Type Of Facial Fracture Research Articles

Facial Fractures: Large Epidemiologic Survey in Northern Brazil Reveals Some Unique Characteristics

Facial fractures are an important health problem worldwide that can cause temporary or permanent disability and an economic burden. Identifying the risk factors associated with facial fractures is a valuable tool to create preventive public health strategies. This study evaluated the epidemiologic profile of facial fractures in northern Brazil. Medical records of 1,969 patients who sustained facial fractures were analyzed for characteristics of the population, types of facial fractures, and treatment performed. The zygomatic complex was the most prevalent fracture site (28.8%). Road traffic accident (RTA) was the most common etiology (52%), followed by interpersonal violence (IPV; 34%). Among IPV cases, gunshot wounds were responsible for 14% of cases and 3% resulted from stab wounds. The third decade of life was the most prevalent age group, with a remarkable change in prevalence and etiology pattern at 15years of age. Open reduction and internal fixation was the most used treatment, especially when the mandible was involved and at least 2 facial bones were fractured. There were 37 deaths (1.9%), with a higher risk observed for stab wounds (3.1-fold higher) and when at least 3 bones were fractured (4.1-fold higher). This epidemiologic survey identified RTA and IPV as important risk factors for facial fractures and a high prevalence of fractures caused by gunshot wounds. A unique preponderance of facial fractures caused by stab wounds was found, which was responsible for the highest risk of mortality.

Among Patients With Facial Fractures, Geriatric Patients Have an Increased Risk for Associated Injuries

It is hypothesized that facial trauma-associated injuries (AIs) are more frequent and severe in elderly than in younger adult patients. The purpose of this study was to determine the occurrence of, reasons for, and severity of AI in geriatric facial fractures and to compare the differences between geriatric and younger adult patients. Two patient cohorts were included in this cross-sectional retrospective study. Geriatric patients were at least 65years old (n= 117) and younger controls were 20 to 50years old (n= 136). The main predictor was age, the primary outcome was AI, and secondary outcomes were affected organ system, multiple AIs, polytrauma, and mortality during hospitalization. The other explanatory variables were gender, trauma mechanism, and type of facial fracture. Statistical methods included χ(2) tests, risk analyses with 2 × 2 table, and logistic regression analyses. AIs were significantly more common in geriatric patients (44.0%) than in younger controls (25.0%; P < .001). Also, multiple AIs (P= .003), polytrauma (P= .039), mortality (P= .008), limb injuries (P= .005), and spine injuries (P= .041) were significantly more common in the elderly. In the risk analyses, geriatric patients had a 1.8-fold risk for AI, a 2.6-fold risk for multiple AIs, and a 2.2-fold risk for polytrauma. AIs are much more frequent and severe in geriatric patients, and the elderly die more often of their injuries. The results emphasize that elderly patients require specific attention and multi-professional collaboration in the diagnosis and sequencing of trauma treatment.

Clinical analysis of facial fractures: A ten years study of 300 cases

The reasons and types of facial fractures and their treatment approaches are different, depending on the age group, and these fractures constitute an important part of the practice of plastic surgery. Demographic characteristics, etiologies of fractures, fracture types, and treatment approaches were evaluated in patients who underwent an operation due to facial fractures between 2006 and 2016. A total of 300 patients were operated on at our clinic over a period of ten years. The reason for the fracture was often motor vehicle collisions in the adult patient group, while the reason was falls and accidents in the pediatric age group. Mandibular fractures ranked first among other types of fracture and orthopedic injuries ranked first among systemic injuries. The preferred treatment approach was open surgery in adult patients and conservative therapies in the pediatric age group. The present study carried out a retrospective review of 300 cases and demographic characteristics, etiologies, fracture types, accompanying injuries, and treatment approaches were presented in consideration of the current literature.

Midface – Cushion for Head Injuries

Recent technological advances have led to improvements in social well being of man’s life in all aspects. This improving and advanced lifestyle is the major cause for some debilitating problems like road traffic accidents. Statistical analysis in literature shows that head and maxillofacial injuries are the most common of these injuries. Recent studies show that fractures of midface are strongly associated with a high mortality rate. The exact relationship between different types of facial fractures and brain injuries is still controversial. Purpose: To evaluate the individuals with fractures of midface from different etiologies and determine if there is any relationship between various fractures of midface acting as a buffer mechanism for head injuries. Materials and Methods: Retrospective study was done to assess all the patients with midface fractures at the trauma center in a rural area in India. The etiologic and demographic data, the type of midface fracture and brain injury, and Glasgow coma scale were assessed. Results: Of 59 patients, 33 patients had head injury. The important correlations were as follows: Le Fort III with brain contusion, nasal orbital ethmoid fractures with subdural hematoma, frontal fracture with subdural hematoma, zygomatic complex fracture with brain contusion. Nasal fracture correlated with brain contusion. The zygomatic complex fracture was the most prevalent fracture. Conclusion: Different midface fracture patterns have the risk of different types of simultaneous brain injuries. So midface fractures absorb the forces of impact to a great extent and prevent the severity of head injuries and high mortality rate.

