Facial Trauma Research Articles

Important Functional Aspects on Face Transplantation. Current Literature Review

Patients who suffer severe facial trauma not only face the burden of social isolation due to disfigurement, but they also frequently lose the ability to breathe on their own, eat without the use of substantial accommodations like straws or pureed food, or communicate verbally or through expressions. FT may be beneficial in improving quality of life and may even be able to avert potentially fatal consequences. To overcome the experimental nature of FT and strengthen evidence, future outcome reports should include information on problems and the capacity to smell, breathe, eat, speak, grimace, and feel facial sensations before and after FT. Unfortunately, many data are lacking from these reports.

Reconstruction of the orbitozygomatic framework: State of the art and perspectives

The reconstruction of the whole orbitozygomatic framework (OZF) is complex and can be encountered in cases of congenital midface deformity, after tumor ablative surgery and in severe facial trauma. Nowadays, surgeon has a wide range of available techniques that have continually grown over the past years, optimizing the surgical management and the aesthetical outcomes. Among them, the autologous bone graft (ABG) remains one of the most suitable options : ABG is easy to harvest and has optimal biological properties for bone healing. It can be tailored to the patient anatomy thanks to the recent advances in computer-assisted surgery. However, substantial drawbacks remain such as the early resorption of the non-vascularized graft, the need of a donor site and its potential morbidity. Alloplastic reconstruction is another option that can resolve both the resorption issue and the donor site morbidity. Moreover, the 3D-printing technologies also allows the manufacturing of patient specific implants. However, alloplastic materials have a variable success, especially due to the high risk of infection or exposure. Consequently, regenerative medicine is a promising field that aims to find a procedure without the disadvantages of ABG or alloplastic based reconstructions, but displaying similar or even higher success rate. Indeed, recent tissue engineering strategies have demonstrated encouraging results for bone regeneration using natural or synthetic biomaterials, patient cells and synthetic bioactive substances. The objective of this review is to present the etiologies of OZF defect, the available reconstruction procedures as well as the current state of the research.

Facial trauma in the major league baseball

ObjectivesThe objectives of this study were to identify and describe significant facial trauma present in the Major League Baseball (MLB) that resulted in players missing games or in the injury reserve list. Study designThis a retrospective cohort study. The predictor variables were player's age, height, weight, and body mass index (BMI), position, team conference and if played games were playoffs. The outcome variables were injury location (upper, middle, and lower facial third) and type of injury (soft tissue, fracture). Chi square and logistic regression were computed to determine associations between predictor and outcome variables. ResultsA total of 109 players missed games due to facial injuries, and a total of 115 injuries were identified. Of the 115 injuries, none occurred in the upper facial third, 96 (83%) were in the middle third, and 19 (17%) in the lower third. Most fractures occurred in fielders (45%); and most soft tissue injuries in basemen (40%). ConclusionSignificant facial trauma in the MLB has risen in recent years. The player's height, conference and playoff games were the most associated factors. Most injuries occurred in the periorbital area, a recommendation towards the use of protection goggles can be made to prevent them.

Maxillofacial trauma and its management presenting at a tertiary care hospital in Lahore during Covid-19 pandemic.

The objective of this study was to assess the patterns of maxillofacial injuries, aetiology and their management during the pandemic of Covid-19 in a tertiary care hospital in Lahore, Pakistan. This is a single center, prospective cross-sectional study. Patients from all age groups who presented at the Emergency room of Jinnah Hospital Lahore and managed by the Oral and Maxillofacial Surgery Department during 1st December 2020 till 31st January 2021 were included. Data were analyzed using IBM SPSS for Windows, Version 20.0. Total 202 patient were analyzed, 161 (79.7%) were male and 41 (20.3%) were females. Male to female ratio was 4:1. About fifty three percent of patients belonged to the age group 15-35 years. The most common cause was road traffic accidents (RTA), followed by fall. Eighty-three (41.1%) had only soft tissue injuries without any bony fracture and 119 (58.9%) had facial bones fractures. Zygomatic bone fracture was most common (53.8%) followed by mandible fracture (31.1%). Sixty-one out of 119 patients with fractures were treated with Open Reduction Internal Fixation (ORIF). Three patients had complete loss of vision because of facial trauma. Only 56 (28%) patients were managed under General Anaesthesia. During the initial pandemic era, a large majority of patients presenting with maxillofacial injuries were young male adults. The most common cause of maxillofacial trauma was RTAs. Soft tissue injuries were predominant followed by facial bone fractures and zygomatic bone was more frequent among the fracture cases. Covid-19 pandemic increased the difficulties faced in the management of maxillofacial trauma patients.

