Maxillofacial Trauma Patients Research Articles

Scoping an interdisciplinary model of student dental therapists in maxillofacial trauma.

Introduction This paper outlines a short pilot programme to assess the feasibility of an interdisciplinary model of involving student dental therapists in the management of maxillofacial trauma patients. It involved dental therapy students attending an oral and maxillofacial surgery trauma review clinic at a major trauma hospital in London, UK.Approach The small cohort of 15 second-year dental hygiene and therapy (BSc in Oral Health) students attended the trauma clinic once a week in pairs, over a period of six weeks, after which they completed a survey questionnaire.Findings No students had previous experience of dealing with trauma patients. The majority (81.8%) had learnt something by attending the clinic. Almost all (91.7%) had not thought previously about the importance of oral hygiene in maxillofacial trauma patients. By the end of the pilot programme, ten students (83.3%) felt that they had a role to play in the care of these trauma patients and they felt valued as members of the wider team.Conclusion These initial findings suggest that the scheme has potential for incorporation of maxillofacial trauma experience within the formal dental therapy curriculum. This would prepare them for future involvement in the management of maxillofacial trauma patients to promote oral health benefits and more widely, to work as a team member in interprofessional health care.

Efficacy of Pre-emptive Infiltration of Dexmedetomidine with a Local Anaesthetic on Postoperative Pain in Maxillofacial Trauma Management under General Anaesthesia: A Prospective Study

Abstract Introduction: Pre-emptive analgesia aims to reduce post-operative pain and the need for analgesics. Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist with sedative and analgesic properties. The aim of this study was to compare the effectiveness of pre-emptive infiltration of DEX combined with local anaesthetic (2% lignocaine with adrenaline) in managing post-operative pain in maxillofacial trauma patients undergoing open reduction and internal fixation procedures, as compared to pre-emptive infiltration of placebo (saline) with the same local anaesthetic. Materials and Methods: Forty-two participants of maxillofacial trauma with a Visual Analogue Scale (VAS) score of more than 4 were included in this double-blinded randomised controlled trial. Group DL (Dexmedetomidine with local anaesthetic) received dexmedetomidine (DEX) with local anaesthesia while group PL (placebo with local anaesthetic) received placebo with local anaesthesia. Participants were evaluated for the time taken for the first rescue analgesic, total doses of fentanyl taken by the patient in the first 24 h, post-operative pain (VAS) at 6, 12, 16 and 24 h, post-operative side effects and analysed. Results: The DL group had a significantly longer time to first rescue analgesic compared to the PL group. Surgeons in the DL group reported higher satisfaction and better surgical field visibility. Post-operative VAS scores were lower in the DL group at 6 and 12 h, with a median score of 1 at 16 and 24 h. Discussion: Pre-emptive DEX infiltration is effective in reducing post-operative pain and opioid consumption in maxillofacial trauma cases undergoing open reduction and internal fixation. This approach can enhance patient comfort and improve surgical outcomes without significant risks.

Role of Whey Protein in the Treatment Outcome of Maxillofacial Trauma Patients: An Interventional Study

Role of Whey Protein in the Treatment Outcome of Maxillofacial Trauma Patients: An Interventional Study

Evaluating the impact of recombinant human epidermal growth factor on scar formation in oral and maxillofacial traumatic wound healing.

