A review of forensic analysis of dental and maxillofacial skeletal trauma.

Dental and maxillofacial trauma analysis in the forensic context, includes assessment of both living and deceased persons. It is required in all cases where human abuse is suspected and where signs of skeletal trauma are detected in human remains. Skeletal trauma refers to the damage inflicted to bone, teeth and other hard tissues. An accurate analysis of the dental and maxillofacial trauma is achieved by the assessment of the remains by forensic pathologists, anthropologists and odontologists. This paper aims to review dental and maxillofacial skeletal trauma in the scope of forensic science. High-velocity projectile, sharp force, blunt force, and thermal trauma showing different traits in maxillofacial structures are discussed. Regarding non-fatal physical abuse, head and neck are the most frequently injured areas, resulting in fractures, contusions, burns and traumatic dental injuries.

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

PURPOSE: The aim of this study was to assess the maxillofacial injuries (MFIs) and our surgical approaches in the Syrian Civil War that emerged during the spring of 2011, among Syria's government and Syrians. PATIENTS AND METHODS: The present study is a prospective clinical study of injured patients at Turkey's Border Hospitals during the Syrian Civil Conflict. Patients' data cover to all emergency and plastic surgery hospitals throughout Turkey. We assessed the patients' data according to location of trauma, duration of hospitalization, the severity and etiology of MFIs with the Injury Severity Score. RESULTS: MFIs were found in 112 of the 956 wounded. The injuries occurred in 69 civilians (61.6%) and 43 soldiers (38.3%). The mean age ranged from 8 to 66 (mean: 29,1 ±â€Š12). Eighty-two percent or higher rates of the injuries needed >4 days' hospitalization. We observed the mortality at a rate of 13.3% for the MFIs. Majority of the MFIs were accompanied by >3 concomitant injuries (n = 59; 52.6%). Most of the facial injuries were located at Mandibula (n = 75; 66.9%), Maxilla (n = 69; 61.6%) and orbitofrontal (n = 52; 46.4%) regions. CONCLUSIONS: Severity and incidence of MFIs were extremely high compared with previously published studies of other wars, especially affecting the civilians in the Syrian Civil War. The high rates of LeFort III fractures exhibit its devastating damages on civilians.

Incidence and patterns of maxillofacial trauma-a retrospective analysis of 3611 patients-an update.

BACKGROUND: Maxillofacial fractures occur in a significant proportion worldwide and can occur as an isolated injury or in combination with other severe injuries including cranial, spinal, and upper and lower body injuries requiring prompt diagnosis with possible emergency interventions. The epidemiology of facial fractures varies with regard to injury type, severity, and cause and depends on the population studied. Hence, understanding of these factors can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries. MATERIALS AND METHODS: In this present retrospective study, we provide a comprehensive overview regarding cranio-maxillofacial trauma on 3611 patients to assist the clinician in assessment and management of this unique highly specialized area of traumatology. A preformed pro forma was used to analyze the medical records of patients treated for facial trauma in The Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai. The distribution according to age, gender, etiology, type of injury, time interval between accident and treatment, loss of consciousness, facial bones involved, pattern of fracture lines, treatment offered, and postoperative complications were recorded and evaluated. RESULTS: We inferred male patients sustained more injuries mostly in the third decade of age. Road traffic accidents were the most common cause of injury. Mandible was the most commonly fractured bone in the facial skeleton. Soft tissue injuries occurred more in road traffic accidents and upper lip was the commonest site of injury. CONCLUSION: Our study provides insights into the epidemiology of facial injuries and associated factors and can be useful not only in developing prevention strategies but also for grading the existing legal regulations and also for framing a more effective treatment protocol.

[The forensic medical evaluation of injuries to the maxillofacial region].

The problem of forensic medical evaluation of injuries to the maxillofacial region remains a serious challenge to the practical activities in forensic medicine and awaits solution. The present article proposes the original classification of the injuries to the maxillofacial region that makes possible their rational structurization. A number of issues and peculiarities of forensic medical diagnostics, expert evaluation of the harm to health and time of infliction of injuries to selected parts of the maxillofacial region are considered in the context of the new classification. Special attention is given to certain aspects of expert evaluation of the injuries to the teeth, periodontum, and oral cavity mucosa as well as to the post-traumatic functional defects of nasal breathing.

Maxillofacial trauma scoring systems.

