Severity Of Maxillofacial Injuries Research Articles

The Impact of Traffic Law Enforcement Regulations on the Incidence and Severity of Maxillofacial Injuries.

This study aimed to assess the effectiveness of the new traffic law enforcement regulations (TLERs) on the incidence and severity of maxillofacial injuries in Oman, as road traffic accidents (RTAs) are the main cause of facial injuries in Oman. A retrospective longitudinal analytic study was conducted at three tertiary care hospitals in Muscat, Oman. All patients with RTA-related maxillofacial injuries during a five-year period from January 2005 to December 2009 (before the new TLERs) and the five-year period from January 2015 to December 2019 (after the new TLERs) were included in the study. A total of 1,127 patients were included in the study. Of these, 646 (57.3%) patients sustained RTA-related maxillofacial injuries before the implementation of the new TLERs compared to 481 (42.7%) after the introduction of TLERs. No significant gender-based difference was found between the two study periods. The incidence of injury before the implementation of the new TLERs was 22.7 per 100,000 population, which then reduced significantly to 11 per 100,000 after the TLERs were implemented. Overall, the mean facial injury severity score reduced significantly, from 3.2 to 2.3, after the implementation of the new TLERs. The findings of this study indicate that the newly introduced TLERs have resulted in a reduction in the incidence and severity of RTA-related maxillofacial injuries. Continuous improvement and reinforcement of TLERs will further help reduce the burden of these injuries to society in general and health services in particular.

Maxillofacial injuries due to motorcycle accidents from suburban Nigeria

ObjectivesTo assess causes, pattern and severity of maxillofacial injuries sustained during road traffic accidents including helmet use and riding status among motorcyclists for comparison to previous studies. MethodsA descriptive study was conducted between January 2020 and December 2021 at two suburban Nigerian treatment centres. Data was collected on demographics; helmet use, whether rider or pillion passenger; and cause of motorcycle accident. There was clinical examination and reviews of radiological investigations. Maxillofacial trauma was scored according to the FISS described by Bagheri et al. (2006) [12]. ResultsThe study had 55 participants (37 riders and 18 pillion passengers), aged 5–73years (mean 32.8years) with more males (89.1 %). One patient (1.8 %) reported helmet use. Bike-to-bike accidents were the most frequent (56.4 %). More soft tissue injuries were lacerations (32, 59.3 %) than abrasions (15, 27.8 %). There were 122 bone fracture, the fracture to patient ratio was 2.5:1. Mandibular (40.5 %), dentoalveolar (22.1 %) and maxillary fractures (13.9 %) were common. Most common sites of concomitant injuries was the lower limbs (50.0 %). Most had moderate/ severe FISS, mean 4.6 with significant association between FISS and gender (p = 0.024) and riding status (p = 0.013). ConclusionHelmet use among the study population was very low and the maxillofacial fracture to patient ratio was relatively high compared to prior Nigerian studies. Males and riders sustained more of moderate/severe maxillofacial injuries. Public enlightenment and enforcement of road traffic laws among motorcyclists to reduce maxillofacial injuries in Nigeria are advocated.

PATTERNS AND SEVERITY OF MAXILLOFACIAL INJURIES IN VICTIMS OF MOTORBIKE ACCIDENTS AND THEIR RELATIONSHIP TO ALCOHOL CONSUMPTION

Abstract Introduction Trauma is a leading cause of morbidity and mortality worldwide. Motorbike riders have the highest incidence of road traffic accidents. The maxillofacial region is highly vulnerable to such incidents. Injuries to this region can lead to severe bleeding and airway compromise. Not wearing a helmet and drug intoxication can increase the risk of accidents and their complications. Patterns and severity of these injuries vary with road conditions, speed and type of impact. Aims and Objectives: The current study intends to assess the patterns and severity of maxillofacial injuries among intoxicated and non-intoxicated victims of motorbike accidents. Materials and Methods: The present study was a single-centre, Prospective Observational study conducted on patients admitted into the emergency medicine department with suspected maxillofacial injuries to motorbike accidents at PESIMSR Hospital, Kuppam, from October 2018 to July 2020. Results There was a clear male preponderance with 11 males for every female. Two-thirds of patients were aged between 25-and 50 years. Skid and fall and head-on-collision were common mechanisms of injury. Soft-tissue injuries like abrasions and lacerations were common injuries. Ninety-one patients had facial fractures, mostly involving the midface. Nasal bone fractures were most frequent. Of the 149 patients, 54 had an A.I.S. score of 1, 43 had 2, 21 had 3, 18 had 4 and 13 had 5. There was no significant difference in the severity or patterns of injuries in intoxicated patients. Conclusion Midface injuries are more common. Intoxication increases the risk of injuries. But it does not seem to alter the patterns and severity of injuries.

