Maxillofacial Trauma Patients Research Articles

An overview of the prevalence and pattern of maxillofacial trauma in the south of Iran

Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma. Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records and analyzed. Data included patient’s demographics, injury mechanism, types of maxillofacial injuries, Injury Severity Score (ISS), associated injuries, length of hospital stay and outcome. Binary logistic regression by backward method was applied to determine the effects of independent variables on mortality odds ratio. Results: 85.23% of patients were males and of all patients 87.5% survived. The mean of age was 34.95 ± 16.51. The commonest cause of maxillofacial injury was road traffic accidents (86.31%). The median of ISS was 20.39± 10.24 and patients aged 30-39 years had the highest ISS. Overall, the most common maxillofacial injuries were orbital (59.47%, n=157) followed by maxillary (48.11%, n=127); common associated injuries were related to head (81.44%, n=215) followed by thorax (58.33%, n=154). Age and gender (being male) increased the odds ratio of mortality. An increase in ISS decreased the odds ratio of mortality, but it was not significant. Conclusion: Most of maxillofacial trauma patients suffered from orbital injuries and there were a huge percentage of associated injuries. Gender (male), age and length of hospital stay were the significant variables of mortality in maxillofacial patients. The findings of the current study sheds light on further investigation to treat these patients and enforce road traffic legislation and public education to prevent these traumas.

Are Embrasure Wires Effective and Reliable Method for Intraoperative Maxillomandibular Fixation in Mandibular Fractures?

Maxillomandibular fixation (MMF) is a basic and fundamental principle in the management of the maxillofacial trauma patients. Some fractures require only intraoperative MMF, during open reduction and internal fixation but not in the postoperative period. The present study was aimed to assess and compare the efficacy of embrasure wire with Erich arch bar as methods of intraoperative maxillomandibular fixation in the management of mandibular fractures. The prospective randomized study was undertaken in 30 patients who required intraoperative maxillomandibular fixation for mandibular fractures. Patients were randomly divided into two groups of 15 each (Erich arch bar in Group A and embrasure wire in Group B). The preoperative assessment included evaluation of demographic data, fracture location, mechanism of injury, degree of displacement of fracture and occlusion. Intraoperative parameters assessed were the time consumed for the application of MMF technique, injury to the operator/assistant, injury to the patient, stability of MMF technique, incidence of glove perforations and the cost of the MMF device. The mean time required for MMF and incidence of glove perforation were significantly (P < 0.001) less in embrasure wire group than the Erich arch bar group. The MMF technique maintained stable occlusion during open reduction and internal fixation in both the groups. Embrasure wire is an effective, reliable alternative form of intraoperative MMF, as needle-stick injury and time taken for placement were less as compared to the Erich arch bar group. However, Erich arch bar wiring is a versatile method and recommended where postoperative maxillomandibular fixation is also required.

Pneumomediastinum as a Complication of Oral and Maxillofacial Injuries: Report of 3 Cases and a 50-Year Systematic Review of Case Reports.

Pneumomediastinum (PM) secondary to oromaxillofacial trauma (OMF) is a rare but well-described complication/pathologic finding. The aim of this study was twofold: first, to report our experience in treatment of maxillofacial trauma patients with PM, and second, to review the literature regarding the clinical features, severity, course, and management of the aforementioned complication. We retrospectively reviewed the medical records and charts of patients who suffered from maxillofacial trauma and treated in our hospital between September 1, 2013 and September 31, 2017. The inclusion criteria were patients with radiologically confirmed PM. In addition, the electronic databases PubMed, Scopus, and Science Direct were queried for articles reporting PM cases secondary to OMF injuries and published in English, French, and German language. Three cases of PM out of 3,514 cases of craniomaxillofacial trauma were found; there were 3 male patients who presented in our emergency department with the chief complaint of cervicofacial swelling. Literature search isolated 58 selected articles and 63 cases were assessed in total; posttraumatic repeated blowing of nose was proved as most frequent triggering factor among them. Furthermore, the outcomes of review showed that thoracic pain, respiratory distress, and swallowing difficulties were not frequently reported in patients with ME due to facial trauma. Both our experience and the results of systematic literature review indicated that patients with PM due to OMF injuries present mild clinical course. If properly managed, this specific pathologic condition may have no further complications or relative comorbidities. The exact etiology and mechanism of PM in the context of maxillofacial injuries always needs to be identified. Radiographic, laboratory, and endoscopic examinations should be applied to rule out the more serious and frequently diagnosed aerodigestive, thoracic, and abdominal causes of PM.

