Midfacial Fractures Research Articles

Incidence of Maxillofacial Injuries in the Emergency Department-Retrospective Study.

Maxillofacial injuries are a common finding among the patients reporting to the Emergency Department. This study was conducted to evaluate the occurrence and characteristics of Oral and Maxillofacial injuries among the patients who reported to the Emergency Department at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. The study was carried out retrospectively by analysing the medical records of patients who were presented with maxillofacial injuries, under the Department of Oral and Maxillofacial Surgery over a period of nine years. A total of 2831 patients were evaluated and segregated into different age groups. Standardized data was gathered on the number and location of lacerations, abrasions, fractures of facial bones, associated head injuries and treatment done. It was found that the majority of the maxillofacial injuries reported to the emergency department are soft tissue injuries comprising of 71.49% of total cases among which 55.77% cases were with single or multiple lacerations and 15.72% cases with abrasions alone. The most common cause of facial injuries is road traffic accidents 56.8% followed by self-fall (33.8%) and assault (5.837%). The most common site of occurrence of laceration was noted to be forehead laceration (13.2%) followed by chin (10.97%), supraorbital (9.44%), upper lip (8.1%) and lower lip (5.97%). Among the fracture cases, Mid-facial fracture occurred in 58.84%, followed by mandibular fractures at 20.86% being the next most common occurrence. The results and understanding obtained from this study will be utilized to develop focused treatments for reducing the severity and frequency of maxillofacial trauma. Further, we believe that public awareness campaigns about enhanced safety measures can reduce the occurrence of maxillofacial injuries.

Motorcycle accidents and high energy midface fractures: a critical review and illustrative case

Accidents involving motorcycle riders often result in maxillofacial injuries and fractures to the midfacial skeleton are common injuries in patients who sustain high-energy trauma to their face. Objective: The aims of this study were to perform a review of the relationship between motorcycle accidents and high energy trauma resulting in midface fractures and to report the case of a motorcycle accident victim who developed a complex fracture pattern of the midface structures. Case report: A 33 year-old man, victim of a motorcycle accident and developed a complex fracture of the midfacial skeleton is reported. Surgical planning included submental intubation using a nasofibroscope and several approaches were performed to the arrangement of the midface fractures. Results/ Discussion: The rates of facial fractures caused by motorcycle accidents tend to increase, especially in developing countries. This increase is also associated with the use of motorcycles for commercial purposes. Young men are the group most involved in this type of accident. The use of helmets is related to lower morbidity in high energy trauma and facial injuries. Conclusion: Fracture patterns involving the midfacial skeleton are directly related to high-energy traumas such as those caused by motorcycle accidents. Prevention campaigns should be encouraged to reduce the high rates of facial injuries among motorcyclists.

Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases.

Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.

Changing trends in central midface fracture – A proposal for revised classification and holistic management

BackgroundMidface fractures are one of the common facial fractures encountered in the current era. High energy impact injuries that lead to gross comminution of the midface warranting modification of the standard treatment plan, often cannot be categorized by existing classification systems. The aim of the current paper is to describe the changing trends in midface fracture patterns and propose a modification for the current classification system and describe the holistic approach for management. Materials and methodsA retrospective study was conducted at our center to include all the patients who reported to us for the management of maxillofacial trauma between 2020 and 2022. The details of the cause of facial trauma and pattern of injury, clinical presentation, diagnosis were retrieved from the medical records and the radiographic details including computed tomography details of the fracture pattern were tabulated for evaluation. The Fractures which could not be classified based on the classical Le fort fracture lines were isolated and were classified based on the current classification system and the modifications in the treatment plan and management were recorded. ResultsA total of 673 trauma cases reported between the given time frame. Out of which 205 were midface fractures. 109 patients from the foresaid group had central mid face fracture. 62 fractures of these cases could not be classified based on conventional Le fort classification due to fragmentation, bone loss and combination with other Le fort level injury of the opposite side of the midface and involvement of orbit/ anterior cranial fossa. The modified Le fort classification (Table 1) was used to reclassify these fractures and according to the same 12 cases of Le fort IA, 9 cases of le fort IB, 4 cases of Le fort IIA, 20 cases of Le fort IIB, 4 cases of Le fort IIIA, 9 cases of Le fort IIIB and 4 cases of Le fort IV fracture.The details of the management strategy along with the timing of repair are discussed. ConclusionWith continual rise in the high impact injuries, the pattern of midface fracture presentation is changing. Advanced fixation modalities that are currently available can be applied only when a precise diagnosis and planning can be performed. The current modification of the midface fractures provides a better insight in defining the fracture patterns which will enable the surgeon to plan the midface reconstruction adequately.

