Traumatic Facial Injuries Research Articles

Initial Assessment and Evaluation of Traumatic Facial Injuries.

The care of the facial trauma patient continues to evolve in the ever-changing face of medicine. Patients can be reassured that their care is managed by a variety of specialists knowledgeable in the assessment and management of complex facial injuries. Thanks in part to advances in imaging modalities, bone fixation techniques and technology, and a wider array of reconstructive procedures, the foundation upon which the reconstructive ladder of facial injuries rests continues to expand. The overall goal of repair is a return to a preinjury state of form and function.

The effect of nimodipine and prednisolone on traumatic facial nerve injury treatment

The effect of nimodipine and prednisolone on traumatic facial nerve injury treatment

Use of Facial Recognition Software to Identify Disaster Victims With Facial Injuries.

After large-scale disasters, victim identification frequently presents a challenge and a priority for responders attempting to reunite families and ensure proper identification of deceased persons. The purpose of this investigation was to determine whether currently commercially available facial recognition software can successfully identify disaster victims with facial injuries. Photos of 106 people were taken before and after application of moulage designed to simulate traumatic facial injuries. These photos as well as photos from volunteers' personal photo collections were analyzed by using facial recognition software to determine whether this technology could accurately identify a person with facial injuries. The study results suggest that a responder could expect to get a correct match between submitted photos and photos of injured patients between 39% and 45% of the time and a much higher percentage of correct returns if submitted photos were of optimal quality with percentages correct exceeding 90% in most situations. The present results suggest that the use of this software would provide significant benefit to responders. Although a correct result was returned only 40% of the time, this would still likely represent a benefit for a responder trying to identify hundreds or thousands of victims. (Disaster Med Public Health Preparedness. 2017;11:568-572).

Brief alcohol intervention in alcohol involved facial fracture patients-a survey of patient attitudes to screening and intervention.

Alcohol intoxication is an important contributor to traumatic facial injuries. The period following injuries afford clinicians a useful window of opportunity to provide alcohol screening and brief intervention (SBI) which may affect changes in patients' future drinking behaviour. Although SBI has been reported to decrease at risk drinking and potentially trauma recurrence, it is not routinely utilised in most clinical settings in the world. This study aims to assess utilisation of, as well as patients' knowledge and attitude towards SBI in the management of patients presenting with alcohol-related facial fractures. Twenty consecutive patients who presented to Western Health with facial fractures who met selection criteria were offered an alcohol screening and survey questionnaire. Ninety percent of patients were male and 50% were aged between 19 and 34. ASSIST score showed 65% were in the moderate risk category; 75% reported this was their first admission with alcohol related trauma. Although 75% acknowledged alcohol as a main cause of injury, only 40% agreed they drink too much. Forty-four percent felt that talking to a healthcare worker might help and 33% would consider accepting help. Forty-seven percent felt reading materials would be helpful in changing future drinking habits. Whilst 63% would like to know safe drinking limit, only 45% would like to have a discussion about alcohol-related harms. Most patients presented in this survey were in moderate risk category who are amenable to behavioural change with provision of SBI. However, there is resistance to implementation of this intervention due to lack of knowledge, self-awareness and willingness to change. Nonetheless, patients are prepared to accept advice from clinicians and some formats of intervention. It is important to formulate a simple screening questionnaire and intervention strategy that are easy to administer to affect positive changes in patients with harmful drinking behaviours.

Traumatic Facial Injuries Among Elderly Nursing Home Residents

As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma. To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data. The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed. There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]). Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.

