Changing Patterns of Zygomaticomaxillary Complex Fractures: A Retrospective Study.

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

Maxillofacial fractures in Pondicherry, India: An eight-year single centre retrospective study.

Background: The purpose of the present study was to analyze the etiology, incidence, pattern, and treatment modalities of patients with maxillofacial fractures treated at the Department of Dentistry of a medical college in Pondicherry during the period between June 2011 and June 2019. Materials and Methods: A retrospective epidemiological study of 277 patients treated for maxillofacial fractures between June 2011 and June 2019 was performed. Data regarding age, gender, etiology, site of the fracture, time of injury, presence of associated injuries, treatment modalities, and complications were recorded. Results: A total of 491 maxillofacial fractures were seen in 277 patients. These were 261 males (94.2%) and 16 females (5.8%) with a male to female ratio of 16.3:1. Most of the patients 79.8% were in the age group of 11 to 40 years. Most common cause of injury was Road Traffic Collisions (RTCs; 62.1%), followed by fall (20.2%), assault (14.4%) and others (3.3%). Fractures of the mandible (52.3%) and zygomatic complex (18.9%) were the most common maxillofacial fractures reported in our study. 196 patients sustained associated injuries with a prevalence of soft tissue injury (61.2%). Majority of fractures were treated with open reduction and internal fixation (ORIF; 71.9%) of patients followed by closed reduction (17.7%) and observation only (10.4%). Postoperative complications were presented in 16.8% of the patients in the study. Conclusion: RTC is the commonest cause of maxillofacial injury with a male predominance in our study. Mandibular and zygomatic complex fractures were the most common. ORIF remains the preferred method of treatment.s.

PATTERNS OF FACIAL FRACTURES AND ASSOCIATED SOFT TISSUE INJURIES: A RETROSPECTIVE STUDY ON 1007 PATIENTS.

Background: Knowing the severity of a pathology in a population helps to both establish a rapid diagnosis and to prepare medical staff to provide adequate and complete treatment. The aim of this study was to determine the patterns of maxillofacial fractures and their associated soft tissue injuries in order to identify the specific types of maxillofacial fractures with the highest incidence of associated soft tissue injuries. Methods: A 10-year retrospective evaluation of maxillofacial trauma was performed on 1007 patients. All 1007 patients were clinically and paraclinically confirmed to have facial skeletal injuries. Results: The highest incidence of maxillofacial fractures was found in the mandible (62.16%), the mandibular angle being the most frequently involved (28.84%). Most of the fractures were complete (97.82%), displaced (87.98%) and closed (86.30%). Hematoma was the most common associated soft tissue injury (44.79%). In mandibular trauma, the incidence of hematoma and laceration was the highest in angle and simultaneous multiple fracture lines (p=0.002). In the midface, hematoma was more frequently associated with non-comminuted zygomatic bone fractures (p=0.003), while laceration was associated with multiple underlying fracture lines (p=0.002). Conclusions: Patients presenting with hematomas will most frequently have an underlying single closed fracture line, while patients with lacerations will most frequently present underlying multiple and displaced fractures.

Association between type of fixation and a length of stay amongst maxillofacial fracture patients: A retrospective charts review.

We aimed to explore the predictors of hospital length of stay for patients admitted and with maxillofacial injuries. Patients presenting with maxillofacial trauma were included. Poly-trauma involving neurosurgery and/ or needing orthopaedics intervention were excluded. Logistic regression was applied to explore the predictors associated with the hospital stay of > 4 days. There were 241 patients with mean age 29.35 ± 12.5 years (age range 12-80 years). Mandibular fracture was the commonest observation 121(50.2%), followed by maxillary 48(19.9%), and zygomatic bone fracture 9 (3.7%). Road traffic accident 196 (81.3%) appears to be the most common etiology of maxillofacial injuries in the studied sample. The mean length of hospital stay among bone plating patients was 5.96 ±6.8 days compared to 4.15±6.2 days for ones treated without bone plating; p-value 0.05. It was concluded that longer length of stay is required in patients with more complex management including bone plates.

The Most Common Relationship of a Midface Fracture in Maxillofacial Trauma Study.

