Multiple Facial Fractures Research Articles

A Case Study of Pan-Facial Trauma with Subsequent Chronic Hyponatremia

Pan-facial trauma represents a complex pattern of injuries requiring meticulous surgical planning and comprehensive post-operative care. We present a case of a 51-year-old male smoker who sustained severe pan-facial trauma. Initial evaluation revealed multiple facial fractures, including the zygomatic maxillary complex, coronoid, condylar, and symphysis regions. Computed tomography demonstrated additional linear undisplaced fractures of the left temporal and parietal bones, with associated hemorrhagic contusion in the right temporal region. The patient exhibited circumorbital edema, ecchymosis, and multiple lacerations over the scalp and face. Laboratory investigations revealed anemia with hemoglobin of 8.7 g/dL. Following initial stabilization, the patient underwent open reduction and internal fixation under general anesthesia. During the post-operative period, the patient developed significant hyponatremia with serum sodium levels dropping to 117 mEq/L, manifesting as altered sensorium and drowsiness. The electrolyte imbalance was managed using a combination therapy of normal saline infusion (500mL at 20mL/hr), 3% hypertonic saline (10mL/hr), and oral tolvaptan (15mg twice daily). This intervention successfully normalized serum sodium levels to 135 mEq/L within three days. This case highlights the importance of vigilant post-operative monitoring in pan-facial trauma patients, particularly for electrolyte disturbances, and demonstrates the effectiveness of prompt, targeted intervention in managing complications. The successful outcome emphasizes the value of a multidisciplinary approach in treating complex maxillofacial injuries

The Burden of Road Traffic Accidents on Facial Fractures: National Trends, Injury Patterns, and Disparities in 154,185 Patients.

National database study. Road traffic accidents (RTAs) are a common and challenging cause of facial fractures in the United States. The present study sought to utilize the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) to investigate national trends, injury patterns and disparities in facial fractures secondary to RTAs. To date, this is the first study to do so. A retrospective analysis was conducted of patients with primary facial fractures secondary to RTAs using the 2018-2021 HCUP-NIS. Patients were classified into the RTA and non-RTA group. Demographics, injury patterns, and inpatient outcomes were compared. In total, 154,185 primary facial fractures were identified, of which 17% (n = 26,115) were associated with RTAs. RTAs commonly involved cars (41%), followed by motorcycles (15%), pedestrians (11%), and bicyclists (10%). The RTA group was younger (34% vs 24% < 25years, P < .01) and more frequently Hispanic (18% vs 15%, P < .01). The most common fracture types were mandibular (23%), frontal (14%), and orbital fractures (14%). The RTA group was 50% more likely to have multiple facial fractures (OR = 1.5, P < .01). The RTA group had a longer length of stay (5.3 vs 4.0 days, P < .01), admission charge ($127,932 vs $79,414, P < .01), and mortality rate (1.9% vs 1.4%, P < .01) than the non-RTA group. The present findings provide valuable insights, informing early involvement of craniofacial surgeons for the assessment of combination facial fractures and tailored treatment approaches for RTA patients.

Emergency Management Patient with Multiple Mid-Lower Face Fracture and Tissue Avulsion of 1/3 Mid Face : A Case Report

Introduction : Facial trauma can be defined as bone and or soft tissue damage in the face region. Severe facial trauma might cause life threatening and permanent damage such as vision loss, unable to speak, swallows and chews because there are many bones, blood vessels, nerves, muscles and sensory organs at the face region. The facial damage could be a facial bone fracture with severe avulsion of facial tissue so two-dimensional and three-dimensional measurement of the wound is taken to assess the size of tissue to be covered. The aim of this case report was to give an explanation regarding the emergency management patient with multiple mid-lower face fracture and tissue avulsion of 1/3 mid face. Case Report : A 46 years old male traffic accident patient came to Emergency Department Hasan Sadikin General Hospital with facial fracture and had a severe avulsion of facial tissue. He also had an active bleeding from his face and based on immediate examination the airway was not clear. The patient has been diagnosed with Le Fort I, right orbital rim inferior aspect, nasal, right zygoma and parasymphisis of mandible bone fracture and Tissue loss at upper lip, nasolabial, left nose, left buccal and Multiple lacerated wound at facial region. He was treated with tracheostomy to clear the airway continued with open reduction internal fixation at right orbital rim inferior aspect, nasal, right zygoma, bilateral maxilla bone and parasymphisis of mandible bone with wound closing using rotational and sliding loco regional flap technique. Conclusion : Emergency treatment on multiple facial fracture with severe avulsion of facial tissue must be done to prevent life threatening condition, permanent damage and also to support the secondary reconstruction. Keywords : Severe avulsion of facial tissue, Mid lower face fracture, Open reduction internal fixation, Rotational flap, Sliding loco regional flap