Ocular Trauma in Patients With Maxillofacial Fractures

The purpose of this study was to analyze and evaluate ocular injuries in patients with maxillofacial fractures. Correlation of the ocular injury and patients' age, sex, trauma mechanism, and type of maxillofacial fracture was also investigated. From January 2000 to December 2009, a total of 1131 patients with facial fractures were registered. The information and data collected and analyzed included the following: age, sex, mechanism of injury, type of facial fracture, type of ocular injury, and the relationship between ocular injury and facial fracture. Ocular injury (349 injuries) was sustained by 209 patients (18.5%), with a male/female ratio of 5.33:1 (176 males and 33 females). The age range of the patients associated with ocular trauma was 3 to 68 years (mean [SD], 32.40 [11.27] y). Patients aged 30 to 39 years showed the highest risk for ocular trauma (odds ratio [OR], 1.852; P < 0.001). Children showed the lowest risk for ocular injuries (OR, 0.162; P < 0.001). Motor vehicle accidents were the most common mechanism of injury (97 patients, 46.4%). Motor vehicle accidents also had a 2.243-fold risk for ocular trauma (OR, 2.243; P = 0.021). Ocular traumas were more prone to occur in patients who sustained midfacial fractures (OR, 10.232; P < 0.001), especially the patients with multiple midfacial fractures (OR, 12.389; P < 0.001). Fracture of the mandible had the lowest risk for ocular injuries (multimandibular fractures: OR, 0.035, P < 0.001; single mandibular fracture: OR, 0.151; P < 0.001). The occurrence of ocular injuries was significantly related to sex, age, etiology, as well as the pattern and position of the maxillofacial fractures.

Assessment of Endoscopic Role in Management of Facial Fractures

This study evaluates the usefulness of endoscopic repair in certain types of facial fractures (orbital floor, isolated zygomatic arch and isolated anterior table frontal sinus fractures).Endoscopic application in otorhinolaryngology has expanded into many areas including facial plastic surgery and facial trauma (orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures), therefore limiting the use of incisions for exposure. Endoscopically assisted facial bone surgery can be performed with many advantages, including: magnified direct visualization, decreased scarring, avoidance of numbness beyond the incision line, greater acceptability to the patient, decreased complication rate and short hospitalization. For assessment of the value of endoscopy in repair of certain facial fractures, we selected 12 consented patients with either orbital floor fracture, isolated zygomatic arch fracture or isolated anterior table frontal sinus fracture to be involved in our study after stabilizing the general condition. The patients were evaluated preoperatively by an ophthalmologist and all had complete CT study including coronal, axial (both bony and soft-tissue windows), sagital and 3D images. The patients were analyzed for sex, age, time of surgery, pre/postoperative symptoms; including ophthalmic symptoms, facial paraesthesia and aesthetic problems. The results of our endoscopic approach were evaluated esthetically and functionally to be classified into good, fair and poor results. We also classified the level of the surgery according to its difficulty into difficult, average and easy surgical performance.Good results were achieved in 8fractures (42%); fair in 8fractures (42%) and finally 3fractures (16%) with poor endoscopic result. The performed surgery considered easy in 9 (41%) patients, average in 6 (31%) patients and difficult in 4 (21%) patients. All patients had no significant complications. Conclusion: Endoscopic repair appears to be a safe and effective technique for repairing certain types of facial fracture.

Airway management in maxillofacial trauma: do we really need tracheostomy/submental intubation.

