Epidemiology of maxillofacial trauma in the elderly: A European multicenter study.

INTRODUCTION: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). MATERIALS AND METHODS: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). RESULTS: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (P<.005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (P<.05) and a high FISS score (P<.005) were associated with concomitant body injuries too. CONCLUSIONS: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.

Management of mandibular condylar fractures in patients with atrophic edentulous mandibles.

INTRODUCTION: Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS: A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS: The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

Pharyngeal airway changes after mono- and bimaxillary surgery in skeletal class III patients: Cone-beam computed tomography evaluation.

The aim of this study was to evaluate the two-dimensional (2D) and three-dimensional (3D) changes in the pharyngeal airway space (PAS) in 20 class III patients who underwent mono- or bimaxillary surgery using cone-beam computed tomography (CBCT). CBCT examination was obtained before surgery (T1) and at least 3 months after surgery (T2). The pharyngeal airway of each patient was studied at three levels: the level of the posterior nasal spine, the level of the most inferior point of the soft palate, and the level of the top of the epiglottis. At each of these levels, the anteroposterior and lateral dimension as well as cross-sectional area were measured. The volume of the whole PAS and volume between each cross section were also measured. The area and anteroposterior dimensions at the level of the most inferior point of the soft palate significantly decreased in patients who underwent monomaxillary surgery. The volume of the PAS decreased in both groups, but decreased significantly only in the monomaxillary group. The upper volume decreased in the mono- and increased in the bimaxillary group. The lower volume significantly decreased in the monomaxillary group. However, results showed that PAS decreased more after mono-than after bimaxillary surgery.

Effects of radiation therapy on craniofacial and dental implants: a review of the literature.

OBJECTIVES: The theories of the effects of radiation therapy on craniofacial and dental implants have been challenged by new models. Animal and clinical studies differ on the importance of dose effect and implant location regarding implant survival. Our purpose was to explore the risks of irradiation regarding dose levels, timing of radiation, implant location, and material. STUDY DESIGN: A systematic search of the literature was performed to identify studies reporting animal and human data on the success of implants in irradiated versus nonirradiated bone. RESULTS: Eleven animal studies exploring histomorphometric, biomechanical, and histologic features of implants in irradiated bone were summarized. Sixteen human clinical studies evaluating craniofacial (n = 8) and dental (n = 8) implants in irradiated bone were summarized. No meta-analyses of dental implants in irradiated bone were found. Efficacy studies comparing different implant types in irradiated bone were not found. CONCLUSION: Studies from both animal subjects and human patients indicate that irradiated bone has a greater risk of implant failure than nonirradiated bone. This increase in risk may be up to 12 times greater; however, studies making these comparisons are of poor to moderate quality, so the magnitude of this difference should be accepted with caution.

Quality of life after surgical excision followed by radiotherapy for cancer of the tongue and floor of the mouth: evaluation of 78 patients.

The aim of this study was to evaluate the quality of life of 78 patients treated for cancer of the tongue and the floor of the mouth, by subjective impressions and by objective assessment through different types of tests. Patients were divided into two groups according to the size of the post-excisional defect: (1) defect less than 5 cm (46); and (2) defect more than 5 cm (32). Patients were divided into three groups according to the type of reconstruction: 28 were partly reconstructed, 31 were reconstructed with local flaps and 19 with pectoralis major myocutaneous flaps. The following aspects were studied: overall well-being, food intake, speech intelligibility, dryness of mouth, willingness to undergo further surgery if necessary, tongue mobility, sensibility disturbances within the reconstructed region and oral competence. Overall results revealed that patients' quality of life was more or less disturbed. Among them, patients reconstructed with myocutaneous flaps and patients with larger post-excisional defects had a poorer quality of life.

Articulatory function and tongue mobility after surgery followed by radiotherapy for tongue and floor of the mouth cancer patients.

The aim of this study was to determine which of the following factors--size of the post-excisional defect, site of the defect and type of reconstruction--influence tongue mobility and articulation disorders after treatment for cancer of the tongue and floor of the mouth. A total of 60 patients, who had been evaluated at least 6 months after surgery followed by radiotherapy (60 Gy in 30 fractions), were evaluated. According to the size of the post-excisional defect patients were divided into two groups: (1) defect less than 5 cm (35); (2) defect more than 5 cm (25). Based on the localisation of the defect patients were also divided into two groups: (1) anterior tongue and/or floor of the mouth (30); (2) lateral tongue and/or floor of the mouth (25) and tongue base (5). According to the type of reconstruction patients were divided into three groups: partly reconstructed (18); reconstructed with locally available tissue--local flaps (27); and with pectoralis major myocutaneous (PMMC) flaps (15). Articulation proficiency was assessed through Articulation Test and tongue mobility through Tongue Mobility Test. According to results of this study, type of reconstruction followed by size of post-excisional defect seemed to be the most influential factor in tongue mobility and articulation disorders after the tongue and floor of the mouth cancer treatment. Site of the defect has no influence.

Refinement of the Fries and Webster modifications of the Bernard repair of the lower lip.

Refinement of the Fries and Webster modifications of the Bernard principle for reconstruction of the lower lip is described. The refinement consists of changing the direction of the incision from the angle of the mouth, which is made along a line passing laterally and curving downward, instead of slightly upward. This refinement has been used in 15 cases, seven with unilateral and eight with bilateral flaps. The functional results of this modification match the results of the original Bernard (Fries, Webster) technique. The aesthetic results are better because the suture line is sited along the fold of the angle of the mouth in a downward direction, which is more natural.

Surgical versus conservative treatment of unilateral condylar process fractures: clinical and radiographic evaluation of 80 patients.

Treatment results of 26 surgically and 54 conservatively treated unilateral condylar process fractures were investigated by standardized clinical examination and by evaluation of computer-simulated graphic presentations of posteroanterior (PA) radiographs of the mandible. The radiographic evaluation compared the relation of actual reduction of the condylar process fractures with ideally reduced fractures produced on the computer. Using clinical parameters (maximal mouth opening, deviation, protrusion), no statistical differences between surgically and conservatively treated fractures were found. However, the radiographic examinations showed a statistically better position of the surgically reduced condylar process fractures.