Management of Mid-Facial Fracture Complicated by Pseudoaneurysm of Posterior Superior Alveolar Artery.

Facial fractures, particularly mid-facial fractures, can result in various complications, such as functional and esthetic problems. Prompt reconstruction of the fractured bones is crucial for restoring normal anatomy and function and preventing complications. However, such procedures can be complex and carry the risk of potential complications. The authors report the case of a 27-year-old man who underwent open reduction and internal fixation of the left zygomatic complex fracture and reconstruction of the left inferior orbital wall. During the surgery, heavy bleeding from the posterior superior alveolar artery due to a broken bone near the pterygomaxillary region caused a prolonged surgery time and the development of a pseudoaneurysm. The pseudoaneurysm was eventually treated with superselective transcatheter embolization using 25% N-Butyl cyanoacrylate glue. This case highlights the challenges in the management of mid-facial fractures and the potential complications that can arise during surgery, particularly when dealing with the pterygomaxillary region.

Etiology and Patterns of Pediatric Maxillofacial Fractures: A Retrospective Analysis at a Tertiary Level Health-care Center in Bangladesh

Introduction: We intended to retrospectively analyze the epidemiological data and pattern of pediatric maxillofacial fractures in this article. Materials and Methods: This retrospective analysis focuses on patients under the age of 18 years who were admitted to an inpatient department with maxillofacial fractures over a 3-year time at a Bangladeshi tertiary health-care center. The following variables were assessed: gender distribution, etiology of trauma, and anatomic site of fractures. Results: The majority of the 90 patients were boys (77.78%), with an average age of 12.9 years (standard deviation, 4.51 years). The result showed a ratio of 3.5:1 between males and females. The majority of patients (56.67%) were between the ages of 13 and 18 years. There was no statistically meaningful relationship (P &gt; 0.05) between the age of the patients and their gender. Road traffic accidents (RTAs; 75.56% of maxillofacial fractures) were the most common cause, followed by accidental falls (13.33%). Mandible fractures were the most prevalent (70%), followed by zygomaticomaxillary complex (ZMC; 14.45%) and mid-face fractures (5.55%). The parasymphysis (17.78%) and body (16.68%) of the mandible were the two most common unilateral fracture sites. Parasymphysis with angle was the most typical set of fracture sites in the mandible (7.79%). There was no statistically significant (P &gt; 0.05) correlation between the age of the patients and the location of the maxillofacial fracture. Conclusions: In Bangladesh, RTAs were the predominant reason for pediatric maxillofacial fractures. The mandible and ZMC were the two areas that fractured most frequently in the pediatric population.

Prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures - A retrospective cohort study

The aim of the study was to evaluate prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures.Complaints after fracture treatment and complications after plate removal were analyzed, retrospectively.A total of 205 patients were included. Plate removal was performed in 99 cases. Complaints related to the osteosynthesis material resulted in more frequent plate removal (p < 0.001). Complications were noted in 22 patients after plate removal. Duration of plate removal did not correlate with postoperative complications. In 69 patients, plates were removed without previous symptoms. Of these patients, postoperative complications were recorded in 15 cases. In patients with complaints after osteosynthesis, complications after plate removal occurred in seven (23.3%) patients. Ectropia developed significantly more often with increasing age (p < 0.05). ConclusionWithin the limitations of the study it seems that prophylactic plate removal is a treatment option that is not associated with an increased complication rate.

