Mandible Injury Research Articles

Successful repair of tubercular tracheal stenosis: a rare case report

We report a rare case of successful surgical management of tubercular tracheal stenosis. There was no history of tracheostomy except for trauma management. A 24-year-old man presented with breathing difficulty. He had previously sustained blunt chest injury, a fractured mandible and minor head injury in a traffic accident. Despite successful mandibular fracture fixation, he subsequently developed progressive breathing difficulty with stridor. The patient was treated successfully with surgical resection and bronchoplastic reconstruction. Post-operatively, endotracheal tuberculosis was diagnosed. Endotracheal tuberculosis is rare despite the high incidence of pulmonary tuberculosis in India. Early diagnosis and prompt treatment are necessary to prevent tuberculous tracheobronchial stenosis, an extremely rare but serious clinical problem which can cause obstructive pneumonia and exertional dyspnoea. Surgical resection and bronchoplastic reconstruction is the established treatment for such stenosis. Patients with active tuberculosis usually respond to conventional antitubercular treatment.

Predictable Patterns of Intracranial and Cervical Spine Injury in Craniomaxillofacial Trauma: Analysis of 4786 Patients

Patients presenting with traumatic craniomaxillofacial fractures often have occult concomitant injuries. This study was designed to determine whether facial fracture patterns are associated with a particular constellation of concomitant head and neck injuries. A retrospective review of 4786 consecutive patients diagnosed with maxillofacial fractures at a dedicated urban trauma center from 1998 to 2005 was conducted; maxillofacial fractures and cervical spine injuries were grouped by dividing the craniomaxillofacial skeleton and cervical spine into thirds. Univariate and multivariate logistic regression analyses were used to identify associations between facial fractures and other traumatic injuries. Among all patients with facial fractures, 461 (9.7 percent) also had cervical spine injuries and 2175 (45.5 percent) had associated head injuries. Fractures of the upper face were associated with increased likelihood of mid lower cervical spine injuries, severe intracranial injuries, and increased mortality rates. Unilateral mandible injuries were associated with an increased likelihood of having upper cervical spine injuries, whereas unilateral midface injuries were associated with basilar skull fractures and several intracranial injuries. Finally, bilateral midface injuries were associated with basilar skull fracture and death. Craniomaxillofacial fractures are commonly associated with head and cervical spine injuries that involve predictable patterns of force dispersion from the maxillofacial skeleton and transmission to the cranial vault and cervical spine. These results suggest that concomitant injuries should be investigated closely with distinct types of facial fractures.

Principles of Pediatric Mandibular Fracture Management

Mandible fractures are commonplace in today's craniofacial practice; however, managing the infrequent, operative pediatric mandible injury requires a thorough knowledge base and thoughtful approach. Not only do these patients demonstrate variable anatomy due to differing stages of dental eruption, but condylar disruption may translate into long-term growth disturbance. In addition, patient immaturity often complicates cooperation, and both fixation strategies and postoperative planning must take this into account. As a supplement to the authors' video presentation, the present article focuses on repair of the symphyseal fracture and bilateral condylar injuries in the pediatric patient.

Patterns and Outcomes of Pediatric Facial Fractures in the United States: A Survey of the National Trauma Data Bank

Pediatric trauma involving the bones of the face is associated with severe injury and disability. Although much is known about the epidemiology of facial fractures in adults, little is known about national injury patterns and outcomes in children in the US. The epidemiology of facial injuries in children and adolescents (ages 0 to 18 years) was described using the National Trauma Data Bank (2001 to 2005) to examine facial fracture pattern, mechanism, and concomitant injury by age. A total of 12,739 (4.6%) facial fractures were identified among 277,008 pediatric trauma patient admissions. The proportion of patients with facial fractures increased substantially with age. The most common facial fractures were mandible (32.7%), nasal (30.2%), and maxillary/zygoma (28.6%). The most common mechanisms of injury were motor vehicle collision (55.1%), violence (11.8%), and falls (8.6%). These fracture patterns and mechanisms of injury varied with age. Compared with patients without facial fractures, patients with fractures exhibited substantial injury severity, hospital lengths of stay, ICU lengths of stay, ventilator days, and hospital charges. In addition, patients with facial fractures had more severe associated injury to the head and chest and considerably higher overall mortality. Causes and patterns of facial fractures vary with age. Cranial and central facial injuries are more common among toddlers and infants, and mandible injuries are more common among adolescents. Although bony craniofacial trauma is relatively uncommon among the pediatric population, it remains a substantial source of mortality, morbidity, and hospital resource use. Continued efforts toward injury prevention are warranted.