The impact of helmet use on oral and maxillofacial injuries associated with electric-powered bikes or powered scooter: a retrospective cross-sectional study

BackgroundElectric bikes (E-bikes) and powered scooters (P-scooters) have become increasingly popular modes of public transportation, but they have been associated with injuries of all kinds, including dental trauma. Helmet use is promoted as a means of reducing injuries in accidents involving motorized and unmotorized vehicles. The aim of the study was to evaluate the impact of helmet use on the number and severity of oral and maxillofacial injuries caused by E-bikes and P-scooters.MethodsA retrospective cross-sectional study design was used. The cohort included all patients referred to the emergency department of a tertiary medical center in 2014–2020 with oral and maxillofacial injuries involving E-bikes or P-scooters. Data were collected from the medical files on demographics, types of injuries, circumstances of occurrence, work-up, treatment, and outcome. Use of a helmet was recorded in each case.ResultsOf the total 1417 patients referred to the emergency department for E-bike and P-scooter-related trauma, 62 had oral and maxillofacial injuries, including 57 riders and 5 pedestrians. All had hard- or soft-tissue injuries; 20 (32.2%) had head injuries and 22 (35.5%) had dentoalveolar injuries. Eleven riders had worn a helmet at the time of injury (17.7%). Helmet use was associated with time of injury (weekday/weekend, daytime/night-time), type of motorized vehicle (E-bike or P-scooter), head injury, and number of bone fractures. Head injuries occurred more often on the weekend (57.9%) than during the week (20.9%) and were more likely to occur in riders who were not protected by a helmet (37.3% vs 18.2%). Patients who used helmets also had a lower rate of fractured bones (18.2%) and dentoalveolar injuries (23.7%) than patients who did not (68.8 and 37.3%, respectively). Interestingly, helmet use had no protective effect on soft-tissue injuries.ConclusionsHelmet use by E-bike and P-scooter riders decreased the probability of head injury and of hard tissue and dentoalveolar injuries. These results may provide guidance for effective legislation and regulation of helmet use and improved treatment protocols for general and dental physicians.

Evaluation of the Severity of Maxillo-Facial Injuries by Motorcycle Road Accident in the Teaching Hospital of Conakry: A Case-Control Study

Introduction: Maxillofacial injuries caused by motorcycle road accidents are serious and represent a real public health issue. They mainly affect young adult males. The objectives of this study were to determine the frequency of motorcycle road accidents, describe the socio-demographic characteristics of the injured, determine the degree of severity of motorcycle injuries compared to car injuries, and describe the therapeutic modalities. Materials and Method: This study was a prospective case-control study carried out in the Department of Odontostomatology, Maxillofacial Surgery and Surgical Emergencies at the National Hospital of Donka. The data was collected over a period of six months from January 1st to June 30th, 2017. All victims of road accidents by motorcycle (cases) or car (controls) that received care and post-surgical follow up were included. Results: A total of 505 patients with maxillofacial injuries were reviewed during the period of the study. From the review, 205 (40.6%) motorcycle accidents were recorded as “cases” and 109 (21.58%) car accidents were classified as “controls” group. Men were the most affected in both groups, n = 254 (177 males in the case group and 77 in the control) (p = 0.01). There was a proportionate relationship between helmet use and death (p = 0.015). A motorcycle accident victim is more likely to develop a mandibular fracture (p = 0.029) and limb injury (p = 0.034) when compared to a car accident victim. However, there was no significant difference between cases and controls for head trauma (p = 0.4878), Facial Injury Severity Scale (FISS) (p = 0.130), and Glasgow score (p = 0.709). Conclusion: Maxillofacial injuries caused by motorcycle accidents are increasing in Guinea. Young adult males have the highest incidence of motorcycle accidents. The death rate related to motorcycle road accidents is high, and mandatory use of a helmet for all drivers and passengers is recommended. These preventative actions could reduce the mortality and morbidity of motorcycle road accidents in Guinea.