The changing complexity of maxillofacial fractures in recent years has created a situation where classical systems of classification of maxillofacial injuries fall short of defining trauma particularly that observed with high-velocity collisions where more than one region of the maxillofacial skeleton is affected. Trauma scoring systems designed specifically for the maxillofacial region are aimed to provide a more accurate assessment of the injury, its prognosis, the possible treatment outcomes, economics, length of hospital stay, and triage. The evolution and logic of such systems along with their merits and demerits are discussed. The author also proposes a new system to aid users in quickly and methodically choosing the system best suited to their needs without having to study a plethora of literature available in order to isolate their choice.

Maxillofacial Fractures: Midface and Internal Orbit-Part I: Classification and Assessment.

Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all physicians treating facial trauma patients to understand the basic principles of injuries to the midface. Thus, this article aims to describe the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern.

Bicycle-related maxillofacial injuries: a double-center study.

OBJECTIVE: Bicycle-related injuries account for an important proportion of road injuries all over the world. As only few reports have focused on the characteristics of maxillofacial fractures sustained in bicycle accidents, the purpose of this study was to present and compare epidemiological data about bicycle-related maxillofacial injuries in two European centers between 2001 and 2010. METHODS: Bicycle-related facial fractures occurred in 105 patients (79 males, 26 females) in Turin, with a percentage of 5.77 among all facial fractures, and in 103 patients (55 males, 50 females) in Amsterdam, with a percentage of 19.69. RESULTS: The major risk groups include young people between their first to third decades. The mandible is the most frequently involved facial bone. Among mandibular injuries the most commonly involved site was the condyle. CONCLUSIONS: Bicycle-related injuries must be considered an important etiological factor in maxillofacial fractures with typical patterns, such as a peculiar seasonal incidence.

Characteristics of ballistic and blast injuries.

Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, with the ultimate outcome dependent on each other, makes the prediction of wounding potential difficult to assess. As the facial features are the component of the body most involved in a patient's personality and interaction with society, preservation of form, cosmesis, and functional outcome should remain the primary goals in the management of ballistic injury. A logical, sequential analysis of the injury patterns to the facial complex is an absolutely necessary component for the treatment of craniomaxillofacial ballistic injuries. Fortunately, these skill sets should be well honed in all craniomaxillofacial surgeons through their exposure to generalized trauma, orthognathic, oncologic, and cosmetic surgery patients. Identification of injured tissues, understanding the functional limitations of these injuries, and preservation of both hard and soft tissues minimizing the need for tissue replacement are paramount.

Gun orientation in self-inflicted craniomaxillofacial gunshot wounds: risk factors associated with fatality.

The purpose of this study was to evaluate whether orientation of a firearm predicts survival, and to identify risk factors associated with fatality in subjects with self-inflicted craniomaxillofacial gunshot wounds. A retrospective cohort study design was used. The primary predictor variable was orientation of the weapon, defined as in the coronal (lateral) or sagittal (anterior-posterior) trajectory pattern. The primary outcome variable was death for subjects on arrival or during their hospital stay. Other covariates measured include demographic, firearm-related, and psychosocial variables. Risk factors for fatality were identified using multivariate logistic regression. Of the 92 subjects that met study inclusion criteria, 47 (67.2) held the firearm in the coronal position. In the full multivariate model, coronal gun orientation (OR=7.7, 95% CI: 2.0, 30.1, p=0.003) and the absence of a psychiatric diagnosis were associated with an increased risk of fatality (OR=0.1, 95% CI: 0.04, 0.5, p=0.002). Coronal firearm orientation was associated with an increased risk of fatality following self-inflicted craniomaxillofacial gunshot injuries. A patient with a documented psychiatric disorder was not found to be more likely to succumb to this type of injury.

Is thromboembolism prophylaxis necessary for low and moderate risk patients in maxillofacial trauma? A retrospective analysis.

This study was designed to investigate retrospectively the incidence of venous thromboembolism (VTE) and the need for thromboembolism prophylaxis in patients undergoing surgery for oral and maxillofacial trauma. Data were obtained from all patients treated under general anaesthesia for maxillofacial trauma between January 2000 and January 2009 in the Department of Oral and Maxillofacial Surgery of the VU University Medical Center, Amsterdam. Patients' records were reviewed for complaints and information related to deep venous thrombosis (DVT) and pulmonary embolism (PE). The patients were classified according to a risk classification, and the incidence of reported DVT and PE was calculated. None of the patients received any form of thromboembolism prophylaxis. Of the 479 patients included in this study, one presented with VTE (0.2%). This male patient was treated for a panfacial trauma and was classified as high risk. From all analysed parameters only surgery time classification proved to have a significant relationship with VTE.