Scarring following oral and maxillofacial trauma can have significant aesthetic and functional repercussions. Recombinant human epidermal growth factor (rhEGF) has emerged as a potential therapeutic agent to enhance wound healing and minimise scar formation. This retrospective study analysed data from March 2020 to June 2023 at a single institution. A total of 105 patients were divided into a control group (n = 70) receiving standard treatment and an observation group (n = 35) receiving standard treatment plus rhEGF. The primary outcomes were the incidence of scar hyperplasia and infection rates, with the secondary outcome being scar aesthetics measured by the visual analogue scale (VAS). No significant differences were found in baseline characteristics between the two groups. The observation group showed a significant reduction in scar hyperplasia (14.3% vs. 57.1%, χ2 = 20.98, p < 0.01) and infection rates (5.7% vs. 21.4%, χ2 = 4.246, p < 0.05) compared to the control group. VAS scores indicated a superior aesthetic outcome in the observation group at all post-treatment timepoints (p < 0.01). rhEGF treatment in oral and maxillofacial trauma patients resulted in favourable healing outcomes and reduced scar formation, improving aesthetic results. These findings highlight the therapeutic potential of rhEGF and underscore the need for larger-scale trials to further investigate its benefits.

What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries?

BackgroundPatients sustaining maxillofacial fractures are at risk for associated injuries to other body regions. The incidence of associated injuries (AIs) is reported to be from 20 to 35%. AIs may be life-threating and play a key role in considering first-line management at the emergency department, as well as planning the definitive treatment of maxillofacial fractures. PurposeThe study aimed to determine the frequency and risk factors for AIs in patients with maxillofacial fractures. Study design, settings, sampleThe investigators designed and implemented a retrospective cohort study of patients with facial fractures treated at Central Hospital (Lahti, Finland) from January 1, 2009 through December 31, 2019. All adult patients with verified maxillofacial fractures were included. Patients under 18 years were excluded from the study. Predictor variableThe predictor variable was the location of the maxillofacial fractures grouped into three categories, mandible alone, midface alone, both midface and mandible. Main outcome variableThe primary outcome variable was associated body region injuries coded as present or absent. The secondary outcome variable was the location of the AI categorized as skull, neck, thorax, pelvis, or extremity injuries. CovariatesOther study variables included demographic data (age, sex, alcohol use), Glasgow Coma Scale (GCS), and etiology (fall, traffic- and bicycle accident, assault, pedestrian hit by motor vehicle, work-related, or sports/free-time injuries). AnalysesContinuous variables were analyzed for normal distribution using the Shapiro-Wilks test and compared with categorical variables using the Mann-Whitney test. The univariate analyses of categorical variables were analyzed by the x2 test (P ≤ 0.05 was considered statistically significant). ResultsDuring the study period, 443 adult (≥18) patients had maxillofacial fractures. AIs were present in 88 subjects (20%). The mean age was 47.6 years (range 18-91); 52 years with AIs (range 19-91), and 47 years (range 18-92) without AIs (p = 0.03). Subjects with midface and mandible + midface fractures had greater risk to AIs compared to mandibular fractures. (RR 2.0, p=0.002, RR 2.8, p=0.009). Conclusions and RelevancyEvery fifth maxillofacial trauma patient had associated injury. Trauma patients should be evaluated in institutions with trauma protocols and imaging modalities before determining and executing the treatment plan for maxillofacial fractures.

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.

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.

Incidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study

Introduction: The aim of the present study was to evaluate the incidence, aetiology and patterns of maxillofacial injuries in a tertiary trauma hospital in Nepal.&#x0D; Methods: A retrospective analysis of all the maxillofacial trauma patients operated at the Department of Plastic, Cosmetic and Maxillofacial Surgery, B and B Hospital, Lalitpur, Nepal between 1st March, 2015 and 31st December, 2020 was performed. Data were collected for each patient in regards to age, gender, cause and nature and type of the injury and the treatment provided.&#x0D; Results: Among 409 patients operated in this period for maxillofacial injuries, 83% (n=356) were male and 17% (n=73) were female. Patients in the second and third decade of life were found to be more prone to sustain maxillofacial injuries. Road traffic accident was the most frequent cause (n=331; 77%) followed by physical assault (n=46; 10.7%) and falls (n=42; 9.7%). Mandible was the most commonly fractured bone (n=125; 26.5%). Fracture of parasymphysis, combined symphysis and condyle fracture and parasymphysis and angle fracture were the most common patterns of mandible fracture.&#x0D; Conclusions: The major cause of maxillofacial injuries among patients operated in our hospital was road traffic accident which directly reflects the poor traffic system and improperly planned roads.