Management of frontal sinus trauma: a retrospective study of surgical interventions and complications

BackgroundFrontal sinus injuries are relatively rare among facial bone traumas. Without proper treatment, they can lead to fatal intracranial complications, including meningitis or brain abscesses, as well as aesthetic and functional sequelae. The management of frontal sinus injuries remains controversial, with various treatment methods and outcomes being reported. This article describes the clinical characteristics, surgical methods, and outcomes among 17 patients who underwent surgery for frontal sinus injury and related complications.Case presentationWe retrospectively included 17 patients who underwent surgery for frontal sinus injury and its related complications at the Kangwon National University Hospital between July 2010 and September 2021. Among them, six underwent simple open reduction and fixation of the anterior wall, eight underwent sinus obliteration, and three underwent cranialization. Two patients who underwent sinus obliteration died due to infection-related complications. The patient who underwent cranialization reported experiencing chronic headache and expressed dissatisfaction regarding the esthetic outcomes of the forehead. Except for these three patients, the other patients achieved satisfactory esthetic and functional recovery.ConclusionActive surgical management of frontal sinus injuries is often required owing to the various complications caused by these injuries; however, several factors, including the fracture type, clinical presentation, related craniomaxillofacial injury, and medical history, should be considered while formulating the treatment plan. Surgical treatment through the opening of the frontal sinus should be actively considered in patients with severely damaged posterior wall fractures and those at risk of developing infection.

Children mandibular fractures: Epidemiological and anatomo-clinical aspects

IntroductionMaxillofacial trauma in children is uncommon, accounting for between 1 % and 14 % of all facial trauma in the general population. ObjectiveTo describe the epidemiological and anatomical-clinical aspects of mandibular fractures in children. Material and methodThis was a retrospective descriptive cross-sectional study with non-probabilistic accidental sampling. It took place in the maxillofacial surgery and stomatology department of Cocody University Hospital in the Republic of Côte d'Ivoire, over a 20-year period (2000–2019). The study population consisted of patients aged 0–16 years admitted to our department for a mandibular fracture. At the end of this study, we identified 58 patients. Data was entered using Excel 2016. Tables and graphs were processed using Excel version 2016. Resultswe have identified 58 patients. The mean age of patients was 9.35 ± 2.1 years, with extremes of 1 and 16 years, and a sex ratio of 2,22 in favouring men. The 6–12 age group was the most affected (n: 34 cases or 60.35 %). Soft tissue wounds were present in all our patients, followed by peri-mandibular swelling (n: 37 cases or 63.79 %) and disorders of the dental articulation (n: 28 cases or 48.2 %). Condylar fractures were the most frequent (46.87 %).Mandibular fracture lines were uni-focal in 75 % of cases. These fractures were associated with other facial lesions in 48.28 % of cases and with extra-facial lesions in 34.48 % of cases. ConclusionMandibular fractures are common in maxillofacial trauma in children. Condylar fractures are the most common, almost always associated with chin injuries. Hence the importance of a systematic examination of the mandibular condyles.

Intraoral Approach for Zygomaticomaxillary Complex and Orbital Floor Fracture With a Customized Ballooning Technique.

The zygomaticomaxillary complex and the orbital floor are commonly affected by mid-face fractures; their fractures pose challenges in reconstruction and can result in complications, such as enophthalmos. This study explores an intraoral approach with the help of a customized balloon technique and a contrast agent as an alternative to the conventional methods. A case report of a 67-year-old man with complex midfacial trauma is presented. The surgical process involved open reduction through an intraoral approach along with a transantral approach with the customized balloon technique. The procedure aimed to achieve reduction, fixation, and reconstruction of a complex mid-face fracture.

The effectiveness of electronic screening and brief intervention for alcohol-related maxillofacial trauma: a randomized controlled trial

ObjectivesThis study aims to deliver a novel web-app-based electronic Screening and Brief Intervention to patients with alcohol-related facial trauma and assess changes in at-risk drinking behaviors and attitudes towards their drinking and alcohol-related trauma. Study design, setting, and sampleThis was a two-arm parallel randomized controlled trial. Participants who had sustained alcohol-related facial injuries were recruited from three Australian hospitals. Results56 participants were enrolled and randomized initially with 45 participants completing the questionnaire at baseline and 3-month follow-up. Most of the participants were male (71.1%), aged between 18 and 29 (40%), and presented to the ED for the first time (68.9%). The study revealed that the intervention group participants found the information provided via the e-SBI helpful in changing their drinking habits and seek help. The e-SBI intervention had a moderate effect on ASSIST Scores (d=-.59; 95% CI, -.03, 1.18). The effect sizes of the e-SBI on the secondary outcomes also ranged between small and moderate. ConclusionsThe novel app-based e-SBI can effectively deliver information on harmful drinking and provide brief intervention and other venues for help and subsequently improve awareness and willingness to seek help and reduce the risk of injury recurrence. Statement of Clinical RelevanceElectronic Screening and Brief Intervention may provide a means of bypassing clinician based limitations of training and time constraints for tertiary prevention for patients who have sustained alcohol related facial trauma, this project encourages further larger studies in the future to assess the effectiveness of this modality of prevention.