ABSTRACT: Oral and maxillofacial fractures are the most common injuries among multiple trauma. About 5% to 10% of trauma patients having facial fractures. The objectives of this case study are to focus the most common mid-face fractures types' and to determine the relationship of the midface fracture in maxillofacial trauma among the patient who attended the outpatient clinic in a Hospital Universiti Sains Malaysia. In this research paper, an advanced statistical tool was chosen through the multilayer perceptron neural network methodology (MLPNN). Multilayer perceptron neural network methodology was applied to determine the most associated predictor important toward maxillary bone injury. Through the predictor important classification analysis, the relationship of each bone will be determined, and sorting according to their contribution. After sorting the most associated predictor important toward maxillary bone injury, the validation process will be applied through the value of training, testing, and validation. The input variables of MLPNN were zygomatic complex fracture, orbital wall fracture, nasal bone fracture, frontal bone fracture, and zygomatic arch fracture. The performance of MLPNN having high accuracy with 82.2%. As a conclusion, the zygomatic complex fracture is the most common fracture trauma among the patient, having the most important association toward maxillary bone fracture. This finding has the highest potential for further statistical modeling for education purposes and the decision-maker among the surgeon.

Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil.

Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

Clinical Analysis and CT 3D-Mediated Precise Internal Fixation in Maxillofacial Fracture.

BACKGROUND/PURPOSE: To retrospectively analyze the epidemiological features, clinical diagnosis, and treatment of 610 patients with maxillofacial fractures, while providing a reference for the prevention and optimized treatment of maxillofacial fractures. METHODS: Data of patients with maxillofacial fractures who were treated and followed up at the Second People's Hospital of Kashi Prefecture from June 2012 to April 2018 were summarized. The epidemiological features, clinical manifestations, fracture sites, treatment methods, and results were analyzed. RESULTS: The highest incidence was in the age range of 20 to 49 years. The main cause of fracture was traffic injury. Mandibular fractures accounted for 37.77%, zygoma and zygomatic arch fractures for 37.00%, and maxillary fractures for 21.19%. Atypical zygomatic arch fractures were more common in the maxilla, followed by Le Fort I and II fractures. Closed fractures accounted for 85.97%. Many (73.39%) patients were treated with computed tomography 3-dimensional (3D)-mediated precision modified incision internal fixation with satisfactory results. CONCLUSIONS: There is a high incidence of maxillofacial fractures among young men, especially in summer, with the most common injuries being traffic-related injuries. The most common site is the mandible, followed by the zygomatic arch, zygomatic complex, and maxilla. Computed tomography 3D-mediated precision modified incision internal fixation can achieve satisfactory results.

Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil / Tempo de recuperação funcional após fraturas faciais: perfil e fatores associados em amostra de pacientes do sul do Brasil

ABSTRACT Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

RESUMO O entendimento da causa, da gravidade e do tempo decorrido para o restabelecimento das funções de lesões maxilofaciais pode contribuir para o estabelecimento de prioridades clínicas objetivando o efetivo tratamento e prevenção dos traumatismos de face. Assim, o objetivo deste estudo foi compreender quais os fatores associados ao restabelecimento das funções mastigatórias, oculares e nasais em vítimas de trauma de face, estimando o tempo para recuperação das funções, após o tratamento cirúrgico. Foram analisados 114 prontuários de pacientes atendidos no Hospital de Montenegro que compareceram às consultas de acompanhamento por até 180 dias. Para a análise do tempo para a recuperação, foi realizada a análise de sobrevida, seguida da análise de COX. Observou-se que metade dos pacientes recuperaram as funções em até 20 dias, sendo que o tempo médio para recuperação dos traumas no complexo zigomático-orbitário-malar-nasal foi de 11 dias e do complexo maxilo - mandibular de 21 dias (HR: 1,5 (0,99 - 2,3) p=0,055). Embora o restabelecimento das funções tenha atingido taxas elevadas após abordagem cirúrgicas, faz-se necessária a análise dos casos de insucessos bem como os impactos econômicos e as estratégias de prevenção associados aos traumas de face a fim de qualificar o serviço prestado à população.

Interrelation between facial soft tissue lessions, underlying fracture patterns and treatment of zygomatic bone trauma: a 10 year retrospective study.