Towards a classification system for complex craniofacial fractures.

The complexity of facial fractures has changed considerably in recent years together with more commonly observed high velocity trauma. Traditional classification systems describe fractures in an isolated manner but fail to recognise those that affect more than one region. We applied four conceptual scoring systems for craniofacial trauma to a cohort of patients in east London. We exposed the limitations of the systems and developed a new scoring system that encompasses elements of all of the models and is capable of overcoming previous limitations.

A comparison of motorcycle and bicycle accidents in oral and maxillofacial trauma.

PURPOSE: The aim of this study was to present a large series of motorcycle- and bicycle-related traumas to the face in an attempt to identify the injury pattern in motorcyclists and bicyclists. PATIENTS AND METHODS: Data were collected from patients during a 10-year period (1999 through 2009), which included demographic data, diagnosis of facial fractures, use of protective devices, dentoalveolar trauma, and facial soft tissue injuries. RESULTS: There were 556 patients with bicycle accidents and 367 with motorcycle accidents. Men were involved in 79% (436) of bicycles accidents and 82% (299) of motorcycle accidents. Young male patients were more frequent in bicycle and motorcycle accidents. Two hundred fifty bicyclists showed 311 maxillofacial fractures. Two hundred twenty-one motorcyclists showed 338 maxillofacial fractures. Motorcycle accidents caused multiple fractures in more patients. Seventy-six percent of motorcyclists were using helmets at the time of the accidents, whereas 6% of cyclists were using helmets. Motorcyclists showed a larger number of lacerations, whereas bicyclists showed a larger number of abrasions. Avulsion was the most common dentoalveolar injury for these accident types. Hospital stays were 3.8 days for motorcyclists and 1.3 days for bicyclists. CONCLUSIONS: The high-impact collisions typically observed in motorcycle accidents is directly related to larger percentages of soft tissue lacerations and facial fractures. The low-impact trauma that is observed in bicycle accidents is more commonly associated with soft tissue abrasion, hematoma, and dentoalveolar fractures. This stresses the need for compulsory legislation for helmet use with face-guards for cyclists and motorcyclists. It is important to take measures to alert the public regarding the severity of injuries likely to occur in bicycle- and motorcycle-related accidents and ways to prevent them.

Mortalidade por acidentes de trânsito e ocorrência de fraturas maxilofaciais / Mortality due to traffic accidents and occurrence of maxillofacial fractures

O objetivo deste artigo foi avaliar a mortalidade por acidentes de trânsito e ocorrência de fraturas maxilofaciais em Campina Grande, Paraíba. Efetuou-se um estudo transversal, por meio da análise de laudos médicos de adultos vitimados por acidentes de trânsito, sendo os dados coletados no Núcleo de Medicina Legal (Numol). A amostra foi composta por 273 laudosde vítimas por acidentes automotivos no ano de 2005. Foram analisadas as variáveis: sexo, idade, dia e horário, tipo de causa, quantificação das lesões, região da lesão (cabeça e face), fratura maxilofacial, avulsão dentária e ossos faciais fraturados. Concluiu-se que as mortes nos acidentes de trânsito envolvem jovens do sexo masculino vítimas de acidentes com motocicletas que apresentam múltiplas lesões. As regiões da cabeça e face são frequentemente envolvidas, sendo comuns as fraturas dos ossos maxilares.

Maxillofacial injuries in Calabar south-south, Nigeria: a 5 year study of jawbone fractures.

OBJECTIVES: The aim of this study is to highlight the overall uniqueness of the pattern of presentation of maxillofacial injuries seen at the Department of Oral and Maxillofacial Surgery of the University of Calabar Teaching Hospital, Calabar south-south Nigeria between January 2000 and December 2004 and to share our experience in terms of occurrence, seasonal fluctuations and the adequacy of treatment methods in our environment. MATERIALS AND METHODS: Case notes of all. the 200 maxillofacial trauma patients were retrieved, examined and analyzed with regards to age, gender and cause of injury, socio-demographic data, diagnosis, pattern of presentation, distribution and treatment. RESULTS: A male-to-female ratio of 3.65:1 was obtained. Out of the 200 patients the highest incidence of injury was in the 20-30 year age group 85 (n=85; 42.5%). The major causes of injuries were motorcycle (n=74; 37%), vehicle (n=62; 31.5%) and assault (n=40; 20%). Six (3%) river-related or boat accidents were recorded. Industrial and sports related accidents contributed the least (n=5; 2.5%). CONCLUSION: Road traffic accident had the highest proportion of the entire maxillofacial injuries with more males affected than females. Seasonal distribution showed a bimodal peak variation of May-June and September-January. This paper calls for the reinforcement of measures for the prevention of automobile accident and the establishment of more maxillofacial specialist centers with modern equipment for effective management of maxillofacial injuries.