Pediatric Facial Fracture Associated Craniofacial and Cervical Spine Injury

Management of pediatric facial fractures depends on location and severity, age, and associated injuries. Accurate diagnosis of associated injuries is crucial for effective treatment. This study evaluates the incidence of associated injuries and seeks to determine the influencing factors to provide imaging guidance. A retrospective review of pediatric facial fractures from the American College of Surgeons National Trauma Data Bank from 2017 to 2021 was completed. Associated cervical spine (c-spine), skull fracture, traumatic brain injury (TBI), and intracranial bleeding were evaluated. Demographics, fracture patterns, mechanisms, protective devices, and the Glasgow Coma Scale (GCS) were reviewed. A total of 44,781 pediatric patients with 65,613 facial fractures were identified. Of the total, 5.47% had a c-spine injury, 21.86% had a skull fracture, 18.82% had TBI, and 5.76% had intracranial bleeding. Multiple fractures significantly increased the rate of all associated cranial and c-spine injuries. Single midface fractures had the highest c-spine, TBI, and intracranial bleeding rates. With increasing age, there was a significant increase in c-spine injury and TBI, while there was a decrease in skull fractures. Motor vehicle accidents and GCS &lt;13 were associated with significantly increased rates of all injuries. Among pediatric patients with facial fractures, 5.47% had a c-spine injury, 21.86% had a skull fracture, 18.82% had TBI, and 5.76% had intracranial bleeding. The authors’ findings recommend c-spine imaging in older age and cranial imaging in younger patients. Multiple facial fractures, fractures of the midface, decreased GCS, and motor vehicle accidents increase the need for both c-spine and cranial imaging.

New generation vehicles: the impact of electric scooter trauma on the severity of facial fractures assessed by FISS score. A multicentre study

With the increasing use of sustainable energy sources, the electric scooter has become a widely used vehicle. The aim of the study is to analyse the types of facial fracture related to road traffic accidents to outline the need for dedicated road rules. An observational, retrospective, multicentre study was carried out at the Maxillofacial Surgery Units of six Italian hospitals. Fifty patients (mean age was 34.76 years) from January 2020 to January 2024 were enrolled. The severity of trauma was evaluated by the Facial Injury Severity Scale (FISS) by Bagheri et al. Most of the accidents occurred during the day and the weekend in spring or summer; 24 drivers collided with infrastructures or pedestrians, while 26 involved other vehicles. A total of 33 vehicles were rented, and 17 were privately owned. A total of 43 subjects were not wearing helmets, five patients were drunk, and three patients took drugs. In order of frequency, the facial fractures involved: zygomatico-maxillary-orbital complex (ZMOC) (n = 16), mandibular condyle (n = 13), nasal bone (n = 11), orbit floor (n = 8), and mandibular body (n = 7). Fractures such as Le Fort I (n = 4), naso-orbito-ethmoidal NOE (n = 4) and mandibular ramus (n = 4) were less common. Other types of facial fracture were rare. Thirty patients reported multiple facial fractures. The vast majority of the cases showed a low severity grade FISS score. Fifteen patients suffered polytrauma. The mean hospitalisation time was 8.3 days. As accidents with electric scooters are increasing, it is important to characterise the most frequent facial fractures to improve patient management and encourage the introduction of new road rules.