BACKGROUND: The pattern of zygomatic bone fractures varies in the literature, their features being frequently masked by the presence of associated soft tissue lesions. In this context the clinical diagnosis and the therapeutic indications can be difficult. The aim of this study was to evaluate the clinical features of zygomatic bone fractures and their interrelation with concomitant overlying soft tissue injuries, as well as to assess the type of treatment methods applied depending on the fracture pattern and the results achieved depending on the incidence rate of postoperative complications. We will use these results in order to improve the diagnosis and the establishment of correct treatment of this pathology. METHODS: A 10-year retrospective evaluation of midface fractures was performed in patients diagnosed and treated in a tertiary Clinic of Oral and Maxillofacial Surgery. Statistical analysis was performed with the MedCalc Statistical Software version 19.2 (MedCalc Software bvba, Ostend, Belgium; 53 https://www.medcalc.org ; 2020). Nominal data were expressed as frequency and percentage. The comparisons of the frequencies of a nominal variable among the categories of another nominal variable were made using the chi-square test. Multivariate logistic regressions were used in order to establish the independent association between variables and lacerations/excoriations. After using the Bonferroni correction for multiple comparisons, a value of p < 0.025 was considered statistically significant. RESULTS: The study included 242 patients with zygomatic bone fractures. The majority of the fractures were displaced n = 179 (73.9%), closed n = 179 (73.9%) and complete n = 219 (90.5%). Hematoma was the most frequent associated soft tissue lesion n = 102 (42.1%) regardless of the fracture pattern (p = 1.000). Complete zygomatic fracture (OR - 2.68; p = 0.035) and fractures with displacement (OR - 3.66; p = 0.012) were independently associated with the presence of laceration. Fractures with displacement (OR - 7.1; p = 0.003) were independently associated with the presence of excoriation. The most frequent type of treatment applied was Gillies reduction (61.9%), followed by ORIF (30.9%). The most frequent postoperative complication was malunion secondary to Gillies treatment (4,6%). CONCLUSIONS: Patients presenting lacerations and excoriations on clinical soft tissue examination will most frequently have an underlying complete, displaced or comminuted zygomatic fracture. In the case of displaced, open or comminuted fractures we achieved the best results secondary to ORIF treatment method, while in the case of non-displaced and closed fractures, the best results achieved were secondary to conservative treatment.

Epidemiological Analysis of Zygomatic Bone Fractures in North-Western Romanian Population: A 10-Year Retrospective Study.

BACKGROUND/AIM: Midface fractures represent a challenge for medical practitioners due to the severe esthetic and functional consequences. This study aimed to determine the causes and to provide a demographic analysis of zygomatic bone fractures in our geographical area, with a view to implementing the necessary prevention methods, training the medical staff for a certain type of patients and decreasing the required costs. PATIENTS AND METHODS: A retrospective statistical epidemiological analysis of 242 patients with zygomatic bone fractures over a 10-year period was performed. RESULTS: The most affected age group was 20-29 years (27.27%). The most affected were men (n=211, 87.19%) from urban areas (n=140, 57.85%), and without education (n=122, 50.41%). The most frequent cause was interpersonal violence (54.04%), followed by falls (17.36%) and road traffic accidents (16.53%). CONCLUSIONS: Interpersonal violence as a cause of zygomatic bone fractures is currently reaching epidemic proportions. Taking legal measures to prevent aggression is a public health emergency that would considerably decrease the incidence of these fractures in our population.

Patterns of facial fractures in children.

Morbidity and mortality among children is usually the result of trauma. Because a child's face is retruded relative to the protecting skull, has a thicker layer of adipose tissue, more elastic bones, flexible sutures lines, the presence of tooth buds within the jaws, and the lack of pneumatisation of the sinuses, the facial bones fracture less commonly than in adults. Our aim was to assess the patterns of such fractures in children who presented to the department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan. All 535 eligible children between the ages of 1-16 years who presented during the two years December 2009 - December 2011 were included in the study. Facial fractures were diagnosed by clinical examination, plain radiographs, and computed tomography, and the pattern of fractures of the facial bones including the frontal bone, orbital bones, maxilla, zygoma, naso-orbito-ethmoidal complex, mandible, and dentoalveolar region was documented. The male:female ratio was 2:1 with 369 male (70%) and 166 female (31%) patients. Fall was the cause in 212 (39%), and in 167 (31%) it was road traffic accidents, while sports were the cause in 135 (25%). The naso-orboto-ethmoid complex was fractured in 37 cases (7%) while 104 children (19%) presented with isolated fractures of the zygomatic bone. The maxilla was fractured in 195 cases (36%), the mandible in 380 (71%), and dentoalveolar trauma was the cause in 256 (50%). The mandible was the bone that was most often fractured (mostly in boys and usually as a result of falls during summer vacations), with the peak occurring in those aged 8-12 years.