Evaluation of Quality of Life and Levels of Depression, Anxiety and Stress in Patients Following Facial Trauma.

Due to the anatomical intricacy of the region and the possibility of psychological as well as physical damage, maxillofacial injuries are unusual. Studies have shown that general psychological morbidity is more prevalent following maxillofacial trauma leading to post-traumatic stress disorder and behavioural changes at various times. To evaluate the quality of life and levels of stress, depression and anxiety in patients following facial trauma. Prospective research including 30 patients with maxillofacial injuries was conducted. Based on the requirements for inclusion and exclusion, these patients were included in the trial and were provided with psychological counselling and guidance from their time of admission till the follow-up period. The baseline levels of quality of life, depression, anxiety and stress symptoms were assessed at the time of presentation (T0), 1month (T1) and 3months (T2), using the Depression Anxiety Stress Scale-21 and World Health Organization Quality of Life-BREF questionnaire. The levels of stress, anxiety and depression, as well as quality of life, did not differ significantly (p > 0.05). There is no correlation between maxillofacial trauma and levels of anxiety, depression, stress and quality of life if the subjects are exposed to psychotherapy and guidance.

RISK FACTORS, CLINICAL PROFILE, AND MANAGEMENT OF PATIENTS PRESENTING WITH EPISTAXIS: A CROSS-SECTIONAL STUDY

Objective: To analyze risk factors, clinical profile, and management strategies for patients presenting with epistaxis. Methods: This was a cross-sectional study that was undertaken in the department of otorhinolaryngology at a tertiary care medical college. 60 adult patients presenting with epistaxis were included in this study. Demographic details, such as age and gender, were noted. Patients were evaluated for the presence of risk factors such as hypertension, bleeding disorder, or clotting defects. The clinical presentation of patients was also studied. Patients were managed as per standard protocol. Statistical analysis was done using SSPS 21.0 software, and p<0.05 was taken as statistically significant. Results: There were 44 males (73.33%) and 16 females (26.67%) with a M: F ratio of 1:0.36. The mean age of male and female patients was found to be 63.48±16.18 and 58.46±13.24, respectively. Assault or road traffic accidents, which were seen in 15 (25.00%) patients. The other common causes included hypertension (18.33%), nose picking (15%), and medication (such as antiplatelet or anticoagulant drugs)-induced (10%). Out of 60 patients, the majority (60.00%) were stable hemodynamically. 11 (18.33%) patients were found to have elevated blood pressure in addition to epistaxis. 5 (11.67%) patients were in hypotension, and hence fluid resuscitation was required. In 2 (3.33%) patients, the airway needed to be secured because of a compromised airway. The majority of the patients (75.00%) responded well to conservative measures. Posterior nasal packing (in addition to anterior nasal packing), cauterization, closed reduction of facial fractures, surgery for nasal mass, and functional endoscopic sinus surgery in remaining patients. Conclusion: Facial trauma, hypertension, and nose picking were the most common cases of epistaxis. Majority of the patients were hemodynamically stable and could be treated conservatively with measures such as medical management and anterior nasal packing.

A review on artificial intelligence for the diagnosis of fractures in facial trauma imaging.

Patients with facial trauma may suffer from injuries such as broken bones, bleeding, swelling, bruising, lacerations, burns, and deformity in the face. Common causes of facial-bone fractures are the results of road accidents, violence, and sports injuries. Surgery is needed if the trauma patient would be deprived of normal functioning or subject to facial deformity based on findings from radiology. Although the image reading by radiologists is useful for evaluating suspected facial fractures, there are certain challenges in human-based diagnostics. Artificial intelligence (AI) is making a quantum leap in radiology, producing significant improvements of reports and workflows. Here, an updated literature review is presented on the impact of AI in facial trauma with a special reference to fracture detection in radiology. The purpose is to gain insights into the current development and demand for future research in facial trauma. This review also discusses limitations to be overcome and current important issues for investigation in order to make AI applications to the trauma more effective and realistic in practical settings. The publications selected for review were based on their clinical significance, journal metrics, and journal indexing.