Evaluation of Surface Changes of Stainless Steel Miniplates and Screws Following Retrieval from Maxillofacial Trauma and Orthognathic Surgery Patients: A Comparative Study.

This study examines the surface changes of stainless steel miniplates and screws after their retrieval from patients who underwent maxillofacial trauma and orthognathic surgery. The assessment focuses on comparing the alterations in these materials, aiming to contribute to our understanding of their durability and performance in clinical settings. A total of 60 stainless steel miniplates and screws were collected from 30 patients who had previously undergone either maxillofacial trauma or orthognathic surgery. The retrieved miniplates and screws were carefully removed from the patients and cleaned to remove any organic debris. Each specimen was then examined for surface changes. Surface changes were evaluated using visual inspection, scanning electron microscopy (SEM), and roughness measurements. Visual inspection provided a qualitative assessment, while SEM allowed for a more detailed examination of the surfaces. Roughness measurements were conducted using a profilometer. Visual inspection revealed varying degrees of surface changes in the retrieved miniplates and screws. These changes included scratches, corrosion, and discoloration. SEM analysis confirmed the presence of surface alterations, with some specimens showing more significant damage, such as pitting and cracks. Roughness measurements indicated an increase in surface roughness for both miniplates and screws, suggesting that the surfaces had become less smooth. This comparative study of stainless steel miniplates and screws retrieved from maxillofacial trauma and orthognathic surgery patients demonstrated that these materials undergo surface changes over time.

Minimal clinically important difference in maxillofacial trauma patients: a prospective cohort study

The present study estimated the minimal clinically important difference (MCID) for pain on a visual analogue scale – numerical rating scale (VAS-NRS) and mean bite force (MBF) in patients treated for maxillofacial trauma (MFT). This cohort study included 120 MFT patients treated according to AO principles. Preoperative and four-week postoperative pain on the VAS-NRS, and MBF were measured to calculate MCIDs as indicators of functional rehabilitation. The patient’s perspective of the treatment was assessed using a four-item anchor question. The MCID was determined by two anchor-based approaches, namely, the change difference (CD) method and receiver operating characteristic (ROC) curve method. According to the CD method, the MCID for pain was 2.4 and the MBF was 147.9 N. Based on the ROC curve, the MCID for pain was 2.5 (sensitivity 91.7%, specificity 47.2%) and MBF was 159.1 N (sensitivity 71.4%, specificity 61.1%). This study demonstrated a high sensitivity (>70%) for MCID, which implies that pain reduction of 2.4–2.5 points on the VAS-NRS and a gain in MBF of 147.9–159.1N are clinically relevant for patients treated for MFT.

Epidemiology of zygomaticomaxillary complex fracture in oral and maxillofacial trauma patients

Introduction: The current study is aimed at investigating the epidemiology of zygomatico- maxillary complex fracture in oral and maxillofacial trauma patients in a trauma hospital.&#x0D; Materials and Methods: This cross-sectional descriptive-analytical study with 187 patients was conducted at Khatam al-Anbia Hospital in Zahedan from April 2018 to December 2021. All the data including etiology, gender, age, ethnicity, year and place of occurrence, and site of fracture were obtained from the medical records of all oral and maxillofacial trauma patients who were subjected to ZMC fracture. Chi-Square and Fisher’s exact tests were used to analyze the data.&#x0D; Results: Mean age of the patients was 29.53±14.13 years. Out of 187 patients, 87.2% (163 people) were male and 12.8% (24 people) were female. People between 20 and 40 years had more ZMC fractures than other age groups with 104 cases (55.7%). Baluch ethnic group with 111 people (59.3%) experienced more fractures than other ethnic groups. The highest fracture rate occurred in 2021 with 63 cases (33.7%). Street was the most prevalent place of occurrence for fractures with 134 cases (71.6%). Isolated cheek fracture was the most common with 95 cases (51%). The most common cause of fracture was traffic accidents with a prevalence of 71.1%.&#x0D; Conclusion: The results revealed that traffic accident is the main cause of ZMC fractures in the studied population. Thus, public awareness and strict implementation of traffic policies are needed.