Facial Fractures in Young Adults: A National Retrospective Study.

OBJECTIVES: "Young adulthood" is a term used to define individuals falling within the 18- to 22-year-old age range. Injuries account for more than a third of emergency department visits in this population. A particular area of concern is accidents that lead to injuries of the facial bones because they can have long-term functional, aesthetic, and psychosocial impacts. As many as 30 million young adults participate in some sort of sport in the United States per year, and facial injuries from these activities are not uncommon and thus require further exploration. METHODS: The National Electronic Injury Surveillance System was used to conduct a retrospective review to explore patterns of maxillofacial fractures in young adult patients between the ages of 18 and 22 years from 2004 through 2017. The data analyzed yielded information about patient demographics, diagnoses, and associated products. RESULTS: A total of 3486 emergency department visits were included in the study. The most common facial fractures were nasal fractures (64.4%), mandible fractures (12.3%), and orbital fractures (6.1%). The most common causes of fractures were sports (55.48%), fixed structures (6.39%), and stairs or steps (5.60%). The top 3 sports associated with facial fractures were basketball (25.4%), baseball (11.6%), and football (10.4%). CONCLUSIONS: For young adult individuals, some sort of sporting activity is common outside of the National Collegiate Athletic Association. The overwhelming majority of facial fractures in this population were caused by sports, and the authors believe this issue warrants further exploration and discussion. According to the Centers for Disease Control and Prevention, an estimated 8.6 million sports- and recreation-related injuries occurred per year between 2011 and 2014. Despite ever growing research and guidelines into sports injury incidence and prevention, it is clear that sports are the cause of a large portion of maxillofacial fractures in the United States.

The "European zygomatic fracture" research project: The epidemiological results from a multicenter European collaboration.

PURPOSE: Fractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery. MATERIALS AND METHODS: This study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications. RESULTS: A total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between Infraorbital Nerve (ION) anesthesia and B class (p < .00000005). CONCLUSION: The most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.

Characteristics on 621 cases of craniomaxillofacial fractures.

PURPOSE: This study examined a single center's experience with regards to etiology and distribution of fractures treated from July 2015 to August 2016 in Shanghai, China. METHODS: The medical records of 621 patients with craniomaxillofacial fractures were reviewed. Patient notes and radiographic images were analyzed for detailed injury data. Age, gender, etiology, and site of fracture were examined. Chi-square test was used to analyze the causes of single and multiple fractures. p < 0.05 was considered statistically significant. RESULTS: This study included 426 male and 195 female with a male-to-female ratio of 2.18:1, among which 28.3% were between 19 and 29 years (n = 176). In all the fracture sites, orbit was most commonly involved (n = 319, 51.4%). Traffic accidents (n = 304, 49%) were the most common cause of injury in this study, while ground-level falls were the most common cause of injury in children (n = 19, 41.3%). The probability of multiple fractures due to falling from height (88.6%, p < 0.05) and traffic accidents (73.3%, p < 0.05) were significantly higher than that of other injuries. Orbital fractures have the highest surgical rate (n = 288, 90.3%). CONCLUSION: Craniomaxillofacial fractures predominantly occur in young men, due to traffic accidents. Orbit was involved in most cases. Falling from height and traffic accidents is more likely to cause multiple fractures.

Coincidence of craniocerebral and craniofacial injuries.

PURPOSE: To determine the incidence of craniocerebral injuries in patients who experienced upper facial or midfacial traumas associated with the disorders of consciousness. To find which types of craniofacial traumas predisposed to craniocerebral injuries. To analyze a relationship between the site of the force application and the type of resultant craniocerebral injury. MATERIALS AND METHODS: The study included 3,481 patients with upper facial and midfacial traumas. All 425 patients with craniofacial traumas and disorders of consciousness at the time of the event or hospital admission, were qualified for computed tomography (CT) of the head. RESULTS: In 85/425 patients (20%), 70 men and 15 women (age 14-71 years), craniofacial trauma coincided with a craniocerebral injury. Upper facial dislocation and zygomatic-orbital-maxillary complex fracture significantly more often co-existed with skull, dura mater or cranial nerve injuries, and zygomatico-orbital fracture with the injuries of the brain. Application of force both centrally and laterally to the horizontal plane predisposed to skull, dura mater and cranial nerve injuries. CONCLUSION: The recommendation to perform head CT in each patient with craniofacial trauma who experienced the disorders of consciousness is as simple as possible, yet provides high diagnostic sensitivity, facilitating proper management at initial stages post-injury.