Zatrzymanie stałego zęba przedtrzonowego i trzonowca mlecznego – rzadki przypadek radiologiczny

Impaction of teeth is more commonly noticed with permanent dentition compared to primary dentition. Impaction of deciduous teeth can result in a variety of consequences including effects on the succedaneous teeth.Here we present a unique incidental finding on a panoramic radiograph of a 19-year-old male who had an unerupted mandibular right second premolar with the deciduous second molar being significantly off positioned against the lower border of the mandible. Inversion of the intraosseous positions of the primary molar and its succedaneous premolar is a very rare phenomenon. Various factors, such as lack of space in the dental arch, obstruction caused by supernumerary teeth, infectious process in the path of eruption or displacement of the tooth bud due to traumatic facial injury, have been implicated in the causation of impaction of teeth. Hence, disturbances in the eruption of the primary tooth could result in non-eruption of the succedaneous tooth.

Efficacy of human amniotic membrane and collagen in maxillofacial soft tissue defects – A comparative clinical study

ObjectiveManagement of traumatic facial soft tissue injury poses a major challenge for surgeons due to aesthetic concerns. Human amniotic membrane (AM) and collagen membrane (CM), biologic materials, have attained importance in various clinical fields, especially in wound healing. Though both materials have their own unique properties, there is a need to compare and evaluate the efficacy of AM and CM as a wound dressing material for post-traumatic soft tissue injuries of the maxillofacial region. MethodsA study was conducted in Department of Oral And Maxillofacial Surgery, at our institution which encompassed all the patients (total of 20 patients) with facial soft tissue injuries (abrasions), due to road traffic accidents from January 2014 to March 2014. They were randomly divided into two groups, with 10 patients treated with AM and 10 patients treated with CM. The groups were compared according to the wound compliance, time taken for granulation tissue formation and scarring. ResultsIt was observed that the pain score was much higher in Collagen group than in Amnion group and complete adherence of the membrane to the wound was detected in both the groups. A statistically significant result in favour of AM was found with regard to average time taken for granulation tissue formation (P=0.036) and the resultant scarring. Incidence of wound infection was reported in two cases in Collagen group. ConclusionWhen compared to Collagen, AM had good adhesive, antibacterial, anti-immunogenic and anti-scarring property. Its low cost of procurement and storage makes it an ideal wound dressing material.

Alcohol consumption and interpersonal injury in a pediatric oral and maxillofacial trauma population: a retrospective review of 1,192 trauma patients.

The social, financial, and health implications of adult alcohol-related oral and maxillofacial trauma have been recognized for several years. Affordability and widespread accessibility of alcohol and issues of misuse in the pediatric trauma population have fostered concerns alcohol may be similarly implicated in young patients with orofacial trauma. The aim of this study was to review data of pediatric facial injuries at a regional maxillofacial unit, assess the prevalence of alcohol use, and review data of patients sustaining injury secondary to interpersonal violence. This study is a retrospective, 3-year review of a Regional Maxillofacial Unit (RMU) trauma database. Inclusion criterion was consecutive facial trauma patients under 16 years of age, referred to RMU for further assessment and/or management. Alcohol use and injuries sustained were reviewed. Of 1,192 pediatric facial trauma patients, 35 (2.9%) were associated with alcohol intake. A total of 145 (12.2%) alleged assault as the mechanism of injury, with older (12-15 years) (n = 129; 88.9%), male (n = 124; 85.5%) (p < 0.001) patients commonly involved and alcohol use implicated in 26 (17.9%) presentations. A proportion of vulnerable adolescents misuse alcohol to the risk of traumatic facial injury, and prospective research to accurately determine any role of alcohol in the pediatric trauma population is essential.

British dental surgery and the First World War: the treatment of facial and jaw injuries from the battlefield to the home front.

When Britain went to war in 1914, the British Expeditionary Force was deployed without a single dentist. Initially considered combatants, the only dental professionals who could serve at the Front were medically qualified dental surgeons in the Royal Army Medical Corps. In treating the traumatic facial and jaw injuries caused by trench warfare, the dental surgeons of this era earned their place on specialist surgical teams and established the principles of oral and maxillofacial surgery. This article will examine the contribution of specialist dental surgeons to the management of facial and jaw wounds in the First World War along the chain of evacuation from the battlefield to the home front, using illustrative examples from the Hunterian Museum at the Royal College of Surgeons of England.