Assessment of quality of life in patients with surgically treated maxillofacial fractures.

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

Emergency Management of Multiple Maxillofacial Trauma Patients with Head Injury: A Case Report

Trauma to the face has the potential to be life-threatening and cause facial deformities. Head injuries are usually a more severe consequence of such incidents and must be addressed earlier. Here we present a case of a 24year old male patient with history fell from motorcycle three hours before the patient was admitted to the hospital, the patient fell with the mechanism of his face hitting the asphalt first. He was diagnosed with panfacial fracture of facial bones and mild head injury. Emergency treatment need to be done for his general condition improvement, transfusion of red blood cell, admister of elecltrolyte, oxygenation and observation of consciousness, primary suture of laceration, placing erich bar wire for maxilla mandible, placing skin traction was done in the emergency room. The patient then was scheduled for open reduction internal fixation of the facial fracture after the condition was optimal enough. Maintaining the airway and limiting bleeding are fundamental concepts in the emergency department's management of maxillofacial trauma.

The Relationship between Maxillofacial Injury Severity Score (MFISS) and Outcomes of Maxillofacial Trauma Patients at Dr. Mohammad Hoesin General Hospital (RSMH) Palembang, Indonesia

Introduction: Maxillofacial trauma is an important public health problem, and understanding the relationship between injury severity and patient outcomes is critical for effective management. This study aimed to determine the relationship between the maxillofacial injury severity score (MFISS) and the outcomes of maxillofacial trauma patients at Dr. Mohammad Hoesin General Hospital, Palembang.&#x0D; Methods: An analytical observational study was conducted involving 121 maxillofacial trauma patients from April to May 2023. Data regarding patient characteristics, MFISS scores, type of management, length of stay, and mortality were collected and analyzed using statistical tests.&#x0D; Results: The majority of maxillofacial trauma patients were male (74.4%) and aged over 18 years (63.6%). Traffic accidents are the main cause of trauma (84.3%). The distribution of MFISS scores showed that 75% of patients had mild scores, 18.2% had moderate scores, and 5.8% had severe scores. Most patients underwent surgical management, with the majority having a length of stay of ≤7 days. The mortality rate was 2.5%. There was no significant relationship between the MFISS score and type of management (p &gt; 0.05). However, there was a significant difference in the length of stay based on the MFISS score (p = 0.000). Patients with severe MFISS scores had significantly longer lengths of stay compared with patients with mild or moderate scores. In addition, there was a significant relationship between MFISS score and mortality (p = 0.000). Patients with severe MFISS scores had a higher risk of death compared with patients with mild to moderate scores.&#x0D; Conclusion: The MFISS score is associated with length of stay and mortality in maxillofacial trauma patients. However, there was no significant relationship between the MFISS score and the type of management.

Changing Patterns of Zygomaticomaxillary Complex Fractures: A Retrospective Study