Management of Posttraumatic Cerebrospinal Fluid Leak with Secondary Diffuse Pneumocephalus Complicated by Meningitis and Communicating Hydrocephalus – Illustrative Case Report

Rhinorrhea is a possible complication after different types of traumatic brain injury or neurosurgical procedures, such as skull base operations. Pneumocephalus is a rarely noted complication after severe traumatic brain injury, and it may be accompanied by meningitis and ventriculitis, especially when treatment has been delayed. Treatment of these entities includes conservative and surgical approaches. Pneumocephalus may result in neurologic disturbances threatening a life. Therefore, active patient management with a multidisciplinary team is required to prevent poor outcomes. In the literature, limited cases of rhinorrhea and pneumocephalus are available, including in our country. Pneumocephalus may also occur spontaneously. In 2015, Pishbin et al. identified 10 cases of spontaneous pneumocephalus. The precise incidence of diffuse pneumocephalus after traumatic brain injury is unknown, reported as &lt;1% of cases with rare complications. In this case, a 41-year-old male patient presented at a tertiary university hospital with the chief complaint of headache. A month prior to admission, the patient was discharged from another hospital with multiple skull and facial fractures, pneumocephalus, and traumatic subarachnoid hemorrhage in the left frontal lobe due to fights (Le Fort III). During the second hospitalization, the patient’s clinical status deteriorated. A repeated brain CT demonstrated diffuse pneumocephalus. Rhinorrhea was still present. The external lumbal drainage procedure was performed without stopping the cerebrospinal fluid leak. In children, pediatric inferior turbinate hypertrophy is a frequent cause of nasal breathing difficulties. In this case, no such hypertrophy was observed. It should be considered a nasal obstructive disease not necessarily related to adult entities, frequently associated with other nasal or craniofacial disorders. Early diagnosis and endoscopic management of rhinorrhea, nasal obstruction, and associated complications is vital, as delays can lead to life-threatening issues like hydrocephalus/meningitis. Eventually, the patient developed meningitis and acute communicating hydrocephalus. Right ventriculostomy with a programmable ventriculoperitoneal shunt placement was done (pressure 110 cm H&lt;sub&gt;2&lt;/sub&gt;O), stopping the rhinorrhea. This is an extremely rare case where a patient, after cerebrospinal fluid (CSF) leakage, develops severe complications, including pneumocephalus, meningitis, ventriculitis, and acute communicating hydrocephalus. In the literature, we did not come across case reports presenting all the complications as in this case. This case report will raise knowledge and awareness of such entities, adding to the rare, similar cases reported so far.

Stabilization of Spontaneous Cerebral Coil Detachment with Stent during Endovascular Treatment of Direct Carotido-Cavernous Fistula: A Case Report

Carotido-cavernous fistula (CCF) is a rare vascular anomaly and endovascular treatment plays a crucial role in managing of it. However, complications can arise, including spontaneous coil detachment, which can lead to embolic or thrombotic events. In this case report, we present the case of a 56-year-old man who suffered multiple skull base and facial bone fractures, along with a traumatic subarachnoid hemorrhage, resulting from a fall. The patient was diagnosed with a right-sided traumatic carotid-cavernous fistula, and endovascular treatment with coiling was performed. During the procedure, a coil spontaneously detached, to address this complication, a stent was deployed to fix the dislodged coil to the carotid artery wall, ensuring proper occlusion and minimizing the risk of further embolic or thrombotic events. This rescue technique provides stability to the detached coil, minimizing the risk of migration or embolization, and preserves the integrity of the internal carotid artery. Spontaneous coil detachment is a challenging situation during endovascular treatment, but with proper techniques, such complications can be managed effectively, ensuring successful closure of the carotido-cavernous fistula and patient safety.