Relationship between midfacial fractures and maxillary sinus pathology.

Midfacial fractures frequently involve the maxillary sinus, leading to maxillary sinus pathology. We aimed to examine the incidence and contributing factors of maxillary sinus pathology in patients who underwent open reduction and internal fixation (ORIF) for midfacial fractures. A retrospective analysis was conducted on patients who underwent ORIF for midfacial fractures at our department over the past 10 years. The incidence of maxillary sinus pathology was identified clinically and/or by computed tomography findings. Factors that significantly influenced the groups with and without maxillary sinus pathology were examined. The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was found to be 11.27%, with sinusitis being the most common pathology. Maxillary sinus pathology was significantly associated with the presence of a blowout fracture involving both the medial and the inferior orbital walls. Factors such as sex, age, diabetes mellitus, hypertension, smoking, inflammatory disease, follow-up period, use of absorbable plates, and use of titanium plates did not have a significant impact on the development of maxillary sinus pathology. The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was relatively low, and in most cases, it resolved without the need for specific treatment. Consequently, there may not be a significant need for concern regarding postoperative maxillary sinus pathology.

Epidemiology of maxillofacial fractures in northwest China: an 11-year retrospective study of 2240 patients

BackgroundThe aim of this study was to determine the epidemiological pattern of maxillofacial fractures in northwestern China by retrospectively analysing the demographics, aetiologies, concomitant injuries, fracture sites, and management.MethodsA 10-year retrospective analysis of 2240 patients with maxillofacial fractures admitted to the General Hospital of Ningxia Medical University was conducted. The extracted data included sex, age, aetiology, fracture site, concomitant injuries, time of treatment, therapeutic approaches and complications. Statistical analyses were performed, including descriptive analysis and the chi-square test. Logistic regression was used to determine the impact factors of maxillofacial fractures and concomitant injuries. P values < 0.05 were considered statistically significant.ResultsThe age of the included patients ranged from 1 to 85 years, and the mean age was 35.88 ± 15.69 years. The male-to-female ratio was 3.9:1. The most frequent aetiology of maxillofacial fractures was road traffic accidents (RTAs) (56.3%), and the most common fracture sites were the anterior wall of the maxillary sinus, arcus zygomaticus and mandibular body. A total of 1147 patients (51.2%) were affected by concomitant injuries, with craniocerebral injury being the most common. Logistic regression analyses revealed increased risks of mid-facial fractures in elderly individuals (odds ratio (OR) = 1.029, P < 0.001) and females (OR = 0.719, P = 0.005). Younger patients had a higher risk of mandibular fractures (OR = 0.973, P < 0.001). RTAs increased the risk for mid-facial fractures and high falls increased the risk for mandibular fractures.ConclusionsThe maxillofacial fracture pattern is correlated with sex, age and aetiology. Patients were mainly young and middle-aged males, and the main cause of injury was RTAs, mostly causing compound fractures. Medical staff must be systematically educated to comprehensively examine patients with injuries resulting from RTAs. The management of patients with fractures requires thorough consideration of the patient’s age, aetiology, fracture site, and concomitant injuries.