Severity of maxillofacial injuries and associated factors in brazilian women victims of domestic violence

Objective: The aim of this study was to determine the profile and prevalence of maxillofacial injury (MFI) and to assess associated factors in women victims of domestic violence. Methodology: This was a cross-sectional and analytical study that evaluated 514 records of women victims of domestic violence diagnosed with MFI attended at a public reference urgency and trauma hospital in Northeastern Brazil. Descriptive and multivari­ate statistics were performed using Poisson regression. Results: The prevalence of fractures and facial lacerations was 80.2% and 19.8%, respectively, the majority with low severity (92.1%). Associations were observed between MFI severity and alcohol / drug consumption by the perpetrator (PR=0.251; 95%CI=0.106-0.595; p=0.002) and the night shift (PR=4.675; 95%CI= 1.745-12.525; p=0.002). Correlations were found between MFI severity and length of hospital stay (r=0.148; p<0.01). Conclusions: The prevalence of fractures was considered high and MFI severity was associated with longer hospital stay and alcohol / drug consumption by the perpetrator and the night shift. Strategies need to be adopted as improving the quality of health care for users, social investment in women in vulnerability, overt supervision by security agencies, as well as the implementation of educational programs focused on preventing this condition.

Dental and maxillofacial injuries associated with electric-powered bikes and scooters in Israel: A report for 2014-2019.

Electric-Powered Bikes and powered scooters present a new method of transportation and are becoming commonly used worldwide. However, the reports on traumatic dental injuries related to their use are scarce. The aim of this study was to report the frequency and severity of dental and maxillofacial injuries associated with electric-powered bikes and scooters in Israel between the years 2014 and 2019. This was a retrospective cohort study based on data from the Israeli National Trauma Registry (INTR). The INTR provides comprehensive data on hospitalized patients from all six Level I trauma centers (TC) and 15 of the 20 Level II TCs in Israel. All injured patients who were hospitalized due to a traffic collision between 2014 and 2019 were identified. The data for those hospitalized due to an e-bike or motorized scooter accident were extracted as well as for pedestrians who were injured as a result of a crash with these vehicles. A total of 3,686 hospital admissions were related to electric-powered bikes and scooters. Of those, 378 (10.3%) were oral and maxillofacial injuries. Most of the oral and maxillofacial injuries were attributed to powered bikes (321 out of 378; 84.92%) and the rest to powered scooters. There was a constant increase in general as well as the oral and maxillofacial injuries during the study years. Almost 20% of the cases involved injuries to the teeth. Overall, 291 pedestrians were reported to be injured due to electric-powered bikes and scooters; 29 (9.97%) of them, suffered from oral and maxillofacial injuries. Most of those were children aged 0-15years (41.38%) and elders older than 60years (37.39%). Trauma related to electric-powered bikes and scooters is an increasing concern. Dental professionals should be actively involved in educational and legislative efforts focusing on the prevention of e-bike and scooter-related injuries, in general, and specifically maxillofacial injuries.

Incidence and Severity of Maxillofacial Injuries During the Syrian Civil War in Syrian Soldiers and Civilians.

The aim of this study was to assess the maxillofacial injuries (MFIs) and our surgical approaches in the Syrian Civil War that emerged during the spring of 2011, among Syria's government and Syrians. The present study is a prospective clinical study of injured patients at Turkey's Border Hospitals during the Syrian Civil Conflict. Patients' data cover to all emergency and plastic surgery hospitals throughout Turkey. We assessed the patients' data according to location of trauma, duration of hospitalization, the severity and etiology of MFIs with the Injury Severity Score. MFIs were found in 112 of the 956 wounded. The injuries occurred in 69 civilians (61.6%) and 43 soldiers (38.3%). The mean age ranged from 8 to 66 (mean: 29,1 ± 12). Eighty-two percent or higher rates of the injuries needed >4 days' hospitalization. We observed the mortality at a rate of 13.3% for the MFIs. Majority of the MFIs were accompanied by >3 concomitant injuries (n = 59; 52.6%). Most of the facial injuries were located at Mandibula (n = 75; 66.9%), Maxilla (n = 69; 61.6%) and orbitofrontal (n = 52; 46.4%) regions. Severity and incidence of MFIs were extremely high compared with previously published studies of other wars, especially affecting the civilians in the Syrian Civil War. The high rates of LeFort III fractures exhibit its devastating damages on civilians.