There are various techniques available for airway management in patients with maxillofacial trauma. Patients with panfacial injuries may need surgical airway access like submental intubation or tracheostomy, which have their associated problems. We have been managing these types of cases by a novel technique, i.e, intraoperative change of nasotracheal to orotracheal intubation. To review our experience about various techniques for the airway management in patient with maxillofacial trauma. To analyse the possibility of using nasotracheal intubation and intraoperative change of nasotracheal to orotracheal intubation in panfacial fractures. In a tertiary care centre four hundred eighty seven patients of maxillofacial injuries, operated over a period of 2 years were reviewed in relation to age, sex, mode of injury, type of facial fractures, methods of airway management and their associated complications. Young patients with male predominance is the most common affected population. Panfacial fracture is the most common type of injury (39.83%) among facial fractures. Airway was managed with intraoperative change of nasotracheal to orotracheal intubation in 33.05% of the patients whereas submental intubation or tracheostomy was done in 8.62% of the patients. Nasal route for endotracheal intubation is not a contraindication in the presence of nasal fractures, base of skull fractures and CSF leak. By changing the nasotracheal intubation to orotracheal intubation intraoperatively in cases panfacial fractures, most of the tracheostomies and submental intubations can be avoided.

Dental trauma in patients with maxillofacial fractures

The purpose of this study was to analyze and evaluate the correlation between dental injuries and the pattern of maxillofacial fractures. The correlation with age, gender, trauma mechanism and type of maxillofacial fracture was also investigated. From January 2000 to December 2009, 1131 patients with facial fractures were registered. Of these, 473 presented with associated dental trauma. The information and data collected and analyzed included: age, gender, mechanism of injury, type of facial fracture, type of dental injury, and the relationship between dental injury and facial fracture. Dental injury was sustained by 473 patients (41.8%), with a total of 2215 injured teeth. Of the 2215 injured teeth, 1191 (53.8%) were in the maxilla and 1024 (46.2%) in the mandible. Fall from a height had the highest risk of dental injuries (OR = 4.145, P = 0.002). The central incisor was the most injured tooth for both the maxilla (388, 36.2%) and mandible (284, 27.7%). The most common type of dental injury was avulsion (1070, 47.4%). More anterior teeth in the maxilla were of crown fracture, avulsion, and intrusion than that in the mandible, whereas more anterior teeth in the mandible were of subluxation and concussion than that in the maxilla. Dental injuries were more prone to occur in patients who sustained only symphysis fractures (OR = 2.817, P < 0.001), only 0.236-fold risk in patients who sustained only mandible angle fracture (P < 0.001). The occurrence of dental trauma is significantly related to the pattern and position of the maxillofacial fractures.

Dental Injuries in Pediatric Patients With Facial Fractures Are Frequent and Severe

This study was carried out to identify the occurrence, type, location, and severity of dental injuries (DIs), as well as predictors for DIs, in pediatric patients with facial fractures. This study examined the files of patients aged 16 years or less who had sustained facial fractures during a 12-year period. The outcome variable was DI. The explanatory variables included gender, age, trauma mechanism, and type of facial fracture. Data analysis was carried out with the χ(2) test and logistic regression analysis. A total of 200 patients, 119 (59.5%) of whom were boys, met the inclusion criteria. The mean age was 12.6 years. A total of 45 patients (22.5%) had DIs. Crown fracture, the most common type of DI, occurred in 59.9% of all DIs. The most common location of crown fractures was in the premolars (37.4% of all crown fractures). Multiple DIs occurred in 71.1% of those with DIs and severe DI in 66.7%. DIs were significantly associated with motor vehicle collision (MVC) (P = .02) and mandibular fracture (P = .03). DIs are common in pediatric patients with facial fracture, often being both multiple and severe. In association with pediatric facial fracture, facial surgeons should be especially alert for crown fractures in the lateral parts of the jaws.

Occurrence and Severity of Concomitant Injuries in Other Areas Than the Face in Children With Mandibular and Midfacial Fractures

To clarify the occurrence, causes, severity, and predictors of concomitant injuries in pediatric patients with facial fractures. Files of 339 pediatric patients who had sustained facial fractures at age 15 years or younger were reviewed. Outcome variables were injured organ systems other than the face, types of injuries in areas other than the face, and severity of injuries in areas other than the face. Explanatory variables were gender, age, mechanism of trauma, and type of facial fracture. Concomitant injuries in organ systems other than the face were observed in 11.0%. Limb injuries occurred in 9.1%, head and neck injuries in 5.6%, and chest injuries in 1.8%. The most common injury types were upper limb injury (8.0%), brain injury (3.2%), and lower limb injury (2.9%). Severe head and neck injuries occurred in 3.5% and severe chest injuries in 1.2%. Concomitant injuries occurred more frequently after motor vehicle accidents and falls from height compared with other etiologies (P < .001) and more frequently in association with combined mandibular and midfacial fractures than in association with other fracture types (P < .001). Concomitant injuries in areas other than the face should be expected first and foremost after high-speed trauma mechanisms and in association with severe facial fractures. Concomitant injuries in general occur most frequently in the limbs, with severe concomitant injuries in particular occurring most often in the head and neck region and chest, emphasizing the importance of multiprofessional teamwork in the diagnosis of pediatric patients who have sustained facial fractures.

