial Trauma Project

Abstract The purpose of this prospective multicenter study was to analyze the epidemiology, patterns, and management of maxillofacial fractures due to road traffic accidents (RTAs) worldwide. Between Monday September 30, 2019 and Sunday October 4, 2020,1066 patients with RTAs related fractures were admitted to 14 maxillofacial surgery departments. The following data were analyzed: age, gender, mechanism of injury, alcohol or drug abuse at the time of trauma, maxillofacial fracture site, facial injury severity scale (FISS) score, associated injuries, day and month of trauma, time of treatment, type of treatment and length of hospital stay. Data were analyzed using bivaried and multivaried statistical analysis. Eight hundred seventy patients were male, and 196 were female. The most common mechanism of injury was motorcycle accidents (48%). More than half of the patients had fractures of the middle third of the maxillofacial skeleton. In total, 59% of the study sample underwent open reduction internal fixation. The median facial injury severity scale (3 points) and the medial hospital stay (3 days) were significantly lower in patients with seatbelts and helmet (P &lt; 0.001). This first prospective, multicenter epidemiological study shows that motorcycle accidents are the leading cause of RTAs related fractures, mostly in young males. Particularly in Australia and Europe, the incidence of RTAs was significantly lower. Moreover, this study found that the severity of maxillofacial lesions was significantly higher in patients without safety devices, with consequent longer hospital stay demonstrating the efficacy of road safety policies in preventing maxillofacial injury.

The Epidemiology and Management of Maxillofacial Fractures at a Tertiary Care Hospital in a Conflict-Torn Region in Somalia.

The etiology of maxillofacial fractures (MFFs) varies according to the geographical location and density of the population. This study aimed to analyze the etiology, pattern, and treatment of MFFs. Epidemiological characteristics and treatment modalities of MFFs have never been evaluated in Somalia. The study included 45 patients who were operated on for MFFs at a tertiary care hospital in Somalia (2018-2019). Patient demographics, fracture causes, types, associated non-facial injuries, treatment modalities, and hospitalization-time were evaluated. The most common etiological factors of the MFFs were explosion (24.4%) and assault (24.4%), followed by gunshot (22.2%), sports accident (15.6%), motor vehicle accident (11.1%), and fall from height (2.2%) patients, respectively. The main site of injury was the mandible bone (64.4%) followed by nasal bone, maxilla, zygomatic, and orbital region. The most common non-facial injuries of the MFFs were soft tissue laceration (37.8%) followed by femoral fracture (6.7%), clavicle fracture (4.4%), and femoral fracture with chest injuries (2.2%). The most applied treatment was open reduction microplate +/- intermaxillary fixation (77.8%). Due to the size of the mandible fractures, an iliac autograft (6.7%) was performed. The mean length of the hospital stay was 11.8 ± 8.4 days (range, 1-45 days), and some patients (15.6%) needed intensive care due to severe injuries. This will be the first study aiming to analyze the etiology, pattern, and treatment of MFFs in Somalia. This study deals with the social aspects of Somalia, and it shows that MFFs develop as a result of highly interpersonal violence in a young man.

The trigeminocardiac reflex: Does the activation pathway of its efferent arc affect the intensity of the hemodynamic drop during the management of maxillofacial fractures?

The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values < 0.05 was considered significant.Out of 260 patients’ files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of hemodynamic drop, followed by maxillary nerve, then mandibular division, and the lowest one was non-trigeminal nerves. The highest mean of drops in the mean arterial blood pressure (MABP) was 62.92 ± 2.39 with the type ITVR, whereas those of the type II, III, and IV were 75.5 ±3.98, 81.02±1.31, and 82.22±1.85, respectively. Also, the type I-TVR led to the greatest decrease in the heart rate (HR) with the mean equaled to 52.31± 3.91. The drop percentage in the MABP was -30.5, -17.5, -12, -10.08 for type I, II, III, and IV, whereas those of the HR were - 33.9, -27.13, -26.6, and -25 with type I, II, III, and IV, respectively. All results showed highly significant differences with p-values less than 0.001 when comparing between the baseline and intraoperative values of each TVR type.There is a positive correlation between the activated pathway of the TVR and the intensity of its efferent arc response due to the neural pathway of each division in the brainstem circuitry. Understanding of the pathophysiology and mechanism of the TVR, together with the rapid recognition and treatment could prevent serious negative outcomes, especially when the ophthalmic nerve is stimulated.1Introduction

Evaluation of surface changes of stainless steel miniplates and screws following retrieval from maxillofacial trauma and orthognathic surgery patients: A comparative study.