Retrospective Analysis of Management of Zygomatic Complex Fractures

Introduction Zygomatic bone and its surrounding bony anatomy are essential for maintaining facial contour—cheek prominence and orbital integrity. Management of the zygomatic complex (ZMC) fractures are important in the maintenance of function and facial integrity. Aim and Objectives To analyze the incidence, aetiology, surgical management, and complications encountered in the treatment of ZMC fractures in our super-specialty hospital, and to compare the number and location of fixation points and surgical access in our patient cohort with the literature. Materials and Method Retrospective analysis of all operative cases (Open Reduction and Internal Fixation) of ZMC fractures over a 3-year period (2017-2021) were reviewed. Craniofacial maxillofacial trauma patient’s medical records were collected and out which only the ZMC fracture cases were reviewed. Only the medical records from the period from 2017 to 2021 were included. The parameters such as etiology, site of the ZMC fracture, type of fracture, associated injuries, clinical findings, treated with conservative or surgical intervention, type of incisions used, number of fixation used, and any complications encountered were reviewed and analyzed. Results Out of 428 cases of craniofacial injury, 96 cases were ZMC fractures, isolated ZMC fractures accounted for 43%, 33% with associated injuries, 13% isolated arch, while 11% accounted isolated infraorbital rim fracture. Most common clinical findings were subconjunctival ecchymosis (71%), flattening of cheek (39%), malocclusion (22%), and so on. Buccal sulcus incision (66%) was mainly used, followed by upper blepharoplasty incision (59%). Depending on degree of displacement of fracture 1-point fixation (8%), 2-point fixation (30%), or 3-point fixation (27%) was performed. About 33% of cases were conservatively managed and followed up on regular intervals. Lymph edema, infra orbital paresthesia, temporary blindness, diplopia, hemianopsia were some of the complications encountered which were managed successfully and followed up. Conclusion ZMC fractures are most commonly occurring midface fractures with variable etiologies. The most common ZMC fracture pattern was tripod type of fracture. Greater portion of the patient were treated with 2-point fixation. Most of the complications were due to the impact and velocity of trauma.

Clinical Patterns and Treatment of Pediatric Facial Fractures: A 10-Year Retrospective Romanian Study.

Pediatric facial fractures have different clinical patterns and require different therapeutic approaches in comparison with those of facial fractures that occur among adults. The aim of this study was to describe the main clinical characteristics of pediatric facial fractures (such as fracture location, fracture pattern, treatment, complications and evolution) in a group of pediatric patients from NW Romania. This research was a retrospective study that was conducted for 10 years in a tertiary hospital for oral and maxillofacial surgery from NW Romania. A total of 142 pediatric patients were included in this study, with ages between 0 and 18 years. Mandibular (66.2%), midface (25.4%) and combined fractures (8.5%) were identified, and patients from the 13-18 years age group were more frequently affected by facial fractures (78.9%). Most of the diagnosed fractures among all three types of fractures were total fractures, and most mandibular (92.6%) and midface (80.6%) fractures were without displacement. Hematomas, lacerations and abrasions were identified as associated lesions. Patients with associated lesions were more frequently associated with combined fractures or midface fractures than mandibular fractures. The instituted treatment was, in general, orthopedic, for all three types of fractures (mandibular-86.2%; midface-91.7%; combined-66.7%). Most fractures, mandibular (96.8%), midface (100%) and combined (91.7%) fractures, had a favorable evolution. Most fractures did not present any complications at the follow-up. Pediatric facial fractures have unique patterns and must be treated with caution, considering the particularities of pediatric facial anatomy.

New Year's Eve in otorhinolaryngology: a 16-year retrospective evaluation

PurposePyrotechnics are a long-standing tradition at the turn of the year. There are little data available on New Year's Eve-associated ORL injuries. Due to restrictions during the Corona pandemic, the handling of fireworks and meetings on New Year's Eve 2020–2022 had been significantly changed. Our aim was to analyze first data about New Year's Eve-associated ORL injuries.MethodsA retrospective analysis of 16 turns of the year (2006–2022) at a University ORL department was performed. The 2 recent years were influenced by the changes and restrictions of the COVID-19 pandemic.ResultsOf 343 emergency presentations, 69 presented with New Year's Eve-associated reasons (20%). 72% were male, 15.9% were underage. 74% presented for fireworks-related injuries, 19% due to violent altercations. Noise trauma was present in 71%. The average number of New Year's Eve-associated emergency patients per year and the average total number of patients were reduced by more than half under COVID-19 pandemic conditions.ConclusionsNew Year's Eve-associated ORL injuries range from inner ear trauma to midface fractures. Long-term damage may include hearing loss and tinnitus. These results shall support the responsible use of fireworks even after the end of the special regulations of the COVID-19 pandemic.