Role of the maxillofacial surgeon in the management of severe ocular injuries after maxillofacial fractures

Aim:This study was designed to evaluate the incidence of severe ocular injuries associated to maxillofacial fractures and report their management in the Emergency Department.Patients and Methods:Among the 1779 patients admitted for maxillofacial fractures, those with partial or total loss of vision at the time of emergency consultation were included in the study. Data collected from the patients’ medical records included age, gender, mechanism of injury, location and type of facial fractures, type of ocular injuries and cause of blindness, methods of treatment, and days of hospitalization.Results:Forty patients (2.2%), 32 men and 8 women, ranging from 17 to 85 years of age, presented with severely reduced vision or blindness associated to fractures of the facial middle third with involvement of one or more orbital walls, mainly caused by motor vehicle and work accidents. In 18 patients, severe ocular injuries were determined by direct lesion of the globe, in 14 by direct or indirect traumatic optic neuropathy and in 8 by a retrobulbar hematoma. Direct lesion of the eyeball was treated by prompt repair or enucleation of the globe, though no or little recovery of vision was obtained. Ophthalmologic and/or maxillofacial treatment of the anterior compartment lesions of the eye allowed a partial or total recovery of the vision. A partial or total recovery of the vision was observed in almost all the patients with indirect traumatic optic neuropathy after administration of steroids according to NASCIS II protocol. Likewise, an evident improvement of the vision was obtained by immediate drainage of retrobulbar hematoma.Conclusions:Early diagnosis of the nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory.

Occurrence and types of dental injuries among patients with maxillofacial fractures

The aim of this retrospective study was to clarify the occurrence and types of dental injuries in 389 patients who had been diagnosed with facial fractures, and to analyze whether the occurrence of dental injury correlates to gender, age, trauma mechanism and type of facial fracture. Dental injuries were observed in 62 patients (16%). The most common type of injury was a crown fracture (48%). Dental injuries were multiple in most patients (63%). Almost half (48%) of all injured teeth were severely injured. Most injured teeth (61%) were in the maxilla. The incisor region was the most prevalent site in both the mandible (45%) and the maxilla (56%). The occurrence of dental injury correlated significantly with trauma mechanism and fracture type: motor vehicle accidents and mandibular fracture were significant predictors for dental trauma. The notable rate of dental injury observed in the present study emphasizes the importance of a thorough examination of the oral cavity in all patients who have sustained facial fracture. Referral to a dental practice for further treatment and follow up as soon as possible after discharge from hospital is fundamental.

Dental Injuries in Association With Facial Fractures

The aim of the study was to investigate the association between dental injuries and facial fractures. We performed a prospective study of 273 patients examined at a level 1 trauma center in Switzerland from September 2005 until August 2006 who had facial fractures. Medical history and clinical and radiologic examination findings were recorded to evaluate demographics, etiology, presentation, and type of facial fracture, as well as its relationship to dental injury site and type. In 273 patients with dentition, we recorded 339 different facial fractures. Of these patients, 130 (47.5%) sustained a fracture in the non-tooth-bearing region, 44 (16%) had a fractured maxilla, and 65 (24%) had a fractured mandible. Among 224 patients with dentition who had a facial fracture in only 1 compartment, 140 injured teeth were found in 50 patients. Of 122 patients with an injury limited to the non-tooth-bearing facial skeleton, 12 sustained dental trauma (10%). In patients with fractures limited to the maxilla (n = 41), 6 patients had dental injuries (14.5%). In patients with fractures to the mandible (n = 61), 24 sustained dental injuries (39%). When we compared the type of tooth lesion and the location, simple crown fractures prevailed in both jaws. Patients with a fracture of the mandible were most likely to have a dental injury (39.3%). The highest incidence of dental lesions was found in the maxilla in combination with fractures of the lower jaw (39%). This incidence was even higher than the incidence of dental lesions in the lower jaw in combination with fractures of the mandible (24%). Knowledge of the association of dental injuries and maxillofacial fractures is a basic tool for their prevention. Our study showed that in cases of trauma with mandibular fracture, the teeth in the upper jaw might be at higher risk than the teeth in the lower jaw. Further larger-scale studies on this topic could clarify this finding and may provide suggestions for the amelioration of safety devices (such as modified bicycle helmets).