Helmets Decrease Risk of Bicyclist-Related Maxillofacial Injuries But Not Severity

Given the increasing use of bicycles for local transportation and recreation, the purpose of the present study was to measure the effects of bicycle helmets on the frequency and severity of maxillofacial injuries. The specific aims were to measure and compare the frequencies and severity of maxillofacial injuries between injured bicyclists who had or had not worn helmets. We implemented a retrospective cohort study and enrolled a sample of bicyclists who had been injured from January 4, 2012 to March 31, 2018 and had presented to Harborview Medical Center for evaluation and treatment. The primary predictor variable was helmet use (yes vs no). The primary outcome variables were 1) the presence of a maxillofacial injury (yes vs no); and 2) injury severity, measured using the Face Abbreviated Injury Scale (FAIS). The other study variables were grouped into demographic or injury-related variables. The appropriate univariate, bivariate, and multivariate logistic regressions statistics were computed, and statistical significance was set at P<.05. The sample included 1379 subjects, with a mean age of 39.6±18.9years (range, 1 to 91years), and 78.4% were male. The frequency of facial injuries between the helmeted and nonhelmeted bicyclists was 17.3% and 30.6%, respectively (relative risk, 0.6; 95% confidence interval, 0.5 to 0.7; P<.0001). The protective effect held after adjusting for age, gender, and alcohol exposure. The FAIS score between the helmeted and nonhelmeted riders was 1.8±0.5 and 1.9±0.6, respectively (P=.8). The helmeted bicyclists were 40% less likely to have a facial injury from bicycle accidents. For those cyclists with a facial injury, however, the injury severity was not different between the helmeted and nonhelmeted wearers. This might have been because, that unlike American football helmets, standard bicycle helmets do not include a face mask to protect the face.

The role of Helmet use on Severity and Pattern of Maxillofacial Injuries among Motorcycle Crash Victims attending Mulago Hospital, Uganda

The role of Helmet use on Severity and Pattern of Maxillofacial Injuries among Motorcycle Crash Victims attending Mulago Hospital, Uganda

Possibilities of maxillofacial injury’s parameters objectification

According to the results of different researches, the prevalence of maxillofacial area injuries during road traffic accidents ranges from 17% to 94%. Most of the victims with maxillofacial region alterations after such accidents have combined injuries (61%), and less than half have isolated injuries. In order to provide adequate rehabilitation of such patients with a tooth-jaw apparatus injuries, should be conducted comprehensive medical treatment that in 77% of cases includes surgical iatrogenic intervention. However, during the analysis of existing methodologies to assess the damages of maxillofacial area, it was found that the most of these approaches didn’t capture functional disorders of the teeth-jaw system after road traffic accidents, respectively the registration of injuries in such cases is based only on anatomical criteria, which does not always provide the appropriate level of objectivity during the evaluation of the accidents post effects. The most promising algorithm for assessing the severity of maxillofacial injuries with regard to anatomic and functional changes included in the MFISS system, that is also limited to the lack of a unified approach for the diagnostics of different types of tooth-jaw apparatus injuries, especially to the mechanism of formation of maxillofacial fractures during traffic accident, adherence to the AIS- 90 criteria as a basic estimation parameter and due to the verification errors of dental status lesions at the stage of initial diagnostics of the victims. That is why the research and development of the optimal method for assessing tooth-jaw apparatus injuries that can be used during forensic medical and forensic dental examinations is an open scientific and practical aspect of modern dentistry and forensic medicine

Maxillofacial and concomitant serious injuries: An eight-year single center experience

PurposeMaxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas. MethodsWe retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different institutions, pediatric trauma patients and adult patients who were transferred in accordance with pre-existing agreements in case of paucity of beds were excluded. Finally we included 447 (0.2%) patients over the 8 years. Data were evaluated with emphasis on epidemiology (age, gender, mechanism of trauma), primary survey and abnormalities and pattern of trauma. ResultsThe most frequent cause of maxillofacial trauma was road accidents (319 patients, 71.4%), among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients; 443 (99.1%) patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries (χ2 = 557.2, p < 0.0001). Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas (χ2 = 17.13, p < 0.0001 vs minor lesions). All of the neglected lesions occurred in paucisymptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hematoma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms. ConclusionAmong the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit, diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial major lesions.