The Mandible Injury Severity Score: Development and Validity

To develop and validate a clinical method for characterizing and scoring mandible injury severity. Constituent fracture variables (fracture type, location, occlusion, soft tissue involvement, infection, and interfragmentary displacement [FLOSID]) were used to develop the FLOSID taxonomy for characterizing injury. Each component was assigned an empirical weight to help derive a summary measure of injury severity called the UCLA Mandible Injury Severity Score (MISS). Subsequently, MISS values were calculated for a group of 336 patients treated for mandible fractures. The validity of the summary score was evaluated by relating the MISS measure to the treatment modality used and to various variables, related as well as unrelated to injury outcomes. Each of the FLOSID components correlated significantly with the MISS (P < .001). Unrelated variables, including ethnicity, education, and gender, had no correlation to the MISS. On average, patients treated with rigid internal fixation had a higher MISS than patients treated with maxillomandibular fixation (P < .001). The MISS had a statistically significant association with surrogate markers of injury severity such as sensory nerve deficit, need for hospitalization, and pain at 1-month follow-up (P < .001). However, there was no significant association between MISS and indicators of postoperative complications (infection, nonunion, malunion, malocclusion). The FLOSID taxonomy offers a useful alternative to narrative summarization of mandible injury. The MISS is readily derived from clinical parameters obtained at the initial patient encounter and appears to be a valid index of mandible injury severity across important clinical domains.

Traumatic injuries: imaging of facial injuries.

Facial injuries are common and require radiologic evaluation to plan treatment. The role of imaging is to detect fractures, describe their morphology and topography, and evaluate adjacent soft tissue damage. Computed tomography is the imaging method of choice for an accurate diagnosis and for depicting the complex anatomic structures of the maxillo-facial region. Magnetic resonance imaging plays a limited role, mainly in the assessment of lesions of orbital soft tissues. This paper reviews the most common traumatic injuries of facial bones, paranasal sinuses, orbits and mandible.

The relationship between facial fractures and death from neurologic injury

Purpose: The purpose of this study was to review patients who failed to survive blunt trauma and to determine whether there is a relationship between specific facial fracture patterns and death. Patients and Methods: This was a retrospective record review of patients with facial fractures admitted to a level I trauma center between January 1, 1993 and December 31, 1996. Records were reviewed for gender, age, injury severity score (ISS), Glasgow Coma Scale (GCS), revised probability of survival (RPS), cause of death, and facial fracture pattern. Facial fracture patterns were grouped as lower face (mandible), midface (maxilla, zygoma, nose, and orbits), and upper face (frontal bone). Causes of death were grouped into neurologic, visceral, combined neurologic and visceral, and other. Surviving and nonsurviving groups were compared. Parametric data were analyzed with a pooled or separate variance t-test, nonparametric data with a Mann-Whitney U-test, and categorical variables with a chi-square test (P≤.05). The odds ratio with corresponding 95% confidence intervals was used to show the association between facial fracture patterns and death. Results: During the 4-year period, 6,117 patients were admitted with blunt trauma, 661 (11%) of whom had facial fractures. Those who died were more likely to be older than those who survived, with a lower GCS, lower RPS, and higher ISS. Although there was a male predominance in the patient population, there was no gender difference between those who died and those who survived. Surviving patients were more likely to have only isolated mandible injuries. Nonsurvivors were more likely to have isolated midface fractures or combinations of midface and other facial fractures. The odds ratio showed a 13 to 75 times greater risk of patients dying of neurologic injury with patterns other than isolated mandible injury than with any mid- or upper-facial fracture patterns. Conclusions: Compared with survivors, nonsurviving patients with facial fractures were older and had a lower GCS, higher ISS, and lower RPS. Nonsurviving patients had a dramatic predilection for mid- and upper-facial fracture patterns and death of neurologic injury. © 2000 American Association of Oral and Maxillofical Surgeons