Penetrating Mid-facial Injury from a Wooden Branch

This case report discusses the management of a patient with severe penetrating wooden branch wounds to the left mid-face following a fall in the garden. Penetrating trauma is classified as an injury that is caused by a foreign object piercing the skin, causing damage to the underlying tissues resulting in an open wound. Penetrating injuries to the head and neck often require attendance to an emergency care unit and subsequent treatment. There are numerous vital structures that can be affected and an understanding of the complex anatomy is vital to the safe management of these patients. CPD/Clinical Relevance: Treatment of facial trauma demands comprehensive understanding of the vital structures of the head/neck along with efficacious treatment delivery.

Perfil de pacientes acometidos por trauma no complexo bucomaxilofacial: um estudo epidemiológico em um hospital no norte do Piauí

ABSTRACT Objective: The objective of this work is to analyze and describe the profile of patients affected by trauma to the oral and maxillofacial complex treated in a hospital in the north of Piauí. Methods: The medical records of patients undergoing surgical treatment by the Oral and Maxillofacial Surgery and Traumatology Team of the Chagas Rodrigues Regional Hospital were evaluated, since the beginning of the program, between July 2022 and October 2023. Results: It was observed that male individuals in the 32-year-old age group are the most affected by facial trauma, corresponding to 80,68% of cases, with a predominance of injuries in the orbito-zygomatico-maxillary complex (OZMC), accounting for 39,56% of the total fractures in this study, with motorcycle accidents as the main etiological factor (76,14%), in these cases, the most common treatment procedure was osteosynthesis of the orbito-zygomatic-maxillary complex (32,97%). Conclusion: It is concluded that trauma should not only be seen as a medical complication, but also as a social and economic problem, therefore it is necessary to create and implement traffic awareness and prevention measures regarding facial trauma.

The immediate impact of mandatory helmet law on maxillo-facial trauma: A comparative study in a major trauma center, Uttar Pradesh.

To analyze the effect of the mandatory helmet rule in helmet usage among motorcycle riders and on facial trauma and to determine the significance of difference in the possibility of facial trauma between the helmeted and non-helmeted motorcycle riders. A retrospective comparative study conducted in a major trauma center at Uttar Pradesh. Data for the present study was obtained from records of the Emergency Department of Trauma Center, for a period of two months before and after the implementation of The Motor Vehicles Act in UP. The study included patients with a history of non-fatal motorcycle accidents who sustained facial injuries regardless of the presence of injuries to other areas of the body during the study period. Information regarding helmet usage during the accident was also recorded. The results were compared between the pre-law period and post-law period. Sample t-test was applied to find the level of significance. Out of 219 injured patients, 152 (69.40%) subjects were not wearing helmets, whereas only 67 (30.59%) subjects were wearing helmets. It was observed that around 68.18% of people stated wearing helmets after law implementation with a statistical significance (P value < 0.05). Our study shows that the mandatory helmet rule with elevated penalty rates has significantly increased the usage of helmet among the motorcycle riders, and it also proves that the possibility of facial trauma is significantly higher in non-helmeted riders when compared to helmeted riders.

Role of procalcitonin, interleukin-6 and interleukin-10 as a predictive marker for the use of perioperative steroid in maxillofacial trauma patients

Maxillofacial trauma often brings significant challenges for surgeons in terms of preoperative oedema. Steroids offer oedema reduction, yet potentially increase the risks of postoperative infection. This study explores procalcitonin (PCT), as a marker for bacterial infection risk, and interleukins IL-6 and IL-10, which respectively signify pro-inflammatory and anti-inflammatory responses, as potential indicators of infection and inflammation in these trauma cases and thereby aid in refining perioperative guidelines for the use of steroids. A prospective study was conducted at a tertiary public hospital in India from 2019 to 2022 on patients >18 years with facial trauma. After specific exclusions, patients were randomised into steroid (Group A) and non-steroid (Group B) groups. Various parameters including oedema, PCT, IL-6, and IL-10 levels were measured and analysed using SPSS software. Out of 80 patients, 44 were in Group A and 36 in Group B. Post-24 hours, Group A showed significant oedema reduction, with 25 patients displaying a decline to mild oedema, versus 10 patients in Group B (p = 0.034). However, Group A witnessed a higher infection risk, with 20 patients showing positive wound cultures versus three in Group B. Subgroup analysis revealed a link between higher PCT levels and infections (p = 0.039). Additionally, Group A showed less intraoperative bleeding and reduced operating time. While perioperative steroids mitigate swelling, they might increase postoperative infection risk. Elevated PCT levels indicate potential wound infections, suggesting those patients should avoid perioperative steroids. IL-6 and IL-10 trends during perioperative phases can predict pronounced oedema outcomes.