Panfacial fractures management, a report of surgical treatment sequence in three cases: A case series study

Multiple facial fractures, which involve the upper, middle, and lower thirds of the face, are called Panfacial fractures, and their management is one of the biggest challenges in the field of maxillofacial surgery. The proximity of maxillofacial skeleton to important sensory or vital structures such as the visual, olfactory, masticatory and respiratory systems and intracranial components in addition to negative effects on esthetic aspects of the face have doubled the intricacy. Small or thin fractured segments that are difficult to find and stabilize make management of pan facial fractures different from anywhere else in the body.&#x0D; One major challenge is to find the best pattern and sequence of treatment. There are different concepts, depending on the surgeon's experience and the pattern of fracture. This study reports three patients with the diagnosis of pan facial fractures. A 54-year-old woman, an 18-year-old and a 14-year-old man that were all victims of road traffic injuries (MVA). Conventional open reduction and internal fixation methods have been used and favorable results have been obtained in follow-up periods.

Management of Unilateral TMJ Dislocated Facial Bone Fracture due to an rarely Industrial Accident

Introduction: Traffic accidents commonly cause maxillofacial trauma but rarely industrial accidents. Treatment of multiple maxillofacial traumas needs comprehensive and immediate care to prevent further complications. Objective: Management of a maxillofacial fracture accompanied by dislocation of the right temporomandibular joint due to a fall in a rice mill. Case report: A 20-year-old male patient complained of bleeding and facial fractures due to a rice milling accident approximately one day before admission. The case diagnosis was multiple maxillofacial fractures with condyle dislocation. Emergency oral and maxillofacial surgery was performed immediately and quickly with minimal intervention on the upper jaw to prevent persistent cerebrospinal fluid leakage and prevent infection. Definitive treatment was soft tissue reconstruction, ORIF of the maxillary and mandibular fractures, and repositioning of the condyle dislocation. Conclusion: Multiple facial bone fractures accompanied by TMJ dislocation can result in deformity and loss of facial function affecting the patient's social life. Immediate action and open reduction internal fixation (ORIF) procedure performed in this case were able to restore stomatognathic and facial function. Keywords: Industrial accident, maxillofacial trauma, open reduction internal fixation, temporal mandibular joint dislocation Introduction: Traffic accidents commonly cause maxillofacial trauma but rarely industrial accidents. Treatment of multiple maxillofacial traumas needs comprehensive and immediate care to prevent further complications. Objective: Management of a maxillofacial fracture accompanied by dislocation of the right temporomandibular joint due to a fall in a rice mill. Case report: A 20-year-old male patient complained of bleeding and facial fractures due to a rice milling accident approximately one day before admission. The case diagnosis was multiple maxillofacial fractures with condyle dislocation. Emergency oral and maxillofacial surgery was performed immediately and quickly with minimal intervention on the upper jaw to prevent persistent cerebrospinal fluid leakage and prevent infection. Definitive treatment was soft tissue reconstruction, ORIF of the maxillary and mandibular fractures, and repositioning of the condyle dislocation. Conclusion: Multiple facial bone fractures accompanied by TMJ dislocation can result in deformity and loss of facial function affecting the patient's social life. Immediate action and open reduction internal fixation (ORIF) procedure performed in this case were able to restore stomatognathic and facial function. Keywords: Industrial accident, maxillofacial trauma, open reduction internal fixation, temporal mandibular joint dislocation