PREVALENCE OF MAXILLOFACIALFRACTURES REPORTEDAT ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL, MELMARUVATHUR, TAMILNADU, INDIA

Background: This retrospective study reviews the maxillofacial fractures over a 2 year period at Adhiparasakthi dental college and hospital Melmaruvathur, tamilnadu, India Introduction: To analyze the most frequent causes, sites, treatment modalities,age and gender wise distribution of maxillofacial fractures. Study design: Over a two-year period (from Jan2020 to Dec 2021), the medical records and radiographs (OPG, PA mandible, occipitomental and submentovertex view) of 223 patients treated for maxillofacial fractures at Adhiparasakthi dental college and Hospital were reviewed. A variety of parameters were assessed and recorded, including the patient's age, gender, race, occupation, and mechanism of injury, type of facial injuries, treatment modality, and postoperative complications. Results: Medical records of 223 patients with maxillofacial fractures were reviewed. Among them 184 (82.5%) had mandibular fractures whereas 39 (17.5%) had midface fractures. Most patients with mandibular fractures had fractures of the symphysis and parasymphysis 62(27.8%) while fractures of the zygomaticomaxillary complex (ZMC) were more common in the midface 15 (6.7%). Most patients were in the 21-30 year old age group, and the male: female ratio was 2.8:1. Road traffic collision was the most common cause that accounted for 127 (57%) of cases. Maxillomandibular fixation (MMF) was the most common type of treatment modality used, 129 (58%) cases were treated with this method and 42% were treated by ORIF+IMF. Conclusion: The most common etiology of maxillofacial injury was road traffic accidents (RTA) followed by falls and assaults, the sports injuries seem to be very less.The majority of victims of RTA were young adult males between the ages of 21 to 30 years.Mandible was the most common sites of fracture,followed by the maxilla. Majority of mandibular fracture occurred at symphsis and parasymphsis region,In Maxilla, majority of the fracture occurred at zygomatic complex region.Majority of cases were treated with maxillomandibular fixation (MMF). Open reduction and internal fixation were performed for indicated fracture patients.Clinical Significance: This research has essential significance in the specialty of maxillofacial surgery.It presents the occurrence of maxillofacial fractures in a particular population and also the ability of a dental surgeon in treating and restoring normal function in the maxillofacial region

Examining the Risk of Concussion in Children With Facial Fractures: A Large Emergency Department-Based Analysis

Background: Children who sustain injuries resulting in facial fractures are at risk for concomitant concussion. Prompt diagnosis and appropriate management of concussions are crucial in preventing neurocognitive impairment. The goal of this study is to examine the relationships between distinct craniofacial fracture patterns, injury mechanism, and concussion in pediatric patients. Methods: A retrospective review of 3334 patients &lt;18 years of age who were evaluated at a pediatric level I trauma center from 2006 to 2021 for facial fractures was performed. Data collected included patient demographics, mechanism of injury, documentation of concussion, and facial fracture type. Patients with an intracranial injury were excluded. Results: Two hundred twenty-seven patients met inclusion criteria (67.9% male), mean age at injury was 12.3 ± 4.3 years. Overall, concussions were more common in children &gt;12 years old (54.2%), with sports as the most common cause of injury (32.5%). In patients &lt;12 years, motor vehicle accidents were the main cause of injury (30.6%, P &lt; .001). Zygomaticomaxillary complex and maxillary fractures were associated with higher rates of concomitant concussion. Patients with a history of prior concussion were 3.4 times more likely to present with another concussion (odds ratio, 3.4; 95% Cl, 1.7-6.9). Conclusions: Nearly 7% of pediatric patients with facial fractures in this retrospective series were diagnosed with a concomitant concussion. The results suggest that a higher index of suspicion for concussions should be maintained for patients with midface fractures and those with a previous history of concussions.