Oral health related quality of life after treatment in maxillofacial trauma patients

ObjectiveThe aim of this study is to assess the impact of oral and maxillofacial fractures and treatment on the quality of life (QoL) of patients referred to an Oral and Maxillofacial Surgery Department in Malaysia. MethodsThe study involved 40 maxillofacial trauma patients who received treatment at a tertiary care centre in Malaysia. Oral health related QoL was measured using translated and validated Malaysian short version of the Oral Health Impact Profile Questionnaire, also known as S-OHIP(M). It is a self administered questionnaire which covers 7 domains: Functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. Patients answered the questionnaire at 3 different timings: Pre-treatment, 1 month post-treatment and 3 months post-treatment. Data was analysed using independent T-test, one way ANOVA and repeated measures ANOVA. ResultsPreoperative QoL scores were the highest (19.25 ± 10.33) with improvement at one month post-treatment (13.23 ± 8.51) and three months post-treatment (9.90 ± 8.11). Lower S-OHIP(M) scores, was seen in at 1 month and 3 months post-treatment, regardless of fracture sustained and treatment received. All OHIP domains showed statistically significant improvement (p < 0.05). ConclusionSignificant improvement in QoL from pre-operation period to 3 months post operation was seen. Patients showed significant improvement in all OHIP domains. Development of a QoL tool specific to maxillofacial trauma patients can be considered in view of the lack of representation of symptoms within existing tools.

Management of oral and maxillofacial trauma during the first wave of the COVID-19 pandemic in the United Kingdom

We assess the effect of coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. From 1 April 2020 until 31 July 2020, OMF surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information included clinical presentation, mechanism of injury, how it was managed, and whether or not treatment included surgery. Participants were also asked to compare the patient’s care with the treatment that would normally have been given before the crisis. Twenty-nine units across the UK contributed with 2,229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and, for hard tissues, mandibular fractures (13%). Of 876 facial fractures, 79 patients’ treatment differed from what would have been normal pre-COVID, and 33 had their treatment deferred. Therefore the care of 112 (14%) patients was at variance with normal practice because of COVID restrictions. The pattern of OMFS injuries changed during the first COVID-19 lockdown. For the majority, best practice and delivery of quality trauma care continued despite the on-going operational challenges, and only a small proportion of patients had changes to their treatment. The lessons learnt from the first wave, combined with adequate resources and preoperative testing of patients, should allow those facial injuries in the second wave to receive best-practice care.

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.

Maxillofacial trauma following road accidents-An 11-year multi-center study in Israel.

Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk. This historical prospective multi-center study was based on Israel's Trauma Registry between 2008-2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e-bike/scooter), maxillofacial injury location, and maxillofacial treatment. MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e-bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0-14years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento-alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians. Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type.

Maxillofacial and Cervical Spine Injuries - A Cross Sectional Study on Prevalence and Association of the Both in Maxillofacial Trauma Patients

Maxillofacial and Cervical Spine Injuries - A Cross Sectional Study on Prevalence and Association of the Both in Maxillofacial Trauma Patients

National Characteristics and Patterns of Facial Fractures in the Elderly Population