Background:Metal implants have the potential to degrade body fluids. Corrosive degradation has been demonstrated in laboratory tests, both under simulated clinical conditions and by electrochemical methods, as well as in studies of retrieved metal implants. The clinical importance of degradation of metal implants is evidenced by particulate corrosion and wear products in tissue surrounding the implant, which may ultimately lead to bone loss.Materials and Methods:The present study is to evaluate the surface changes such as corrosion, surface roughness, and microfractures and for the tensile strength of 18 stainless steel miniplates and 18 stainless steel screws which were used as rigid internal fixation in the management of maxillofacial fractures and orthognathic surgeries.Results:In this study, surface roughness and microfractures were found in all the miniplates and screws that is 100%. Corrosion degradation was found in 12 of 18 plates that is 66.66%.Conclusion:Our results through scanning electron microscopy and stereo electron microscopy showed surface roughness, microfractures, and corrosion. However, tensile strength was not affected when the plates were in situ. Through our study, we recommend their retrieval after the purposes of rigid fixation have been fulfilled.

Is the Use of Intermaxillary Fixation Screws an Alternative to Erich Arch Bars for Maxillomandibular Fixation During Management of Maxillofacial Fractures? A Systematic Review and Meta-Analysis.

Systematic review and meta-analysis. Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws came into existence and are being used routinely. The present study was designed to identify if the intermaxillary fixation screws are really an alternative to Erich arch bars for management of maxillofacial trauma. An exhaustive literature search was conducted in May 2020 on various electronic databases and studies comparing Erich arch bars and intermaxillary fixation screws were recruited for the analysis. Random-effects model with Mantel Haenszel statistics was used to analyze oral hygiene and duration of achieving MMF. A total of 96 studies were identified, out of which 8 studies were included in the meta-analysis. There was no statistically significant difference in oral hygiene status of the patients in both the groups. Intermaxillary fixations screws required statistically significantly less time in achieving MMF. Needle stick injury was prominently seen with the use of Erich arch bar whereas other complications like mucosal coverage, root injury, screw loosening and screw fracture makes the use of intermaxillary fixation screws questionable. The present meta-analysis suggests that there is not enough evidence to recommend the use of intermaxillary fixation screws as an alternative to Erich arch bars. Further research with large sample size, high quality evidence and better methodology is recommended in this direction.

Management of Bilateral Head-Condyle Fractures and Chronic Dislocation In Children: Case Report

Introduction : Mandibular condyle fracture in children which is late to be treated can cause complications. The management of mandibular condyle fractures in children still controversial between open reduction and closed reduction. The management of maxillofacial fractures in children need to be considered properly due to the growth period in maxillofacial bone. Case Report : A 7-year-old girl patient came with complained her mouth couldn’t close tightly. Patient fell from a motorcycle about 2 months ago. A month after the accident, patient has been treated in private hospital but was unsuccessful. Patient’s mouth still couldn’t close tightly. Intraoral examination shown open bite in patient’s bite relation. Radiographic examination shown discontinuity in bilateral mandibular head-condyle. Patient has been diagnosed with temporomandibular joint dislocation and bilateral head-condyle fracture, then treated with condylectomy. Result : At sixth month control, the opening of patient’s mouth was 3 cm and the occlusion was normal. Discussion: The late management in children’s mandibular fracture can cause complications, such as ankylosis. If it was not treated immediately, it may be impaired the growth of jaw. Surgery or open reduction is the best choice of treatment when long-standing fracture has persisted and ankylosis occurred. Conclusion : The management of mandibular condyle fracture must be treated immediately and based on the accurate diagnosis, it can reduce and eliminate the possible complications. In this case, the treatment was late to be performed so the surgical intervention was necessary due to fibrous tissue that has been formed in temporomandibular joint and interfered the mandibular movement.

Efficacy of Microplates versus Miniplates in the Management of Maxillofacial Fractures.