P227 THE UNEXPECTED CONSEQUENCES OF A 30 METERS FALL

Abstract Introduction Acute myocardial infarction (AMI) is a rare but often lethal consequence of a blunt cardiac trauma. Falls leading to coronary artery dissections are rare, thus underlining the lack of experience in their management. Case report description: a 55–year–old male patient with type 2 diabetes and no relevant past medical history was admitted to our hospital facility after a 30–meter fall during rock–climbing. On arrival, he was hemodynamically and neurologically stable. He underwent a full trauma evaluation: multiple facial bones fractures were diagnosed. An electrocardiogram revealed a QS morphology of the QRS and ST elevation in the precordial lead from V1 to V3 with reciprocal ST depression in the inferior leads. High sensitivity (hs) Troponin T was slightly elevated (49 ng/L, normal values &amp;lt;14 ng/L). A cardiac ultrasound documented a left ventricular dysfunction (LVEF 40%) with akinesia of mid–apical antero–septal and anterior walls. Biomarkers further increased with Troponin reaching 199 ng/L and creatinine phosphokinase–MB 24,7 ug/L (normal value &amp;lt;5 ug/L). Coronary angiography demonstrated proximal occlusion of the left anterior descending (LAD) coronary artery with an image consistent with traumatic coronary artery dissection, confirmed by a cardiac CT scan showing the proximal occlusion of the LAD with retrograde perfusion of its downstream portion. Considering the left ventricular dysfunction, the elevation of cardiac biomarkers (peak CK–MB 187 ug/L, peak hs troponin T 5400 ng/L) and the acceptable hemorrhagic risk in spite of the need for facial surgery, a coronary angioplasty was performed. A dual antiplatlet therapy with acetilsalicidic acid and clopidogrel began. Nine days later the patient underwent the maxillo–facial surgery: clopidogrel was stopped provisionally and a bridge strategy using tirofiban was chosen. Post–operatory was uneventful. A full recovery of cardiac function was assessed after one year (LVEF of 55%). Discussion Few cases of blunt cardiac trauma with coronary artery dissections have been reported and treated successfully, with the LAD being the most frequently involved vessel (76%). If urgent non–cardiac surgery can be postponed, a percutaneus revascularization eventually followed by tirofiban as bridge therapy can be suggested, carefully considering the risk of stent thrombosis and the hemorrhagic risk conveyed by the trauma itself.

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

Objectives 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. Material 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.

A RARE PRESENTATION OF DELAYED EPISTAXIS: POST TRAUMATIC INTERNAL CAROTID ARTERY PSEUDOANEURYSM AT A TERTIARY CARE CENTRE IN EASTERN NEPAL

Epistaxis is a common ENT emergency. Various causes are mucosal trauma, anticoagulants and bleeding disorders. Vascular causes and trauma accounts for less than 5% causes. A 25-year-old man presented to emergency with intractable epistaxis. He had sustained road traffic accident 5 months back. His previous CT scan showed multiple facial bones fracture along with sinuses (frontal, maxillary and sphenoid sinus on right para clinoid area) fracture. Initial CT angiography showed no vascular defects. The latest episode of epistaxis was massive and he underwent nasal endoscopy and packing of nose. Pulsatile sphenoidal polyp was visualized, along with transmitted pulsations in the sphenoid sinus on the right side. Subsequent Magnetic Resonance Angiography (MRA) showed a 12x4 mm pseudoaneurysm of clinoidal portion of Internal Carotid Artery on the right side. Post-traumatic Pseudoaneurysm of the Internal Carotid Artery may be the differential diagnosis in traumatic epistaxis, especially the delayed type. If pseudoaneurysm is suspected, CT or MRI angiography should be performed immediately.

New trends and insights in facial fracture treatment in the United States

Aim: Facial fractures have multiple etiologies, including motor vehicle collisions, interpersonal violence, falls, and sports-related accidents. The objectives of this study are to reassess, compare, and expand the epidemiologic analysis and postoperative complication rates of facial fracture treatment. Additionally, we sought to compare the length of stay and operative time outcomes between plastic surgeons and non-plastic surgeons. Methods: NSQIP (National Surgical Quality Improvement Program) participant databases were queried to identify all patients undergoing facial fracture operations. Epidemiological data was divided into two groups and compared by surgeon specialty: patients operated on by a plastic surgeon and patients operated on by a non-plastic surgeon. Our primary outcomes of interest were operation time and length of stay. Postoperative complications included wound complications, mortality, return to the OR, and major bleeding. Results: 3,354 patients underwent facial fracture repair (2012 to 2016). In men, the most common fracture was mandibular (40.9%); in women, the most frequent was orbital (32.4 %). 79.6% had single facial fractures and 20.4 % had multiple facial fractures. Plastic surgeons’ operating time was less than that of non-plastic surgeons (P = 0.0007). The average length of stay was higher for the plastic group (mean = 1.65 days, plastic) (P &lt; 0.00001). Postoperative complication variables showed no statistically significant differences between the plastic and non-plastic groups. Conclusion: Continuous epidemiologic analysis is vital for the proper allocation of healthcare resources to the most affected facial fracture patients in the US. Assessment of complication rates between surgical specialties allows a better understanding of the management of facial fracture patients on a national level. Our data analysis may allow surgeons to better counsel patients preoperatively and improve inter-specialty collaboration.