Facial Fractures – Association with Ocular Injuries: A 13-Year Review of One Practice in a Tertiary Care Centre

The incidence of ocular injury associated with facial fractures has been reported to be between 0.8% and 30%. Because of this wide range of incidences, a system to stratify the risk of ocular injury by type of facial fracture was sought. The present study reviewed 266 patients with facial fractures to determine the risk factors for ocular injury. The anatomy of each facial fracture was classified using an orbit-centred approach according to the number of orbital walls fractured. Patients were then grouped using this classification system. Charts documenting follow-up for each patient over a minimum of one year were examined and initial emergency room presentations of patients with subsequent visual impairment were recorded. The incidence of severe visual impairment and blindness was 4.5% overall. Although all facial fractures (including isolated fractures of the mandible) had a notable incidence of ocular injury, an increased number of orbital wall fractures were correlated with an increased incidence of permanent visual disability. One of 147 (0.68%) patients without an orbital wall fracture sustained permanent severe ocular injury or blindness, while 13.5% (five of 37) of three-wall orbital fracture patients and 25% (four of 16) of four-wall orbital fracture patients sustained the same injury. The risk of ocular injury in complex facial fractures can be stratified by the degree of orbital wall involvement. However, because all patients with persistent visual impairment had ocular findings on initial examination, it is proposed that oculovisual testing is a more sensitive indicator of lasting ocular injuries than the type of facial fracture.

Correlating Facial Fractures and Cranial Injuries

This study retrospectively evaluated individuals with traumatic injuries from different mechanisms and tried to determine if there is any relationship between various isolated or combined fractures of facial skeleton and cranial injuries. We retrospectively studied hospital charts of all patients who reported to the trauma center at Kasturba Hospital in Manipal with facial fractures and suspected cranial injuries during a 5-year period (January 1, 1995 to December 31, 1999). These patients were admitted to the Department of Neurosurgery or the Maxillofacial Unit of Kasturba Hospital, Manipal. The complete medical record of each patient was reviewed, recording the following in a standard format: age, gender, cause of injury, type of facial fractures, type of cranial bone fracture, concussion, intracranial injury, cerebrospinal fluid (CSF) rhinorrhea, CSF otorrhea, and the Glasgow coma scale. The study data were collected as part of retrospective analysis. A total of 12,329 patients reported to the trauma center of the study hospital during a 5-year period with various injuries. A total of 772 patients had facial fractures (6%). A total of 108 patients with a combination of cranial injuries and facial fractures were identified within this group (14%). Gender predilection was seen to favor males (90%) more than females (10%). The ratio was seen to be nearly 9:1. The ages of the patients ranged from 7 to 70 years with mean age being 32 years (standard deviation [SD] = +/-12). Central midfacial bone involvement was found to be more commonly associated with head injury. There is a correlation between midfacial injuries and CNS trauma. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of head injuries associated with facial fractures.

Changing picture of facial fractures in northern Nigeria

This was a prospective study that aimed to find out the current pattern of facial fractures in northern Nigeria and to see if changes in the socioeconomic conditions in Nigeria during the past 20–30 years have affected the aetiology, sex and age distribution of the patients, and type of facial fractures. The setting was the maxillofacial unit of the University of Maiduguri Teaching Hospital, which is the only referral centre for facial trauma in north-eastern Nigeria, serving a population of about 30 million people. All 306 patients were treated for facial fracture between January 1996 and December 1999. Most of the patients (126/306, 41%) were in the age range 21–30 years and the male to female ratio was 2.1:1. The main causes of the fractures were assault (n=147, 48%) followed by road traffic accidents (n=111, 36%). Other aetiological factors such as falls, and sports or industrial accidents accounted for the remaining cases. Of the assault-related injuries 102 (33%) were the result of armed robbery and 45 (15%) the result of fights, mainly on the farms. The mandible was the most common site of fractures (n=273, 89%) and most of the mandibular fractures were in the body of the mandible. Only 44/306 patients (14%) reported to the hospital within the first 24 hours after injury. Changing socioeconomic conditions are associated with an increase in assault-related facial fractures, but the predominantly affected age group, sex and site of fracture remain relatively constant.

Blindness associated with midfacial fractures.