Introduction:Increased facial trauma has led to advances in techniques of internal fixation, improvements in plating system, refinements in exposure of facial skeleton fueling the rapid use of internal fixation for the management of facial fractures. Evaluating 40 patients with confirmed midfacial (Le Fort I and II) and mandibular fractures, this study presents the efficacy of microplate in comparison with miniplate in terms of load bearing capacity, stability at the fracture site and postoperative palpability.Objectives:To evaluate the efficacy of microplates in comparison with miniplates in maxillofacial trauma.Materials and Methods:Study sample consists 40 subjects, 20 each in two groups clinically and radiographically diagnosed with Group 1 (maxillary) and Group 2 (mandibular fractures) which were subdivided into 10 each treated with miniplate and microplate respectively. Postoperatively, stability of fracture, bite force, need for postop MMF, pain, infection, wound dehiscence, mouth opening, occlusion and palpability was noted. All cases have been evaluated clinically for various parameters for minimum of 3 months to assess any postoperative complications.Results:We found microplates are stable enough and have adequate load bearing capacity. Due to close adaptability and less hardware, postoperative palpability is less but larger sample study with long term follow up is necessary to conclude its efficacy in load bearing fracture sites.

Simultaneous Surgical Correction of Skeletal Class III Dentofacial Deformity During Acute Management of Facial Fractures: Patient Selection and Surgical Technique.

Mandibular prognathism is a common dentofacial deformity in Asia. Treatment of such condition may vary from orthodontic camouflage to surgical orthodontics with orthognathic surgery depending on the severity of the condition. Because of the prominent position of the mandible, fractures involving different locations of the mandible commonly occur in maxillofacial trauma. Anatomical reduction of maxillofacial fractures and restoration of the pretraumatic occlusion are the primary goals of acute management of facial fractures. In patients with dentofacial deformity, simultaneous surgical correction of their malocclusion and improvement of their facial aesthetics while providing open treatment to the maxillofacial fractures are rarely reported in the literature. We reported 3 cases with combined open reduction and internal fixation and surgery-first orthognathic surgery principles to correct class III malocclusion with mandibular prognathism during acute management of maxillofacial fractures. Computer-assisted surgical simulation was used in surgical planning and fabrication of surgical splint. Two patients underwent mandibular osteotomies in addition to open reduction and internal fixation of maxillofacial fractures. One patient had both maxillary and mandibular osteotomies during facial fracture repair. Class I occlusion with satisfactory facial profile was achieved in all 3 cases. Careful patient selection with presurgical planning using computer-assisted surgical simulation is essential in achieving successful outcomes in correcting dentofacial deformities while managing maxillofacial fractures. This combined technique is a viable option in the surgical management of facial fractures in patients with dentofacial deformities.

Management of Maxillo Facial Fractures in a Cameroonian Tertiary Hospital

This is a descriptive study that was carried out at the accident and emergency, Dental, and Ear Nose and throat (ENT) units of the Douala General Hospital between April 2014 to September 2014 on patients with maxillofacial trauma referred to this tertiary hospital. Maxillofacial injuries were found among 7 (23%) female and 24 (77%) males in patients mostly of between 21-31 age groups most of whom are motorcycle bike riders 10(32.3%). All patients were first resuscitated at the emergency department and 22 (71%) of the patients were referred to the general surgery department. The lips (13) 41.9%, facial trauma 10 (32.3%), facial edema 28 (90.3%), bleeding 25 (80%), dental articulation disorders 23 (74.2%), para symphyseal fractures38 (51.6%) were the most clinical signs. Treatment took place between the 5th and 10th day after consultation with anti-inflammatory 15 (48.4%), 24 (77.4%) on mouth washes and more than half were prescribed antitetanus prophylaxis. The majority 25(81%) of patients were treated using open reduction 6(48%), closed reduction 20(65%), intermaxillary fixation 26(84%) and 4(13%) pterigo-zygomatic suspension for the management of maxillofacial fractures either by the dentist or the ENT surgeons.

Comparative analysis of miniplate design and metal magnesium screw ECAP against titanium

In the internal fixation management of maxillofacial fractures, placement of miniplates and screws is necessary until bone repair occurs. Magnesium has the potential for use as a miniplate and screw for the jaws due to its biocompatibility and biodegradability, so that reoperation to remove the miniplate and screw is not necessary. The equal channel angular pressing (ECAP) process is a method to control the corrosion rate of magnesium and increase the mechanical properties. When constructing the miniplate and screw design from ECAP magnesium, referring to the safety factor of the titanium design that already is being used, adjustments must be made according to the characteristics of magnesium so that damage can be avoided. We compared the characteristics of the magnesium ECAP miniplate and screw design against those of titanium. For this study, we used the finite element method, which consists of a displacement formula to calculate component movement, strain, and pressure under internal and external load. Afterwards, the magnesium ECAP miniplate and screw design was subjected to a loading simulation that was analyzed according to the von Mises theory. After stress simulation testing, the magnesium ECAP miniplate and screw, which was expected to be used in the management of maxillofacial fractures, was engineered to reduce the stress received. The design was divided into two types: In type 1, the number of screws was increased to eight, and the total weight of the miniplate and screw was 118.212 mg. In type 2, the diameter of the screw heads was made larger than their original shape so that the total weight was 169.414 mg. The type 1 alternative design of the magnesium ECAP miniplate and screw could be more effective in the management of maxillofacial fracture.