Maxillofacial Trauma Following Road Accidents and Falls.

Motor vehicle accidents (MVA) and falls are major causes of maxillofacial injuries posing real challenges for the medical staff. To describe the demographic and injury characteristics, as well as the treatment procedures of casualties diagnosed with maxillofacial injuries. The investigators implemented a multicenter retrospective study composed of hospitalized maxillofacial trauma patients recorded in the Israel Trauma Registry for 2000 to 2011. The predictor variable was mechanism of injury and the outcome variable was type of injury, severity, and hospital resources utilization. Descriptive and bivariate statistics with P values was set at 0.05. The study included 11,592 reported hospitalized maxillofacial trauma patients (39.4% of them were MVA, 33.5% were falls), with a male predominance of a 3:1 ratio. The high-risk age groups were the first 3 decades of life in both etiologies, while age groups above 75 years were also frequent in falls. Severity of maxillofacial injuries, multiple injuries, admission to intensive care units, hospitalization for more than 15 days, inpatient mortality, and rehabilitation after discharge was significantly higher in MVA compared with falls. Conversely, maxillofacial surgeries were performed slightly more among patients injured in falls (34.1% and 31.1% respectively), as tongue and mouth are more prone targets in falls, compared with zygoma, maxilla, mandible, and teeth in MVA. The results of this study suggest that the etiologies present an entire separate pattern of trauma. A better understanding and proper identification of their high-risk groups should lead to appropriate prevention programs and treatment protocols.

Patterns, severity, and management of maxillofacial injuries in a suburban south western Nigeria tertiary center

Background:Trauma remains a leading cause of maxillofacial injury globally. Changing etiological factors and patterns of maxillofacial injury continue to be reported and are largely modulated by socio-geographic and environmental factors. It is important to have an in-depth understanding of the pattern and etiology in a particular region before effective preventive measures can be developed.Aim:The aim was to evaluate the patterns, etiological factors, and management of maxillofacial injuries in Ogun state, Nigeria.Materials and Methods:A prospective descriptive cohort study of all consecutive patients that presented with maxillofacial injuries at our center between January and December 2013. Information about demographic data, types of maxillofacial and associated injury, etiology of injury, treatment received and complications were collected and analyzed.Results:Seventy patients presented with maxillofacial injury during the study period with a male to female ratio of 4:1. The age range was 9 months to 60 years with a mean of 30.11 ± standard deviation 14.97 years. Majority of the facial fractures were due to motorcycle related crashes. There were 57.1% mandibular fractures and 55.7% middle third fractures. Closed reduction with maxillo-mandibular fixation was the major method of treatment of facial fractures. Postoperative complications were observed in 11.4% of patients.Conclusion:Road traffic crashes (RTCs) remain the leading etiological factor of maxillofacial injuries in our center. Enforcement of stricter traffic regulations and possibly replacement of motorcycles with tricycles for commercial transportation may help to reduce the incidence of RTCs.

Updates in Facial Fracture Management

Facial fractures are common injuries that frequently necessitate plastic surgery intervention, and motor vehicle accidents are among the most common etiologies of facial fractures. Current passenger restraint devices have consistently proven to decrease the rates of facial fractures in MVCs, but improvements should be pursued to further reduce fracture rates and the severity of maxillofacial injuries sustained in these accidents. Innovations in plate fixation systems, imaging technology, and virtual surgical planning contribute to the dynamic landscape of facial fracture management. Well-designed prospective and controlled studies of these technologies are necessary in order to establish rigorous, evidence-based guidelines.

Analysis of Road Traffic Crashes-Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan.

The objective of this study was to determine the prevalence of road traffic crashes (RTC)-related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the severity of maxillofacial injury and head, ocular and polytrauma. This study further emphasizes the need for thorough examination of patients presenting with RTC-related maxillofacial injuries.

