Management Of Midfacial Fractures Research Articles

Pediatric-Specific Midfacial Fracture Patterns and Management: Pediatric Versus Adult Patients.

The purpose of this study was to compare the midfacial fracture patterns and management approaches between pediatric and adult patients. We retrospectively analyzed 164 pediatric patients (<16 years old) and 564 nongeriatric adult patients (16 to 65 years old) with midfacial fractures at a single institution between 2011 and 2016. The location of the fractures, along with the etiology and management of the midfacial fractures, were compared. Significantly greater proportions of pediatric versus adult patients had sports-related injuries (P < 0.001) and sustained nasal fractures (P < 0.001). On the other hand, significantly greater proportions of adult versus pediatric patients were injured in falls, traffic accidents, or assaults (P = 0.004, P < 0.001, and P = 0.002) and sustained maxillary or zygomatic fractures (P = 0.039 and P < 0.001). Bivariate logistic regression analyses revealed that the risks of nasal, maxillary, and zygomatic fractures were significantly related to age status after adjusting for etiology (P < 0.001, P = 0.045, and P < 0.001). In contrast, the risks of hospitalization and surgical treatment were significantly associated with etiology, but not with age status (P = 0.290 and P = 0.847). These data suggest that the age-related structure and composition of the facial skeleton affect the pediatric-specific fracture patterns independent of the etiology. The comparisons in this study may serve as a guide for the management of pediatric midfacial fractures.

Management of Midfacial Fractures: An Overview

ABSTRACT Trauma to the midface involves fracture of the maxilla, the zygoma, orbit and the nasoorbital ethmoid complex. The facial skeleton is made up of thin segments of bone encased and supported by a more rigid framework of ‘buttresses’. The midface is anchored to the cranium through this framework. Midfacial fractures can occur in isolation or in combination with other serious injuries. The road traffic accidents are still the main etiology of the midface fractures followed by assault, fall, sports and warfare injuries. The management of the midface remains a challenge for the maxillofacial surgeons, demanding both skill and expertise. Midface fractures are most often seen in young adult males whereas there is very low incidence in children. There is little difference in the outcome of stable patients whose fractures are treated very early vs those treated in a more delayed fashion. Rigid and semirigid plating systems perform well with few complications when used to repair midfacial fractures provided proper reduction is obtained. The dental occlusion must be used as the lower frame of reference when treating fractures that result in instability of the maxillary alveolus relative to the skull base. The most common complication after rigid repair of facial fractures appears to be malunion secondary to inadequate reduction. How to cite this article Thapliyal GK, Ranga Rajan H. Management of Midfacial Fractures: An Overview. J Postgrad Med Edu Res 2014;48(2):68-74.

Oral endotracheal intubation in the management of midfacial fractures

The management of a patient’s airway when operating on midfacial fractures can be difficult. Nasal intubation may compromise the reduction and stabilisation of nasal fractures and although it is rare, intracranial malposition of a nasopharyngeal airway has been reported.1 Tracheostomy requires an invasive procedure with substantial morbidity. Various submental orotracheal intubation techniques have been advocated rather than tracheostomy.2,3 However, these may result in damage to submental structures and postoperative infections.3 Maxillomandibular fixation is often necessary intraoperatively for adequate reconstruction of facial fractures, so standard oral endotracheal intubation has been considered inappropriate in the management of these patients.3 Changing from a nasal tube to an oral tube at the end of an operation to treat nasal fractures is traditionally the least invasive way to manage the airway. However, this can lead to contamination of the surgical field and compromise the accuracy of reduction of the nasal fractures. Oral intubation for midfacial fractures is not commonly advocated but it can be done using an armoured tube that has flexible metallic reinforcement.4 The tube is positioned behind the last molar tooth in the retromolar trigone, along the buccal sulcus, and out of the mouth. It can then be displaced laterally so that the teeth can be placed in maxillomandibular fixation. We present a case of midfacial fractures where a simple modification of this technique allowed oral endotracheal intubation to be used successfully.

Management of midfacial fractures

The subject of middle-face fractures is treated at some length in a discussion that encompasses some facets of general evaluation, clinical and radiographic diagnosis, anatomy, physiology, and various modalities of treatment. It is hoped that the ideas, philosophies, and techniques described will serve as a springboard for reflection and stimulate ever-increasing research in the management of these injuries.

Management of mid-facial fractures.

Management of mid-facial fractures.