This study assessed the frequency of blindness associated with midfacial fractures and correlated this with the fracture pattern. A retrospective analysis of 49 patients admitted with midfacial fractures from January 1995 to March 1997 was performed to determine the presence of posttraumatic blindness. The medical and radiological records of the patients with blindness were reviewed for age and sex, cause of the injury, type of facial fracture, type of ocular trauma, and probable cause of the blindness. Ten of the 49 patients lost vision in one eye (20% of all midfacial fractures and 22% of midface fractures involving the orbit). The possibility of blindness associated with facial fractures was directly related to the severity of injury. Road traffic accidents were the most common cause. Blindness was attributable to traumatic optic nerve injury in seven cases and a ruptured globe in three cases. The high frequency of blindness associated with midfacial fractures in this series was attributable to the predominance of road traffic accidents as the major cause and absence of an obligatory seat belt law. Early diagnosis of the exact nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory.

Orbital fractures in children

Objective: To determine if the pattern of orbital fractures may be influenced by the changing craniofacial ratio of the growing child, as the orbit is the boundary between the face and the cranium. Design: Retrospective case series of 40 patients between the ages of 1 year and 16 years with orbital fractures. Setting: The Albany (NY) Medical Center Hospital, a tertiary level 1 trauma center. Outcome measures: The sex, age, site, and mechanism of injury, associated injury, and treatment methods for children admitted to the Albany Medical Center Hospital with orbital fractures between July 1986 and June 1992. Results: Fourteen children had fractures of the orbital roof, 10 children had fractures of the orbital floor, 14 children had mixed fractures, and two children had fractures of the medial wall. The mean age (4.8±3.3 years) of the 14 patients with roof fractures was significantly less than the mean age (12.0±4.2 years) of the 26 children with other orbital fractures. Logistic regression demonstrated that the age at which the probability of lower orbital fractures exceeds the probability of orbital roof fractures is 7.1± 1.0 years. Orbital roof fractures had a significantly greater likelihood of associated neurocranial injuries. The need for surgical repair was significantly lower among children with roof fractures as well as among children 7 years of age and younger. Conclusions: Orbital roof fractures are a type of skull fracture that occur primarily in younger children as a consequence of the proportionally larger cranium and the lack of frontal sinus pneumatization. Lower orbital fractures are a type of facial fracture that occur primarily in older children as a consequence of the increased vulnerability of the face due to growth and the pneumatization of the paranasal sinuses. (Arch Otolaryngol Head Neck Surg. 1995;121:1375-1379)

Orbital fractures in children.

To determine if the pattern of orbital fractures may be influenced by the changing craniofacial ratio of the growing child, as the orbit is the boundary between the face and the cranium. Retrospective case series of 40 patients between the ages of 1 year and 16 years with orbital fractures. The Albany (NY) Medical Center Hospital, a tertiary level 1 trauma center. The sex, age, site, and mechanism of injury, associated injury, and treatment methods for children admitted to the Albany Medical Center Hospital with orbital fractures between July 1986 and June 1992. Fourteen children had fractures of the orbital roof, 10 children had fractures of the orbital floor, 14 children had mixed fractures, and two children had fractures of the medial wall. The mean age (4.8 +/- 3.3 years) of the 14 patients with roof fractures was significantly less than the mean age (12.0 +/- 4.2 years) of the 26 children with other orbital fractures. Logistic regression demonstrated that the age at which the probability of lower orbital fractures exceeds the probability of orbital roof fractures is 7.1 +/- 1.0 years. Orbital roof fractures had a significantly greater likelihood of associated neurocranial injuries. The need for surgical repair was significantly lower among children with roof fractures as well as among children 7 years of age and younger. Orbital roof fractures are a type of skull fracture that occur primarily in younger children as a consequence of the proportionally larger cranium and the lack of frontal sinus pneumatization. Lower orbital fractures are a type of facial fracture that occur primarily in older children as a consequence of the increased vulnerability of the face due to growth and the pneumatization of the paranasal sinuses.

Orbital floor implants.

THE ORBITAL floor may be involved in various types of facial fractures; in particular, the tripod fracture of the zygoma, the blowout fracture, and fractures of the maxilla of the LeFort II and III types. Surgical repair may be necessary when the orbital floor is so comminuted as to permit entrapment of the ocular muscles, or a defect is present which permits herniation of the orbital contents into the maxillary antrum. It is not within the scope of this paper to discuss the clinical findings for these fractures or the sequelae, but only to present the more common means of orbital floor repair with particular reference to orbital implants, and to relay our experience with the surgery of these facial fractures. <h3>Anatomy</h3> The orbit is a cone-shaped structure with the weakest area situated immediately in front of the inferior orbital fissure.¹This is the area that must be thoroughly