BACKGROUND: Given the increasing elderly population in the United States, the number of people seeking care for trauma injuries is expected to rise.1 However, nationwide studies on the epidemiological profile of elderly facial fractures remain sparse.2 Our retrospective study presents the characteristics and patterns of elderly facial fractures on a national scale. METHODS: Characteristics of facial fractures among nonelderly adults (64 years and younger) and elderly population (65 years and older) were examined using the 2016 American College of Surgeons—Trauma Quality Improvement Project (ACS—TQIP) database. All elderly patients were further subdivided into 3 age groups: 65–74 years old, 75–84 years old, and 85 years and older. This study examined types of facial fracture patterns, mechanisms of injury, and demographic data. Further subgroup analysis of the different fracture types was also conducted, examining the same variables. RESULTS: Three thousand four hundred fifteen (3.3%) elderly patients presented with facial fractures out of 104,183 elderly trauma patients. The majority of facial fractures in the older 85 and over group (60.7%) were experienced by females, whereas only 19.5% of fractures in the younger adult group (<65 years old) were experienced by women. The most common mechanism of injury in the elderly was falls, with motor vehicle transport being the most common mechanism of injury in adults. The most common type of facial fractures among the elderly and nonelderly were nasal fractures (P = 0.04). Elderly patients presented with significantly fewer zygoma and mandibular fractures when compared to nonelderly patients (P = 0.001 and P = 0.001, respectively), while showing significantly more maxillary/malar and orbital bone fractures. Fractures suffered by elderly patients were less severe compared to younger adults (P = 0.001) as reflected by the Injury Severity Score. Elderly patients experienced less operative management (4.3%–8.2%) compared to younger adults (15.6%), with the rate of operative management decreasing with increasing age of patients. In addition, mortality rates were higher in the elderly patients when compared to their younger counterparts (P = 0.001). Elderly patients were also less likely to present with associated skull fractures, but more likely to present with TBI. CONCLUSIONS: Elderly patients presented with different causes of injury, distribution of fractures, comorbidities, and rates of operative management as well as mortality compared to their younger adult counterparts. REFERENCES: 1. Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health. 2017;142:64–69. 2. Shumate R, Portnof J, Anundson M, et al. Recommendations for care of geriatric maxillofacial trauma patients following a retrospective 10-year multicenter review. J Oral Maxillofac Surg. 2018;76:1931–1936.

Enhanced Recovery after Surgery for the Outpatient Management of Maxillofacial Trauma

Enhanced Recovery After Surgery (ERAS) is a standardized, multimodal, and multidisciplinary team approach to the perioperative care of the surgical patient. It is an evidence-based and data-driven program that incorporates preoperative, intraoperative, and postoperative steps for success. ERAS programs have achieved significantly improved outcomes by decreasing length of stay, readmissions, and opioid use following general surgery, OB/GYN, and orthopedic procedures. While protocols may be in development, no such protocols have been published in regards to the maxillofacial trauma patient. Our objective is to provide recommendations for optimal care of the maxillofacial trauma patient by adopting an ERAS protocol for optimization of nutritional, fluid, pain, and mobilization parameters leading to improved patient satisfaction.

Assessment of Incidence of Presence of Bacteria in Sutures of Maxillofacial Trauma Patients

Background: Sutures under selective host or environmental factors can potentiate postoperative surgical site infection. The present study characterized microbial recovery and biofilm formation from explanted absorbable and non-absorbable sutures from infected and non-infected sites of maxillofacial trauma patients.&#x0D; Aim: The aim of the study was to assess the incidence of microbiology of explanted suture segments from infected and non-infected maxillofacial trauma patients.&#x0D; Methods and Materials: Non absorbable and absorbable suture segments were collected at Randomly from 80 patients with two groups one group with infected sutures second group with non-infected sutures. Explanted sutures were recovered from maxillofacial trauma surgeries. Suture segments were obtained upon patient return to the clinic after seven days for review. All suture segments were collected aseptically. Designation of non-infected versus infected was determined by clinical presentation and criteria defined by the National Healthcare Safety Network of the Centers for Disease Control and Prevention. All the suture specimens were sent to University Microbiology department for bacterial culture and the results were studied.&#x0D; Results: A significant difference in mean microbial recovery between non infected and infected sutures were noted. Age distribution showed, males 86.25% and females 13.75% [Fig. 1]. Fig. 5 shows the Association of infected and non-infected suture groups with presence or absence of bacteria infected suture shows presence bacteria 13.75%, and non-infected suture showed presence of bacteria 6.25%, absence of bacteria 80.0%. Table 1- Presence or absence of infection cross tabulation showed, presence of bacteria in infected suture 11, presence of bacteria in non-infected suture 5 and absence of bacteria 64.&#x0D; Conclusion: Within the limitation of study, we found that bacterial presence on the suture has a statistically significant role in causing postoperative infection. Any suture may be considered as a port of entry for infection, which in turn may compromise healing of the surgical wound. It is advised to minimize the duration of the presence of sutures, and their removal should be carried out as early as possible, according to the specific healing conditions.

Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques.

The present study is a systematic review of the literature. The goal of this study is to review our experience and the current literature on airway management techniques in maxillofacial trauma. Independent searches of the PubMed and MEDLINE databases were performed from January 1, 2019 to February 1, 2019. Articles from the period of 2008 to 2018 were collected. All studies which described both airway management and maxillofacial trauma using the Boolean method and relevant search term combinations, including "maxillofacial," "trauma," and "airway," were considered. A total of 452 relevant articles in total were identified. Articles meeting inclusion criteria by abstract review included 68 total articles, of which 16 articles were focused on airway management techniques for maxillofacial trauma in the general population and were deemed appropriate for inclusion in the literature review. Establishing an effective and stable airway in patients with maxillofacial trauma is of paramount concern. In both the acute setting and during delayed reconstruction, special considerations must be taken when securing a reliable airway in this patient population. The present article provides techniques for securing the airway and algorithms for utilization of these techniques, including both during the initial evaluation and the definitive operative management.

Outcomes following use of a standard antibiotic protocol in the management of maxillofacial trauma patients

PurposeTo evaluate the effectiveness of a standard antibiotic regimen protocol in the management of maxillofacial trauma patients. Materials and methodsThe study sample included patients with at least one facial fracture and managed by either closed (CR/MMF) or open reduction (ORIF) by the Oral and Maxillofacial Surgery service. A standardized antibiotic administration protocol based on type of treatment performed and timing of surgical intervention was used in the management of all patients. The primary predictor variable was antibiotic usage. The primary outcome measured was postoperative surgical site infection. Bivariate analysis was performed to assess the association between antibiotic exposure and postoperative surgical site infection. A p value of less than or equal to .05 was deemed to be significant. ResultsThe study sample comprised of 392 patients (102 midface and 290 mandible fractures). The mean age of the study group was 35 years and 89% of the patients were male. Postoperative infection was encountered in 18 patients (all with compound mandible fractures). The infection rates were 3.6% after CR/MMF and 8.7% after ORIF. No patient with midface fractures developed an infection. Chi-square test showed no statistically significant difference in postoperative infection rate in mandible fractures treated either by CR/MMF (p = 0.91) or ORIF (p = 0.94). ConclusionsUse of this antibiotic administration protocol limits antibiotic usage and standardizes their administration in the management of maxillofacial trauma without increasing the rate of postoperative surgical site infections.

Prevalence of Neurologic Deficits in Combined Facial and Cervical Spine Injuries: A Retrospective Analysis.

A retrospective data analysis of maxillofacial trauma patients with combined cervical spine injuries. This study is based on investigating the importance of timely diagnosis of patients who suffer with cervical spine injuries along with maxillofacial trauma by estimating the prevalence of neurologic deficits and its relation with etiology. A database of 4460 patients suffering from maxillofacial injuries and admitted in specialized environment surgery of Government Medical College, Trivandrum, Kerala was taken under consideration. The prevalence and types of neurologic deficits and its relation with etiology were assessed in patients with combined facial and cervical spine injuries. Of 4460 patients, 48 were having cervical spine injury along with facial damage with the prevalence of 0.01%. Neurologic deficits were seen highest with etiology of road traffic accidents followed by falls from height. Most of the accidents occurred in bike riders and helmets were absent. It was concluded that most of the accidents engage bike riders and drivers, due to unethical and unsafe driving. There was no significant correlation found between facial and cervical spine injuries.