A Makeshift Blue Light Filter for Endoscopic Identification of Traumatic Cerebrospinal Fluid Leak Using Fluorescein

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACTObjective: To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods:Study Design:Surgical Instrumentation&#x0D; Setting:Tertiary Government Training Hospital&#x0D; Patient:One&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Usefulness of customized titanium plates for midface contouring surgery.

Introduction and importanceIn our department, we have been performing bone reconstructions on a case-by-case basis using vascularized free tissue transfers and custom-made artificial bones (HA). While these procedures have specific advantages, they are also limited in terms of the invasiveness as well as the stability and strength of implants. In the present study, we describe the use of a CTP to achieve minimally invasive midface plastic surgery with the superior moldability of a 3D structure and reliable stability compared to the use of autologous tissue.Case presentationA total of three patients were included in the study. The patients (all female, ages: 66, 18, and 35 years) had bone malformation or hemifacial microsomia following surgery for maxillary cancer or multiple facial fractures. Based on DICOM data from preoperative CT, 3D models were created on a computer using CAD/CAM techniques. The models were compared in simulations to determine the optimal structure. These 3D models were used in additive manufacturing systems to create custom-made titanium alloy plates for facial reconstruction.Clinical discussionAlthough the amount of soft tissue was insufficient in some cases, all patients were able to maintain the desired morphology without developing any complications such as infections, significant soft tissue atrophy, or implant failure.ConclusionOur CTP model created by CAD/CAM was effective in contouring surgery of the midface as it had the superior stability and biocompatibility of titanium. Changes to the soft tissue should also be considered in order to further improve the procedure.

The effects of treatment timing on the management of patients with multiple facial fractures and on the self-perception of TMD recovery

ABSTRACT Objective To investigate the effects of time on the orofacial functions and on the self-perception of temporomandibular disorders (TMD) recovery in a population of patients with multiple facial fractures. Methods Orofacial functions and self-perception of TMD recovery was verified in patients with midface and/or lower face fractures. Patients were divided according to the time between fracture reduction and the clinical assessments: 0–1 month (Group 1), 1–3 months (Group 2), and 15 >3 months (Group 3). Results Patients in Group 1 presented a greater compromise of swallowing and mastication when compared to patients with older fractures (p = 0.015), whereas patients in Group 3 presented a poorer TMD recovery (TMJ pain: p = 0.010 and tinnitus: p = 0.004). Conclusion Delays in functional treatments involving the myofunctional orofacial system have a negative impact on the recovery of essential orofacial functions and on TMD symptoms..

Pan Facial Trauma Fracture Management: Case Report &amp; Literature Review

Pan facial fractures involve the mandible, maxilla, and zygomatic complex at the same time, and are frequently associated with NOE and frontal bone fractures. Reconstruction of multiple facial fractures including the top and lower face should be handled as a jigsaw. To accomplish this, two common management sequences for Pan facial fractures have been proposed: "Bottom up and inside out" and "Top down and outside in." There are more sequences, but these two major ways are the most common. The proximity of the maxillofacial region to important features or senses such as vision (diplopia), olfaction, respiration (airway management), chewing or mastication (occlusion), deglutition, and aesthetics makes the scenario a little more complex for the surgeon operating in this region than in any other part of the body.&#x0D; It's difficult to stick to a tried-and-true procedure for treating pan face fractures. Despite rigorous therapy, most patients with pan facial trauma may have some residual deformity, which may necessitate more surgery in the future. The care and easy procedures utilized to decrease and fix a case of pan facial trauma in a 26-year-old are described in this article.