Oral Rehabilitation with Removable Partial Denture in a Patient with a Maxillary Defect Caused by a Firearm

The use of Removable Partial Denture (RPD) for the oral rehabilitation of patients who have suffered facial trauma and consequent tooth loss of several elements, serves as an alternative for replacing hard and soft tissues, as well as providing aesthetic and functional support. Facial trauma related to firearm injuries is a challenge for the surgical team, both in planning and during surgery, due to the destruction of anatomical planes and the multifragmentation of soft tissues and bone. The aim of this study is to report on the oral rehabilitation using removable prostheses of a patient who had suffered firearm trauma. Patient F. B. C., 30 years old, male, normosystemic, attended the postgraduate dental prosthesis clinic at Unichristus with the aim of rehabilitation after a firearm trauma. During the clinical assessment, a bone defect was observed in the anterior region of the maxilla, with the loss of several teeth and part of the alveolar bone structure. The plan was designed to rehabilitate the extensive bone loss caused by the trauma, through the use of an RPD, to promote the return of masticatory function, the patient's facial aesthetics and soft tissue support. The prosthesis was designed to use the remaining posterior teeth as a support and means of retention, aided by full coverage of the palate in order to bring more stability and comfort to the patient. At the end of the treatment, the aesthetic and functional aspects were restored, showing that this type of prosthesis is an alternative for rehabilitation in this type of case

Cryptococcus neoformans and cryptococcosis: a contribution made by Prof. Dr. Mahendra Pal

Mycotic infections are reported to occur in both sexes, all age groups, in all seasons, and in urban and rural areas of the world. The people with weakened immune systems are more likely to get an infection due to fungi, which are widely prevalent in our environment. Cryptococcosis primarily caused by Cryptococcus neoformans is a life-threatening enigmatic mycosis of global importance. It is estimated that 1000000 cases of cryptococcal meningitis complicating HIV/AIDS are reported every year worldwide. Disease has been encountered in humans as well as in a variety of animals including cats and dogs. The source of infection is exogenous, as the fungus occurs as a saprophyte in nature. Currently, the pigeon excreta serve as the chief saprobic reservoir of C. neoformans. Human as well as animals may acquire the infection from the environment where the fungus grows luxuriantly. The respiratory tract is recognized as the principal mode of entry of the organism. The pathogen can also enter through the fungal contaminated objects via traumatized skin. Clinical spectrum of disease is varied, as manifested with several forms, such as pulmonary, meningeal, visceral, osseous, and cutaneous. The laboratory help is imperative to confirm an unequivocal diagnosis of cryptococcosis. The pathogen can be easily isolated from the clinical specimens of the patients on Pal sunflower seed medium. Modified Pal sunflower seed can be employed to undertake the sexual compatibility studies of Cr. neoformans. Several drugs including amphotericin B, fluconazole, and itraconazole have been recommended for the treatment of disease. The immediate attention to the skin injury and use of face mask when dealing with avian droppings can help in the prevention of infection.

ПРИМЕНЕНИЕ МАЗИ ТРАУМЕЛЬ® С В КОМПЛЕКСНОЙ ТЕРАПИИ ПОСТТРАВМАТИЧЕСКОГО СОСТОЯНИЯ В ПРАКТИКЕ ОТОРИНОЛАРИНГОЛОГА

A clinical case describes the treatment of facial and nasal trauma in a child complicated by rhinosinusitis. The choice of optimal treatment tactics allows you to eliminate the adverse cosmetic and pathophysiological consequences of the injury.

Features and networks of the mandible on computed tomography.

The mandible or lower jaw is the largest and hardest bone in the human facial skeleton. Fractures of the mandible are reported to be a common facial trauma in emergency medicine and gaining insights into mandibular morphology in different facial types can be helpful for trauma treatment. Furthermore, features of the mandible play an important role in forensics and anthropology for identifying gender and individuals. Thus, discovering hidden information of the mandible can benefit interdisciplinary research. Here, for the first time, a method of artificial intelligence-based nonlinear dynamics and network analysis are used for discovering dissimilar and similar radiographic features of mandibles between male and female subjects. Using a public dataset of 10 computed tomography scans of mandibles, the results suggest a difference in the distribution of spatial autocorrelation between genders, uniqueness in network topologies among individuals and shared values in recurrence quantification.

Facial trauma undergoing surgery: A 10-year epidemiological analysis in the interior of Brazil

Facial trauma undergoing surgery: A 10-year epidemiological analysis in the interior of Brazil