Complex Traumatic Facial Degloving Injury

By definition, degloving is detachment of skin and subcutaneous tissue, most often affecting the limbs and extremities and occasionally the scalp. Degloving generally occurs from high-energy trauma. This paper describes an extreme case of traumatic facial degloving injury.

Concomitant dental injuries in maxillofacial fractures - a retrospective analysis of 1219 patients.

Traumatic dental injuries are frequently combined with maxillofacial fractures, but literature addressing this topic is rare. In a retrospective study, the frequency of dental lesions in inpatients with traumatic facial injuries was analyzed. All patients referred to the Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University Mainz for inpatient treatment due to facial fractures between January 2001 and December 2007 were analyzed regarding the type of fracture, its localization, and potential concomitant dental injuries. In addition a systematic review was performed to compare the findings of this study with existing data. Altogether 1219 facial trauma patients underwent inpatient treatment. 184 (15.87%) out of those had 451 injured teeth, and 4.9% were edentulous. The most frequent causes were assaults (25.1%), followed by falls (19.6%) and bike accidents (10.1%). Avulsion, especially of the upper incisors, occurred in most cases (27.9%). Assaults caused 1.29 dental fractures per patient, while traffic-related accidents led to three to four times higher injury-rates. With almost every sixth patient having at least one kind of dental injury, this study shows that a thorough anamnesis and examination of the dental status are absolutely necessary, especially in patients who suffered from high-speed impacts or collisions with low-resilience surfaces.

External Auditory Canal Fracture after Posterior Dislocation of an Intact Condylar Head

Aims: The aim of this article is the kind of applied treatment for fracture of the external auditory canal, following traumatic facial injuries. Presentation of Case: The case report of the patient described in this article, is evaluated for the posterior dislocation of an intact mandibular condyle after facial injuries she had due to a car accident. The physical and x -ray examination of the External Auditory Canal (EAC) revealed facial fractures, TMJ dysfunct ional symptoms with severe disk displacement, as well as fracture of the anterior wall of the EAC. Atraumatical reduction of the fracture was accomplished during the TMJ disc reduction and joint exploration, resulting in a satisfactory outcome with no comp lications and with

Rapid and Accurate Identification of Cut Ends of Facial Nerves Using a Nerve Monitoring System During Surgical Exploration and Anastomosis

Surgical exploration and end-to-end neurorrhaphy is the preferred management for traumatic facial nerve injury. Traditionally, finding the cut ends of facial nerves depends mainly on a surgeon's experience. In this study, a nerve monitoring system to help the surgeon quickly and accurately identify, confirm, and locate the cut ends of facial nerve branches was investigated. Six patients with traumatic facial nerve injury were selected, and the nerve monitoring system was applied during the surgical process of facial nerve exploration and anastomosis. Operation time and surgical outcome were used to evaluate the effect of this method. The surgical procedures required 6 to 15 minutes (mean, 10 minutes) for detecting and dissecting each cut end of a facial nerve branch. All cut ends of injured facial nerve branches were found during surgery in all 6 patients, and no intraoperative complications were encountered. The postoperative function of the facial nerve, evaluated by clinical examination and diagnostic electroneurography, was satisfactory and symmetrical in all 6 patients at 3 months. Using a nerve monitoring system could effectively help surgeons achieve rapid and accurate identification of the cut ends of facial nerves during surgical facial nerve exploration for traumatic facial nerve injury.