Transcatheter Arterial Embolization in the Treatment of Maxillofacial Fractures With Life-Threatening Hemorrhage

Transcatheter arterial embolization (TAE) has gained importance in the management of maxillofacial fractures with life-threating hemorrhage (MFH). However, clinical evidence supporting the use of TAE has not been clearly established in the literature. Therefore, we evaluated the effectiveness of TAE for MFH, based on data obtained from the Japan Trauma Data Bank. Patients were identified from Japan Trauma Data Bank entries for the years 2004 to 2014. Inclusion criteria for MFH were defined using the Abbreviated Injury Scale code (Maxilla fracture, LeFort III; blood loss. > 20%). On the basis of the treatment strategy, patients were categorized into either the TAE group or the non-TAE group. A comparative analysis of the demographics, injury characteristics, and outcomes was performed. From among 198,744 documented cases of trauma, a total 118 patients were eligible for the study; 26 of these patients (22.0%) underwent TAE. The Glasgow Coma Scale score was significantly lower in the TAE group than in the non-TAE group (P = 0.019); the other variables did not significantly differ between the groups. Overall, the in-hospital mortality rate was 39.8%, and the median hospital length of stay was 21.0 days (0.0-53.5 days). The in-hospital mortality was significantly lower in the TAE group than in the non-TAE group (23.1% vs 44.6%; odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14-1.02; p = 0.048). However, patients in the TAE group had a longer median hospital length of stay (39.5 [7.3-53.5] vs 14.0 [0.0-55.3] days, p = 0.072). In the logistic regression model, the use of TAE was extracted as the independent predictor for better outcomes after adjusting for potential confounders (OR, 0.32; 95% CI, 0.66-0.88; P = 0.032). Hypotension, a high Injury Severity Score, aged 60 years or older, and a low Glasgow Coma Scale score were also independently associated with mortality, with an OR of 5.48, 3.99, 3.30, and 2.89, respectively. Cases of MFH are rare, but they are associated with a high mortality. Transcatheter arterial embolization use appears to lead to successful outcomes in such cases. Further studies are required to confirm the efficacy of TAE and evaluate its indications and complications.

Associated head injuries and survival rate of patients with maxillofacial fractures in road traffic accident: A prospective study in Saudi Arabia.

Background:Every minute, an accident occurs in Saudi Arabia, causing 39,000 injuries and 7,000 deaths annually. Facial trauma or maxillofacial trauma (MFT) is a frequent presentation of road traffic accidents (RTAs), ranging from simple nasal fractures to gross or severe maxillofacial injuries.Methods:A total number of 237 patients were included in this prospective study from May 2013 to January 2018. The following medical details were recorded for each case, gender, age, fracture location, the presence of scalp laceration, the presence of brain damage, type of brain damage, shock degree, Glasgow Coma Scale (GCS), number of units used for blood transfusions for documentation of patient survival rate. We followed up the patients in their first appointment after 21 days of patient discharge from the hospital.Results:Majority of the patients were young male adults. A total of 59.1% of patients had cerebral damage, 38% (n = 90) of patients had at least, one scalp laceration, 43.5% (n = 103) of patients had some degree of shock, whereas 27.8% of the recruited patients needed at least 1 unit of blood transfusion. A total of 14.3% of the patients died as a result of their injuries, and the survival rate was 85.7%.Conclusions:Kingdom of Saudi Arabia (KSA) is having a high incidence of RTAs leading to high mortality rate. Therefore, it requires a sound evaluation of the risk factors for RTAs and establishment of guidelines to decrease the incidence of road traffic injuries and reduce health-care burden. Road safety campaigns focused on young population can help reduce RTAs and subsequent mortalities. Prompt arrival at the hospital, early diagnosis, and timely management of maxillofacial fractures and brain damages by skilled physicians will lower mortality rate in KSA..