Limited research exists regarding the incidence and variations of zygomaticomaxillary complex (ZMC) fracture patterns and their correlation with the mechanism of injury. Hence, further research is indicated. The purpose of this study was to analyze the different ZMC fracture patterns in relation to its etiology using computed tomography scans. This retrospective cohort study was conducted at a single institution. The medical records of maxillofacial trauma patients from 2016 to 2020 were analyzed. Patients from any gender and all age groups with complete records diagnosed with isolated ZMC fractures were included in the study. The primary predictor variable was the etiology of trauma. It was categorized as road traffic accidents (RTAs), falls, interpersonal violence, fall from height, sports injuries, etc. MAIN OUTCOME VARIABLES: The primary outcome variable was the ZMC fracture patterns observed and was defined as similar to or different from the classical fracture patterns. Any type of variation noted from the classical fracture lines was defined as the secondary outcome variable. Covariates included demographic variables such as age, gender, the type of vehicle involved, the type of RTA, side of fracture, associated orbital fractures, and number of ZMC points fractured. Descriptive and bivariate statistics were used to measure association between the predictor and outcome variables using multiple proportions χ2 test. Statistical significance was defined at P value of <.05. Out of the 232 scans assessed, a total of 163 cases were included in this study. A majority of the cases belonged to a range of 21 to 30years and showed a male predilection. The most common mode of injury was found to be RTAs (88.3%). Most cases had fracture patterns different from the classical fracture patterns (65.64%). A statistically significant association was found between the types of ZMC fracture patterns and etiology of trauma (RTA P= <.0001, falls P=.0001, and interpersonal violence P=.0001). Five different variations in ZMC fracture patterns were found and had a statistically significant association with the classical fracture lines (P<.0001). The authors conclude that the variations in fracture patterns encountered today may be attributed to the mechanism of injury. With due consideration to the limitations of this study, the authors suggest that the treatment plan may require slight modification based on the variation of the fracture pattern. Additional intervention may also be indicated.

Characteristics of Maxilllofacial Trauma Patiens before and during the Covid-19 Pandemic in Oral and Maxilllofacial Surgery Department of Dr. Hasan Sadikin Hospital Bandung

Introduction: Prior to the COVID-19 pandemic, motor vehicle accidents, falls, physical assaults, and sports injuries were the main causes of maxillofacial trauma. The existence of interventions to prevent the COVID-19 pandemic resulted in home-centered social activities in the community. This also contributes to alterations in the aetiology of maxillofacial trauma that occur worldwide and may affect other characteristics of this entity. Methods:This is a retrospective study conducted at the Hasan Sadikin Hospital, Bandung, West Java, Indonesia, and was carried out in September–December 2022. The population of this study were maxillofacial trauma patients with diagnoses of vulnus (laceratum, schissum, punctum, and morsum), frontal, mandibular, maxillary fractures, orbit, naso-orbito-ethmoid (NOE), zygomaticus, and dentoalveolar fractures before the 2018–2019 pandemic period and during the 2020–2021 pandemic period at the Oral and Maxillofacial Surgery Department at RSUP Dr. Hasan Sadikin Bandung through the emergency department.The variables studied included age, gender, type of trauma, etiology, alcohol involvement, and management.The data are presented as frequency distribution and percentage in tabular and diagram. Results: During the 2018–2021 periods, there were 504 patients who experienced maxillofacial trauma before the COVID-19 pandemic, and this number has decreased to 216 patients during the COVID-19 pandemic. The majority of maxillofacial trauma experienced both before (n = 314; [62%]) and during (n = 166; [77%]) the COVID-19 pandemic was caused by motor vehicle accidents. Most of patients before the COVID-19 pandemic were aged 0–19 years (n = 230; [46%]), meanwhile, during the COVID-19 pandemic most patients were aged 20–39 years (n = 88; [41%]).Overall, there were no differences in sex characteristics, alcohol involvement, type of maxillofacial trauma, or treatment given before and during the COVID-19 pandemic. Conclusion: The existence of interventions to prevent the COVID-19 pandemic by imposing Large-Scale Social Restrictions (PSBB) has resulted in modifications to community social activities that are centered in the home. This factor contributed to some differences in the characteristics of maxillofacial trauma patients at the Oral and Maxillofacial Surgery Department in Hasan Sadikin Hospital before and during the COVID-19 pandemic. Keywords: Maxillofacial trauma, Characteristics, COVID-19

Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study.

The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients. About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months. No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures. A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures. In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.