Root Apex Closure and Unique Modification of Mouthguard in Prevention Traumatic Facial Injuries- A Case Report and Review

It has been widely reported that participation in sports carries a considerable risk of sustaining dental injury. A considerable number of papers have appeared in the dental literature highlighting the dangers of participation in such contact sports activities, in particular ‘stick’ sports such as lacrosse, and fi eld and ice hockey. An almost universal fi nding is that the majority of injuries affect the upper jaw, with the maxillary incisors being most prone to injury, often accounting for as many as 80% of all cases. Highly signifi cant differences have been shown to exist between the number of teeth injured and the causes of injury. In children, sports accidents reportedly account for 10-39% of all dental injuries and often involve teeth with incomplete root formation. Boys are more likely than girls to incur injuries; at a ratio of 1·5-3·1, the highest incidence occurs between the ages of 8 and 11. Hence injuries occur mostly to the primary or young permanent teeth, which is generally complicated because of patient/parent’s compliance and diffi cult clinical conditions such as treatment of immature young permanent teeth. Adding signifi cance to these fi nding is that school teachers often have inadequate knowledge of how to deal with such dental injuries. The current case report describes a healthy 11 years old male with history of frequent trauma to teeth 11 and 21 while playing since 2 years.

Superselective Microcatheter Embolization of Hemorrhage after Buccal Lipectomy

Superselective microcatheter angiography and embolization has been shown to be an effective modality for prompt treatment of bleeding from traumatic facial injury and refractory epistaxis when local methods fail to achieve hemostasis. It obviates the need for further surgical exploration and provides precise diagnostic and therapeutic modalities in a minimally invasive manner. Despite this successful profile, its use in treatment of hemorrhagic complications after facial aesthetic surgery is underreported. This report is a unique case of life-threatening hemorrhage after buccal fat pad lipectomy that was successfully treated with superselective microcatheter embolization of internal maxillary artery branches. A 31-year-old male was transferred to our emergency room from an outside facility with an active intraoral hemorrhage after a buccal lipectomy in which severe bleeding was encountered deep within the buccal space that persisted despite further attempts at surgical exploration. On arrival to the emergency room, the patient demonstrated signs of significant blood loss and had intraoral packing in place tamponading further hemorrhage. The patient underwent resuscitation and stabilization with endotracheal intubation for airway protection and was sent emergently to the angiography suite. Superselective angiography was used to study branches of the internal maxillary artery. Superselective embolization using microspheres was then performed on target vessels to control the bleeding. The surgical packing was then removed with no evidence of active bleeding. The patient was transferred to the surgical intensive care unit for further monitoring and was discharged the following day in stable condition. In the case of refractory surgical measures, superselective microcatheter angiography and embolization provides an alternative to both precisely localize and control severe small-artery bleeding. This may be ideal in cases that otherwise would require extensive dissection and in regions of complex anatomy, both of which can compromise aesthetic outcomes. We demonstrated the use of this method in a case of refractory bleeding after facial lipectomy. The expanding role of superselective angiography and specifically designed embolic agents may play an invaluable role in treatment of arterial injury after aesthetic surgery when local methods fail. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Brain and facial trauma: A neuroradiology perspective

Traumatic head and facial injuries are common causes of emergency department admissions. Head trauma, in particular, is the commonest reason for emergency out of hours computed tomography (CT) performed. Most patients with traumatic brain injuries (TBIs) have mild head injuries, but up to 20% require hospitalisation or further management. The fixed size of the bony cranial cavity means that only small increases in volume within the intracranial compartment can be tolerated before pressure within the cavity increases dramatically leading to secondary brain injury, with potentially catastrophic consequences. Head and brain injuries are commonly associated with facial trauma, particularly of the upper face, and it is important to be aware of this because the treatment of the former injuries may need to take precedence over the facial injuries. This review aims to summarise the epidemiology of blunt trauma to the head and face and the various patterns of TBI. The role of CT, both in the acute setting and in follow-up these patients, is described.