Cervical spine fractures associated with maxillofacial trauma: A 3-year-long study in the Greek population.

BACKGROUND: Maxillofacial fractures have been recognized as high risk trauma for concomitant cervical spine or spinal cord injury. OBJECTIVE: To investigate the incidence of concomitant cervical spine fractures (CSF) in patients with maxillofacial trauma and elucidate their relationship, guiding diagnosis and pointing their implications in maxillofacial trauma repair. MATERIAL AND METHODS: An analysis of 432 patients with maxillofacial fractures, treated at the Department of Oral and Maxillofacial Surgery of the "KAT" General Hospital of Attica during a three-year-long period, was conducted to investigate concomitant CSF. RESULTS: 22 patients or 5.1% (14 male/8 female, mean age 39.81 years) sustained a total of 29 concomitant CSF. In 77.3% of the cases the injury mechanism was motor vehicle accidents. The most frequent levels of CSF were C6-C7 (55.17%) and C1-C2 (27.58%). Regarding the type/site of maxillofacial fractures, 5 patients (22.73%) had sustained isolated zygomatoorbital, 5 (22.73%) isolated mandibular and 12 (54.54%) combined fractures. Concomitant injuries (i.e. intracranial hemorrhage, cerebral concussion, etc) were registered in 14 patients; additional thoracic/lumbar spine fractures in 5. Hospital stay ranged from 6 to 86 days (mean 27.6 days). CONCLUSIONS: Maxillofacial surgeons should be aware of the relationship between CSF and maxillofacial fractures, having implications in their patients' treatment.

Retrospective analysis of 471 surgically treated zygomaticomaxillary complex fractures.

PURPOSE: Zygomaticomaxillary complex (ZMC) fractures are frequent in facial trauma; only fractures of the mandible are more common. Although the frequency of these fractures is geographically consistent, the aetiology differs widely among countries and even regions. Differences in socio-economic status and the ageing population seem to be two causes. This retrospective epidemiological study evaluates patients who were surgically treated for ZMC fractures at a Swiss university clinic. MATERIALS AND METHODS: This study included 471 patients who were surgically treated for ZMC fractures in an oral and maxillofacial surgery clinic at a Swiss university hospital between January 2004 and December 2012. Complicated fractures such as LeFort II/III and bilateral ZMC fractures were excluded. Data on gender, age, and type of trauma were recorded. Fractures were classified by aetiology: motorised road traffic (car or motorcycle), bicycle, interpersonal violence, sports, falls (both less than and greater than 3 m in height) and other causes. RESULTS: A total of 350 patients were male (74%), and 121 were female (26%). The ZMC fractures were most likely to occur in the third decade (117 cases, 25%). A predominance of male patients was found in the young age groups, but an equal ratio was found in the elderly groups. Etiologically, falls of less than 3 m were the most common cause of ZMC fractures (125 cases, 27%). Interpersonal violence was second (88 patients, 19%); male patients dominated this group, which had a male-to-female ratio of 21:1. A predominance of male patients was found in every subdivision when analysing by aetiology and gender. The lowest proportion of males (57%) was found for falls of less than 3 m. CONCLUSION: In our study, interpersonal violence and falls outnumbered road traffic accidents among causes of maxillofacial fractures. This is probably a consequence of strict road and work laws. Additionally, the older and more active populations accounted for the highest proportion of falls, and young male patients were the predominant victims of ZMC fractures.

Maxillofacial fractures in a budding teaching hospital: a study of pattern of presentation and care.