Descriptive and Surgical Analysis of 196 Cases of Traumatic Maxillofacial Fractures: An experience of 6 years

Aims To analyze the etiology, anatomical pattern, and management of upper, midface, and lower face fractures pertaining to our demography and compare our results with other regions and worldwide. Materials and methods A 6-year retrospective record analysis from 2013 to 2018 of eligible patients’ data was recorded with a prepared proforma. Demographic parameters including age, sex, etiology, anatomical site, closed or open, displaced or un displaced fracture, type of treatment, associated with head injury, and implants used were evaluated. Inclusion criteria were all patients with facial bone fractures irrespective of age and gender. Exclusion criteria were patients with pure soft tissue injury of the face and with facial burns. Results Most were involved with multiple facial bone fractures. Out of 196, 72 patients (pts) had involvement of mandible fractures, 79 had involvement of the maxilla, 65 zygoma, 68 nasal bone, 42 orbital wall, 21 frontal bone with processes, and 7 NOE involvement. The most frequent etiologic factor was detected to be road traffic accidents (RTA; 162 ,83%), due to falling (24, 12%), and assault (10, 5%). In total, 173 were male (88%) and the rest 23 were female (12%). The mean age was found to be 29 years. Twelve patients (6.1%) were less than 14 years of age. Most RTAs had occurred in young adults from 16 to 30 years of age group. We analyzed individual bone fracture involvement and compared it with other geographical locations. Conclusions Most facial fractures are combined involving multiple bones in young adults with RTA as the most common etiology. There was a balance seen in managing the facial fractures between conservative and operative methods. These data provide us the information in evaluation of the preventive measures to be taken and give the direction of focusing the clinical and research priority in the future.

Justifying the implementation of intraoperative computed tomography for midface fracture treatment in improving outcomes

Intraoperative CT scanning is the international standard for treating midface fractures as it allows intraoperative assessment of reduction and fixation. To our knowledge, no NHS hospital in the UK has this facility yet due to the financial and logistical burden of its implementation. The aim of this study was to determine if complications including the requirement for a return to theatre (RTT) could have been predicted from the post-fixation CT scan. All treated midface fractures that had presented to a regionalised major trauma centre within two years (01 January 2020 - 31 December 2021) were identified. Those developing complications including RTT were determined. All postoperative CT scans (including those without complication or RTT) were re-analysed with the clinicians blinded to the outcomes to determine the positive predictive value (PPV) and negative predictive value (NPV) of requiring RTT to alter plate position intraoperatively based on CT scan alone. In all, there were eight episodes of unplanned return to theatre, resulting in an overall RTT rate of 8/119 (6.7%). When only analysing patients treated for orbital fractures this RTT rises to 8/40 (20%). Of those eight patients who had a postoperative CT and required RTT, this could have been predicted in 7/8 (87.5%). A total of 16/44 (36.4%) patients that did not have RTT would have additionally been recommended to have the plate position altered based on CT alone. Based upon those that had a CT, the PPV of CT alone being able to predict those requiring RTT was 40.6% and the NPV 96.2%. Our results would suggest intraoperative CT would likely have prevented eight patients requiring RTT in two years and could have improved outcomes in 16 cases. In preventing RTT as well as potentially improving the outcomes of a further 16 cases in maxillofacial surgery, the purchase of an intraoperative CT scanner could yield net savings of £75534-£114990 over two years.

Risk Factors for Acute Postoperative Complications Following Operative Management of Le Fort Fractures-A NSQIP Study.