Percutaneous Dilatational Tracheostomy: Review of Technique and Evidence for Its Use

Tracheostomy is a technique for airway management commonly used by surgeons who care for critically ill patients. Patients with traumatic facial injuries, severe odontogenic infections, and head and neck malignancies are often recipients of tracheostomies. As such, the oral and maxillofacial surgeon who frequently treats such patients should be well-trained in tracheostomy placement. For decades, the standard technique for tracheostomy was the open surgical technique. However, during the past 20 years, the use of percutaneous dilatational tracheostomy has increased. The purpose of the present report is to review the percutaneous dilatational tracheostomy technique, describe the use of intensive care units as proxies for the operating room, and review the available evidence comparing percutaneous dilatational tracheostomy to open tracheostomy.

The opportunity of the rehabilitation of the post traumatic facial and alveolar nerves injury with the application of physiotherapy

The opportunity of the rehabilitation of the post traumatic facial and alveolar nerves injury with the application of physiotherapy

The prevalence of psychological distress in a sample of facial trauma victims. A comparative cross-sectional study between UK and Australia

Aim The potential psycho-social sequelae of traumatic facial injury have received increasing attention in recent years, however there remains paucity of cross-national comparative data on the prevalence of psychological distress following such trauma. The aim of the present study was to investigate and compare the prevalence of anxiety and depression in an adult patient group who have been treated for maxillofacial trauma, and who attend a follow-up clinic in either the West Midlands, UK or New South Wales (NSW), Australia. By using an identical methodological and statistical approach, we hoped to add to the available information on the incidence of early psychological distress in patients following facial trauma. Method This was a comparative cross-sectional study. A sample of fifty consecutive adult victims of facial trauma in the West Midlands UK, was compared to a group of fifty-two facially injured patients in NSW, Australia. Demographic data was collected, following which the Hospital Depression and Anxiety Scale (HADS) were applied to both groups of patients. Results Psychometric scores suggestive of anxiety and depressive state were common in both groups of patients. The mean HADS depression subscale score for UK patients compared to Australian patients was not significantly different (5.94 versus 5.54 p = 0.62). This was also the case for the HADS anxiety subscale (5.96 versus 5.94 p = 0.98). Although the number of patients achieving scores suggestive of a ‘caseness’ for co-morbid psychological state was higher within the UK sample when compared to the Australian group (20% versus 11.5% for HADS depression subscale, and 20% versus 15% for HADS anxiety subscales respectively); these differences did not reach statistical significance. Conclusion This cross-national comparative study has shown that anxiety and depression in facial trauma victims were comparable in both settings.

Assessment of T Cell Activation in a Mouse Model of Traumatic Facial Nerve Injury

ObjectiveTo investigate T cell activation following facial nerve axotomization and latent neuroimmunologic mechanisms in traumatic facial paralysis. MethodsA murine model of facial nerve transaction was used. Lymphocytes from cervical and mesenteric lymph nodes in BABL/c mice at specific times were collected and expression rates of CD69 on T cells were assessed by flow cytometry. ResultsInfiltrating T cells were detected around the facial neurons in the facial nerve nucleus in mice whose facial nerve was transected. Immunofluorescent staining showed recruitment of activated T cells. Three days post–facial nerve transection, the expression rate of CD69 on T cells from cervical draining lymphoid nodes(CDLNs) was significantly different from that on T cells from mesenteric lymph nodes(MLNs) (P = 0.0457), whereas the latter was similar to that in animals undergoing sham surgeries and that in blank control animals(p= 0.2817 and 0.2724, respectively). Two weeks post–nerve transection, the T cell CD69 expression rate from CDLNs remained at a higher level and than that in the sham–operation animals(p= 0.0007). At two weeks, CD69 expression rate on T cells from MLNs was also up–regulated and different compared with the sham–operation animals and with itself at three days postoperation(p= 0.0082 and 0.0133, respectively). ConclusionT cells appear to be activated and up–regulated in CDLNs following facial nerve transection. There is even evidence of T cell activation in MLNs at 2 weeks post–nerve transection. This suggestes an alteration of immune response from local to general immunity in the acute stage of facial nerve trauma, which may help coordinating and controlling the scales and orientation of the neuroimmune response during the pathogenesis and progression of facial nerve trauma.