INTRODUCTION: Previous reports indicated that there is geographic and sociodemographic variation in the epidemiology of maxillofacial fractures. Audit of maxillofacial injuries managed at any institution is therefore necessary to understand the trends and proffer strategies for prevention. We therefore embarked on this study to determine the pattern of maxillofacial fractures and concomitant injuries in our institution. METHODS: We carried out a retrospective review of information on demography, aetiology and type of maxillofacial fracture, patients' status, type of crash, level of consciousness and concomitant injuries. The data collected was analysed with SPSS Version 20. RESULTS: A total of 233 patients aged 2 to 66 years were reviewed. A higher male preponderance (M:F 3.4:1) was observed. Road traffic crashes (RTC) accounted for 78.5% of injuries. Motorcycle related crashes were responsible for 69.4% of RTC and 54.5% of all fractures. Fracture of the mandible (63.2% n=172) was the most predominant skeletal injury and the body (25% n=43) was the most common site of fracture while the zygoma (29%) was predominantly affected in the midface. Ninety three patients (40%) suffered loss of consciousness. The relationship between aetiology of injuries and consciousness level of the patients was statistically significant (p=0.001). Of the 43 patients who had concomitant injuries, craniocerebral affectation (60.5%) was the commonest. CONCLUSION: RTC remains the major aetiology of maxillofacial fractures. The mandible was mostly affected and nearly half of the patients have associated loss of consciousness. There is need for continual advocacy and enforcement of laws on preventive measures among road users.

Applications of 3D orbital computer-assisted surgery (CAS).

INTRODUCTION: The purpose of the present report is to describe the indications for use of 3D orbital computer-assisted surgery (CAS). PATIENTS AND METHODS: We analyzed the clinical and radiological data of all patients with orbital deformities treated using intra-operative navigation and CAD/CAM techniques at the Hôpitaux Universitaires de Genève, Switzerland, between 2009 and 2016. We recorded age and gender, orbital deformity, technical and surgical procedure and postoperative complications. RESULTS: One hundred and three patients were included. Mean age was 39.5years (range, 5 to 84years) and 85 (87.5%) were men. Of the 103 patients, 96 had intra-operative navigation (34 for primary and 3 for secondary orbito-zygomatic fractures, 15 for Le Fort fractures, 16 for orbital floor fractures, 10 for combined orbital floor and medial wall fractures, 7 for orbital medial wall fractures, 3 for NOE (naso-orbito-ethmoidal) fractures, 2 for isolated comminuted zygomatic arch fractures, 1 for enophthalmos, 3 for TMJ ankylosis and 2 for fibrous dysplasia bone recontouring), 8 patients had CAD/CAM PEEK-PSI for correction of residual orbital bone contour following craniomaxillofacial trauma, and 1 patient had CAD/CAM surgical splints and cutting guides for correction of orbital hypertelorism. Two patient (1.9%) required revision surgery for readjustment of an orbital mesh. The 1-year follow-up examination showed stable cosmetic and dimensional results in all patients. CONCLUSION: This study demonstrated that the application of 3D orbital CAS with regards to intra-operative navigation and CAD/CAM techniques allowed for a successful outcome in the patients presented in this series.

Comparison of ultrasonography with conventional radiography in the diagnosis of zygomatic complex fractures.

PURPOSE: Zygomatic complex fractures have changed in patterns of occurrence, severity, and, more importantly, in the mode of injury. Protection of the globe and maintaining the width of the face are the more important roles of the complex. Diagnosis and treatment planning of such fractures become imperative in the sequencing of repair if and where indicated, especially in the case of isolated zygomatic complex fractures. Exploring the versatility of ultrasonography (US), in diagnosing zygomatic complex fractures in comparison to conventional radiography in a double-blind study, the objective of this study was to evaluate the efficacy of US and to explore the possibility of making US examination a mainstay in the primary diagnosis of such fractures. MATERIAL AND METHOD: The prospective, double-blind study design included 32 patients suspected of having sustained isolated zygomatic complex fractures. The patients underwent US examination and radiographic examination in the form of para-nasal sinus (PNS) and sub-mentovertex (SMV) views for comparison. RESULTS: A sensitivity of 100% was seen in favor of US in the areas of the fronto-zygomatic suture (FZ), arch, infra-orbital, and buttress areas. Statistically significant differences (p < .01) was seen in areas of the arch and buttress region and in the infra-orbital area. CONCLUSION: Although US showed 100% sensitivity in detection of fracture lines at three articulations of the four that make up the zygomatic complex, it lacked in quantifying the amount and degree of displacement of the fractured segments, which hampered accurate treatment planning.