Characteristic and Management Of Oro-Maxillofacial Trauma in Emergency Department of Oral and Maxillofacial Surgery During Covid-19 Pandemic: Retrospective Crosssectional Study

AbstractIntroduction: Oromaxillofacial traumas comprise injuries to the face, jaws, or both that are largely caused by physical forces, foreign bodies, or burns; they include injury to any of the bony structures, skin, and soft tissues around the face. Maxillofacial trauma is related to human activity or mobility, so traffic accidents are the highest cause. During the Covid-19 pandemic, human activity was mostly at home with movement restrictions. This paper aims to describe the types of characteristics and management of oromaxillofacial traumas during covid-19 pandemic at the emergency room RSUP Dr.Hasan Sadikin Bandung Hospital.Methods: A cross-sectional study was conducted to evaluate every maxillofacial trauma in patients treated by the oral surgeon in the emergency room at RSUP Dr.Hasan Sadikin Bandung Hospital. Maxillofacial trauma incidence records were taken directly from case reports department of oral and maxillofacial surgery emergency room patients from January 2020-December 2021. The variables considered were: patient age, gender, etiologies, sites, classifications, and management of the trauma. All the information found is then integrated into a table to be analyzed epidemiologically. Result: 177 maxillofacial trauma patients were registered in the department of oral and maxillofacial surgery report. It was found that the gender ratio, female to male, is equal to 2.3: 7.6. The 18-36 age group accounted for the largest subgroup in both sexes. Motorcycle accidents accounted for as much as 80.22% of the etiology of the most common traumas. While dentoalveolar (28.22%) was the most common site of the fracture, followed by the mandible (23.31%). Injuries around the mouth make up the most portion (62.15%) regarding the area that is directly impacted by the injuries, followed by injuries to the face (18.64%) and injuries to the mouth and nose combined (6.21%). Among the 177 patients mentioned above, 10.17% were hospitalized.Conclusion: It can be concluded from this cross-sectional study that traffic accidents, mainly motorcycle crashes, are the primary cause of traumas, with males being more prone to accidents. Meanwhile, the dentoalveolar fracture was the most common site of fracture. For this reason, we might be better prepared with all the resources necessary to diagnose and treat patients with oromaxillofacial traumas in the future.

Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial

IntroductionEnhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes. MethodologyA randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes. ResultsBaseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001). ConclusionOur study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.

The effect of COVID-19 lockdown on the epidemiology of maxillofacial trauma at tertiary health facilities in Pretoria

Background: COVID-19 restrictions have reduced the number of consultations of patients including Maxillo-facial trauma patients.&#x0D; Aim: To analyse and compare the epidemiology of maxillofacial trauma during four months of the lockdown period and compare it with the same months from the previous year (2019 and 2020).&#x0D; Materials and Method: A retrospective record-based study was conducted with data drawn from all maxillofacial trauma patients who presented in the maxillofacial and oral surgery unit, of the University of Pretoria (UP) and Steve Biko Academic Hospital (SBAH) from April to July of 2019 and April to July of 2020. Data collected included age, gender, aetiology of injury, site of injury, severity and extent of injury, fracture pattern and site, waiting period for treatment and month of injury. Chi-square test was used to evaluate the association between variables. The level of significant was set at p ≤ 0.05.&#x0D; Results: A total of 197 patients were seen in the two institutions with maxillofacial injuries for the years 2019 and 2020 with ages ranging from 1 to 81 years and a mean of 36.24. Most patients were males 167(85%). Many patients were seen in 2019 at 139(71%). There was no association between the fracture site and the aetiology. The mandible was significantly the most common site of injury and more conservative treatment was done as compared to other forms of treatment (p &lt; 0.05).&#x0D; Conclusion: More Maxillofacial cases were seen in 2019 than in 2020 with more males as compared to females. The majority of injuries were assaults followed by motor vehicle accidents (MVA). The mandible was the common site of injury. More conservative treatment was done compared to other forms of treatment.