Le Fort fractures comprise a pattern of complex midfacial fractures that arise secondarily to craniofacial trauma. Although management of these fractures has been detailed within the literature, there is a paucity of research examining postoperative outcomes after surgical repair. The primary aim of this study is to assess patient outcomes after operative management of Le Fort fractures, and examine factors influencing the risk for developing postoperative complications, through utilization of the ACS-NSQIP database. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for cases recorded between 2012 and 2019 with International Classification of Disease (ICD)-9 and ICD-10 codes corresponding to Le Fort fractures. Patient demographics, clinical variables, and postoperative variables were recorded. Logistic regression analysis was conducted to identify independent risk factors for postoperative complications. Identification of cases with appropriate ICD codes, and exclusion of those with missing data, yielded 562 patients for analysis. There were no cases of minor complications and 14 cases of severe complications (3 cases of wound dehiscence, 3 cases of transfusion requirement, 1 case of failure to wean from the ventilator for more than 48 h, 1 pulmonary embolism, and 8 cases of reoperation), corresponding to an overall complication rate of 2.49%. Logistic regression analysis revealed steroid use as an independent predictor of severe postoperative complications (OR =13.73, 95% CI: 1.08-128.02, P =0.02). The present study is the first to conduct a risk factor analysis of patients with Le Fort fractures using the ACS-NSQIP national database. The overall postoperative complication rate was 2.49%, with 14 cases of complications recorded in 8 years. Although this may suggest that surgical management of Le Fort fractures is generally well-tolerated, it should be noted that this problem is frequently associated with other severe injuries of the head and neck that may influence patient prognosis. Given this, further analysis would benefit from a larger patient cohort and longer postoperative data as the ACS-NSQIP database only records outcomes within 30 days.

Assessment of Change in Patterns of Mid Face Fractures by Using Computed Tomography Scans

Assessment of Change in Patterns of Mid Face Fractures by Using Computed Tomography Scans

Retrospective comparison of one-stage and two-stage orbital reconstruction in patients suffering from combined injuries of the midface

Reconstruction of the bony orbit in patients with combined midface injuries is frequently discussed in the current literature. Two main concepts can be distinguished: single-stage reconstruction, usually with a hand-bent titanium orbital mesh, and two-stage reconstruction, in which osteosynthesis of the zygomaticomaxillary complex (ZMC) is followed by orbital reconstruction with a virtually-planned, patient-specific titanium implant in a second surgery. This study aimed to compare one-stage and two-stage surgical approaches on combined midface fractures regarding postoperative diplopia. A total of 58 patients treated with one-stage (n = 29) or two-stage (n = 29) reconstruction of the ZMC and orbit were included, and their postoperative course over five months was retrospectively analysed. A descriptive quantitative analysis of the course of occurrence of diplopia was recorded to calculate the success of orbital repair in complex midface fractures including the orbit. The two workflows differed in the prevalence of postoperative clinical diplopia and eyelid complications. Multiple factors affect the decision whether or not to reconstruct the orbit first, and in the same intervention as the associated midface fracture. Thorough evaluation of each individual patient with a patient-specific choice of surgical concept is crucial, and includes multiple factors.

A retrospective study – Pattern of maxillofacial injuries in government dental college and hospital Aurangabad, Marathvada region

Government dental college and hospital in Aurangabad, India's state of Maharashtra. Traffic accidents were found to be the most common cause of facial fractures (55.1%), with a male preponderance and a peak incidence between the ages of 20 and 30. The most frequent type of fractures were isolated mid-face fractures (586 patients; 24.05%), followed by isolated mandibular fractures (1257 patients; 51.6%). The zygomatic bone and arch were most frequently involved in midface fractures. The majority of the time, closed reduction and internal fixation were used instead of open reduction and internal fixation. According to the study's findings, traffic accidents are the main reason for maxillofacial fractures. Every citizen is required to enforce and abide by laws that establish preventative measures.