Mind the Difference: Characterizing the Impact of Behavioral Health Disorders on Facial Trauma

Patients with psychiatric diagnoses are at greater risk for traumatic injury than the general population. Current literature fails to characterize how premorbid behavioral health disorders (BHDs) complicate craniofacial trauma. This study aimed to describe the characteristics and outcomes of patients with premorbid BHD sustaining facial fractures. All adults in the 2013-2016 Trauma Quality Improvement Program datasets with facial fractures were identified. Demographics, injury characteristics, fracture patterns, and in-hospital outcomes were compared in patients with and without premorbid BHDs. BHDs included major psychiatric illnesses, alcohol or drug use disorders, attention deficit hyperactivity disorder, or dementia. Twenty-five percent of the 240,104 subjects with facial fractures had at least one premorbid BHD. Assault (29.9% versus 23.9%, P< 0.001), self-inflicted injury (2.9% versus 1.2%, P< 0.001), and multiple facial fractures (40.2% versus 38.7%, P< 0.001) were more common among the BHD group. The BHD group displayed significantly higher rates of nearly all in-hospital complications, including pneumonia (4.3% versus 3.3%, P< 0.001), substance withdrawal (3.9% versus 0.3%, P< 0.001), unplanned intubation (1.5% versus 0.9%, P< 0.001) and unplanned transfer to the intensive care unit (ICU, 1.3% versus 0.8%, P< 0.001). BHD was strongly predictive of pneumonia, unplanned intubation, and unplanned ICU admission in multivariate analyses. Patients with BHD represent a subset of facial trauma characterized by different mechanisms and patterns of injury and premorbid health status. BHDs are associated with higher in-hospital complication rates and resource utilization. Understanding the relationship between craniofacial trauma and premorbid BHD creates opportunities to improve morbidity and resource utilization in this group.

Closed Isolated Zygomatic Arch Fracture Management Made Easy.

Zygomatic arch fractures can occur either as isolated fractures or as a part of multiple facial fractures. There are several techniques available for reduction of zygomatic arch fractures, which include closed reduction and open reduction with fixation using metallic splints, closed reduction via Gillies or a gingivobuccal approach is preferred for minimal invasiveness, short operative time, and low complication rate. The aim of the present study is to present a simple, easy, and reliable method for closed reduction of isolated zygomatic arch fractures. This study included twenty patients presented with isolated zygomatic arch fractures between January of 2017 and December of 2018. All patients were evaluated based on the clinical and radiographic findings. Closed reduction of the zygomatic arches was carried on by a stainless steel wire. Surgical outcomes were subjected for objective assessment based on the postoperative alignment of the zygomatic arch in the computed tomography (CT scan) immediately after surgery and after 3 months. Subjective evaluation was carried out comparing preoperative, 1 and 3 months photographs assessing facial symmetry, as well as the patients' satisfaction. After a period of 3 to 6 months follow-up between January 2017 and December 2019, all patients were satisfied by the overall results, no major complications were recorded and no additional surgery needed for them. The suture wire method is quick, simple, easy, and effective for the reduction of isolated, depressed fractures of the zygomatic arch.

Early Pediatric Multiple Facial Fractures Treatment With Resorbable Fixation.

The facial skeleton in pediatric patients can undergo several changes during development, according to their growth zones and the traumas they suffer. Thus, some of these traumas can lead to multiple complications if not treated properly. Epidemiology can vary according to the social, cultural, and environmental aspects of each individual. Therefore, each case must be treated individually, and it is important to consider age-specific aspects, such as the high osteogenic potential, which leads to faster bone healing. The use of resorbable fixation materials in facial fractures of pediatric patients is widespread, with good acceptance and great advantages over conventional titanium materials, mainly for the elimination of a second surgery to remove the materials. The present study aims to report a series of clinical cases of infants, who suffered trauma and evolved with fractures in the facial bones. Surgical treatment was instituted to reduce and fix fractures, using the resorbable system. Patients are followed up with periodic outpatient follow-up visits and have a good case evolution.