Oral and maxillofacial injuries in children: a retrospective study.

ObjectivesThe purpose of this retrospective epidemiological study was to determine the etiology and pattern of maxillofacial injuries in a pediatric population.Materials and MethodsData for pediatric maxillofacial trauma patients aged 12 years and younger who were registered at the Department of Pediatric and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, India, were reviewed and examined. Patients who were treated between October 2016 and September 2018 were analyzed according to age, sex, cause of injury, frequency and site of facial fractures, and soft tissue injuries. The chi-square tests were carried out for statistical analyses with a significance level of 5%.ResultsOf 232 patients with a mean age of 6.77±3.25 years, there were 134 males (57.8%) and 98 females (42.2%). The overall male to female ratio was 1.39:1. The most common causes of injuries were falls (56.5%) and motor vehicle accidents (16.8%). Incidence of falls decreased significantly with age (P<0.001). Dentoalveolar injuries (61.6%) and soft tissue injuries (57.3%) were more common than facial fractures (42.7%). Mandibular fractures (82.8%) were the most common facial fractures, and perioral or lip injuries were the most prevalent injuries in our patient population. There was a positive association between facial fractures and soft tissue injury (P<0.01) (odds ratio 0.26; confidence interval 0.15-0.46).ConclusionFalls were the leading cause of maxillofacial trauma in our sample of children, and the most common site of fractures was the mandible.

The Prevalence of Blood-Borne Pathogens in Maxillofacial Trauma Patients.

Blood-borne pathogen infections (BPIs), caused by the human immunodeficiency virus, hepatitis C and hepatitis B viruses pose an occupational hazard to healthcare workers. Facial trauma reconstruction surgeons may be at elevated risk because of routine use of sharps, and a higher than average incidence of BPIs in the trauma patient population. The authors retrospectively reviewed health records of patients admitted to a level 1 trauma center with a facial fracture between January 2010 and December 2015. Patient demographics, medical history, mechanism of injury, type of fracture, and procedures performed were documented. The authors detemined the frequency of human immunodeficiency virus, hepatitis B, and hepatitis C diagnosis and utilized univariable/multivariable analyses to identify risk factors associated with infection in this population. In total, 4608 consecutive patients were included. Infections were found in 4.8% (n = 219) of patients (human immunodeficiency virus 1.6%, hepatitis C 3.3%, hepatitis B 0.8%). 76.3% of BPI patients in this cohort were identified by medical history, while 23.7% were diagnosed by serology following initiation of care. 39.0% of all patients received surgical treatment during initial hospitalization, of whom 4.3% had a diagnosed BPI. History of intravenous drug use (odds ratio [OR] 6.79, P < 0.001), assault-related injury (OR 1.61, P = 0.003), positive toxicology screen (OR 1.56, P = 0.004), and male gender (OR 1.53, P = 0.037) were significantly associated with a BPI diagnosis. Patients presenting with facial fractures commonly harbor a BPI. The benefit of early diagnosis and risk to surgical staff may justify routine screening for BPI in high risk facial trauma patients (male, assault-related injury, and history of intravenous drug use).

Epidemiology and Pattern of Oral and Maxillofacial Trauma.

Maxillofacial trauma represents a serious public health problem and their epidemiology is extremely variable.The objective of the present study was to analyze and discuss the epidemiological characteristics of 2492 patients with oral and maxillofacial trauma over a 5-year period. This retrospective study was conducted at different hospitals of Xinjiang from 2012 to 2016. Data were collected for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, presence of associated injuries, nerve injury, different treatment protocols. All the data were analyzed using statistical analysis that is chi squared test.Statistical analyses performed included descriptive analysis, chi square test, and logistic regression analyses. A total of 2492 maxillofacial trauma patients were seen in 1981 patients with a male to female ratio of 3.88:1. The age group 21 to 30 years accounted for the largest subgroup in both sexes. The most common etiology of the trauma was traffic accident, accounted for 41.8%. The mandible (31.97%) was the most common site of fracture followed by the zygoma (25.3%). The common type associated injuries was limb injury (27.5%), it was followed by brain (24.5%) and eye (21.4%) injuries. The common nerve injury was the facial nerve injury, accounting for 62.9%. The incidence of oral and maxillofacial trauma is related to gender, age, and the cause of trauma. Young adults are the most likely group (P < 0.05). Maxillofacial trauma is often associated with limb, craniocerebral, and eye injuries. Traffic accident is the main cause of maxillofacial injury (P < 0.5).

Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants.

Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures. A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann-Whitney U testing. During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this cohort was 47.6 ± 20.2 years with the majority identifying as African-American (53.7%) and male (67.2%). Otolaryngologists were significantly more likely to assess pre-operative nasal obstruction (100%) compared to plastic surgeons (24.1%) (P < .001). Otolaryngology elected operative management (53.3%) at a significantly higher rate than plastic surgery (24.1%) (P = .005). Additionally, otolaryngology was significantly more likely to manage patients in an outpatient setting (91.2%), whereas plastic surgery more commonly performed inpatient management (57.1%) (P = .006). Plastic surgery averaged a significantly shorter amount of time from presentation to operative management (7.3 ± 10.7 days) compared to otolaryngology (20 ± 27.7) (P = .019). Consulting service was not associated with a need for revision surgery. Consultants across subspecialties differ in the management of nasal bone trauma. A more standardized approach is warranted by all individuals involved in the care of maxillofacial trauma patients.

To What Extent Does Illicit Drug Use Predispose to Facial Injury? An Institutional Investigation for an Emergent Problem.

There are potential substantive linkages between illicit drug use and the occurrence of injury. The purpose of our study was to determine the prevalence, class of illicit drugs abused, and demographics in relation to a cohort of patients who sustained facial injury. The authors undertook a retrospective observational study of a prospectively accessioned cohort of patients who had sustained a facial injury and presented to the John Hunter Hospital (Newcastle, NSW, Australia). The primary predictor variable was the presentation of a facial injury and the secondary outcome variables included illicit drug use, alcohol use, and socioeconomic factors. The study was carried out over a 12-month period. A descriptive analysis was undertaken on the assembled data. Of the 465 patient medical records that were accessed for the study, 348 were male and 117 were female. Their average age was 42.6 years: 5.8% (n = 27) were under the influence of illicit drugs at the time of their presentation and 13.1% (n = 61) admitted to an intercurrent illicit drug habit. Those who were under the combined influence of alcohol and drugs comprised of 2.8% (n = 13). Our study found that illicit drug use plays a small, but nonetheless, demonstrable role in the presentation of maxillofacial trauma patients to an urban level I trauma center. Illicit drug users are an emergent sociodemographic group of patients who can sustain facial trauma and their presentation needs to be appropriately considered, assessed, and managed collectively.

Time Recommendation and Alternative Parameters for Severe Maxillofacial Trauma Reconstruction

Background: Severe maxillofacial trauma often associated with other injuries, therefore the delay of reconstruction often occur until the patients are stable. Early reconstruction results a better facial function and appearances. Aim: The aim of this study to give the recommendation and alternative parameters for severe maxillofacial trauma reconstruction. Methods: The method of this study is adult patients with bimaxillary and bilateral maxillofacial trauma were eligible for this study, while pregnant women were excluded. Nine patients with maxillofacial trauma were involved in this study and we measured 15 facial anthropometric and 41 lateral cephalometricon 7, 14, 21 days compared to 3 months post-reconstruction. Results: The result of this study showed reconstruction can be planned 14 days after trauma for lower jaw fracture and 21 days after bimaxillary fracture. Lateral cephalometry was a reliable method to measure facial edema following surgery which combined facial anthropometry with lateral cephalometry using parameters that are not affected by edema. This can be applied as an additional guiding tool in surgical planning for maxillofacial trauma patients especially those with bimaxillary and bilateral fractures. Conclusion: Combination of anthropometric and cephalometric parameters which are not affected by edema can be applied as an additional guiding tool in surgical planning for maxillofacial trauma patients.