Influence of Motor Vehicle Restraint Systems on Maxillofacial Fractures

Statement of the Problem: Since implementation, airbags and restraint systems have demonstrated overall reduced morbidity and mortality. The high cost to society of motor vehicle collisions has been well documented. Similarly, the effectiveness of restraint devices has been researched extensively. However, the incidence and severity of maxillofacial injuries related to restraint devices has not been elucidated as clearly in the literature.

Incidence and Severity of Maxillofacial Injuries During the Second Lebanon War Among Israeli Soldiers and Civilians

To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians. This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals. Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries. In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

A Retrospective Analysis of Oral and Maxillofacial Injuries in Motor Vehicle Accidents

To clarify the relations of the severity of oral and maxillofacial injuries from traffic accidents (TAs) to seating position and the use of restraint systems. Hospital records were reviewed for all patients who had sustained oral or maxillofacial injuries in TAs and then were admitted to the Department of Oral and Maxillofacial Surgery, Dokkyo University School of Medicine (Tochigi, Japan), from 1994 through 2003. A total of 201 patients, with a mean injury severity score (ISS) of 7.9 +/- 7.6, were included in this study. Although patients with any oral or maxillofacial injury with an Abbreviated Injury Scale (AIS) score of 2 or more had extremely low ISSs, hospitalization was relatively long. The ISS and AIS score of the head or neck were significantly higher in unrestrained drivers (12.4 +/- 11.2, 1.2 +/- 1.4, respectively) than in restrained drivers (6.5 +/- 4.6, 0.4 +/- 1.0, respectively). However, AIS scores of the face were similar in unrestrained drivers (1.9 +/- 0.7) and restrained drivers (1.7 +/- 0.5). Furthermore, the incidence of maxillofacial fractures did not differ between the 2 groups. Because wearing seat belts cannot prevent all oral and maxillofacial injuries in motor vehicle occupants, both physicians and engineers must pay greater attention to the mechanisms of oral and maxillofacial injuries in TAs.

Application of a Facial Injury Severity Scale in Craniomaxillofacial Trauma

To establish a Facial Injury Severity Scale (FISS) that correlates with patient outcome and provides a practical tool for communication between clinicians and healthcare personnel for management of facial trauma. All patients presenting to the Emergency Department (ED) at Legacy Emanuel Hospital (Level One Trauma Center) in Portland, Oregon between 01/1993 and 6/2003 with facial fractures with or without concomitant non-facial injuries where identified retrospectively. The diagnosis and treatment of all facial fractures were conducted by the Oral and Maxillofacial Surgery (OMFS) service. The following data were collected; age, gender, mechanism of injury, detailed diagnosis of facial fractures, disposition, and the length of hospital stay (LOS). The hospital operating room charges (ORC) for the treatment of each patient's facial fractures were also obtained. We designed the FISS to be a numeric value composed of the sum of the individual fractures and fracture patterns in a patient. Not all fractures of the face are weighted equally in the FISS because not all fracture patterns are equal in severity. Individual fracture points within the scale were optimized to result in the highest correlation. A total of 1,115 patient admissions to the ED with blunt or penetrating maxillofacial injuries were identified and reviewed. Full information on operating room charges (ORC) was available for 247 patients (average age: 32, SD +/- 17; range, 2 to 84; male:female, 3:1; blunt:penetrating, 232:15). The FISS scores were calculated for each patient (average FISS: 4.4, SD +/- 2.7; range, 1 to 13). Hospital ORC for the treatment of each patient's maxillofacial injuries were obtained from the hospital financial services (average ORC: 4,135 dollars, SD +/- 2,832 dollars; range, 845 dollars to 18,974 dollars). A significant correlation was identified between the FISS and the ORC (R value = .82). The length of stay was significantly associated with the FISS (t = 4.7, 245 degrees of freedom, P = .000004). Although the association was statistically significant, FISS is not a very good predictor of length of stay. The correlation between the predicted and observed values was 0.38. There were 3 deaths among the 247 entries. Those 3 deaths had higher than average FISS scores, but the difference between the scores of survivors and non-survivors was not significant (P = .08). The number of deaths was small and a larger study would be required to resolve this question. We introduce a FISS that is easily calculated and reliably predicts the severity of maxillofacial injuries as measured by the operating room charges required to treat the facial injury. The scale is also an indicator of hospital length of stay. We anticipate this to be a valuable tool for assessment and management of maxillofacial trauma.