Pattern and treatment of facial trauma in pediatric and adolescent patients.

Pediatric maxillofacial trauma is a challenge for surgeons. There are no completely defined protocols, and sometimes, the initial management could be complex. The aim of this research was to perform a retrospective study to analyze the pattern and treatment of maxillofacial fractures in pediatric and adolescent patients. We reviewed the clinical records of 2986 patients treated at the Oral and Maxillofacial Surgery Division of Piracicaba Dental School between 1999 and 2008. Seven hundred fifty-seven patients were younger than 18 years and were divided into 3 groups according to age; the age and sex of the patients, etiology, fractures and associated injury, treatment, and complications were evaluated. Five hundred thirty boys (70.01%) and 227 girls (29.99%) were treated for injuries with major prevalence in adolescents. The most common injury causes were bicycle accidents (29.06%) and falls (28.40%). The mandible was the most fractured bone (44.8%); associated injuries were lacerations of the soft tissue and dental trauma. Surgical treatment was performed in 75 cases (30%) with minor complications (10% of surgical patients). We conclude that maxillofacial trauma in child is associated to fall and bicycle accidents; the mandible is more affected than other maxillofacial structures, and frequently, nonsurgical treatment is performed.

Reconstruction of the maxilla and midface: introducing a new classification.

Most patients requiring midface reconstruction have had ablative surgery for malignant disease, and most require postoperative radiotherapy. This type of facial reconstruction attracts controversy, not only because of the many reconstructive options, but also because dental and facial prostheses can be very successful in selected cases. This Personal View is based on a new classification of the midface defect, which emphasises the increasing complexity of the problem. Low defects not involving the orbital adnexae can often be successfully treated with dental obturators. For the more extensive maxillary defects, there is consensus that a free flap is required. Composite flaps of bone and muscle harvested from the iliac crest with internal oblique or the scapula tip with latissimus dorsi can more reliably support the orbit and cheek than soft-tissue free flaps and non-vascularised grafts, and also enable an implant-borne dental or orbital prosthesis. Nasomaxillary defects usually require bone to augment the loss of the nasal bones, but orbitomaxillary cases can be managed more simply with local or soft-tissue free flaps. We review the current options and our own experience over the past 15 years in an attempt to rationalise the management of these defects.

Adolescent orofacial injury: association with psychological symptoms.

Ethnic minority youth living in urban areas experience disproportionately high rates of violent intentional injuries. This study investigates the association of violent intentional injuries with psychological distress and alcohol use among adolescents treated in trauma centers for facial injuries. Interviews were conducted with 67 adolescents treated at two urban trauma centers (predominantly males [86%], and minority [Latino, 72%; African American, 19%]). Adolescents reported experiencing several different types of accidental and assault-related injuries that required medical attention in the past six months. About half (53%) reported experiencing only unintentional injuries (e.g. car accidents, falls, sports injury); 23% experienced one type of intentional injury resulting from either fighting or being attacked; and 24% experienced two types of intentional injuries resulting from both fighting and being attacked. Measures of alcohol use and psychological distress were examined in relation to these three types of injuries. Overall, 30% of study participants reported they had been drinking alcohol at the time of injury. Compared to adolescents without intentional injuries, those who experienced a physical fight and/or attack had higher levels of alcohol problems, depression, paranoia and somatic symptoms, and were more likely to have family members with alcohol problems. There is a considerable need for adolescents with intentional assault-related injuries to be screened for alcohol and mental health problems, and to be referred for appropriate treatment interventions if they score at problem levels.

Management of pediatric maxillary fractures.

BACKGROUND: Maxillary trauma in pediatric patients is a challenge to health care professionals. The successful treatment and extended care of pediatric maxillary fractures requires multiple considerations. METHODS: This review of the current literature investigates all components of management to provide optimal outcome. Specifically, pediatric management distinctions are discussed for both facial reconstruction and rehabilitation. The current etiology, incidence, classification of injury, and methods to diagnose and treat these patients is outlined. CONCLUSIONS: Pediatric maxillofacial fractures remain a challenging problem. The management of this patient population includes comprehensive knowledge of pediatric maxillofacial growth and development, available reduction techniques, biocompatible materials, and duration of the selected therapy.

Maxillofacial fractures resulting from falls.

PURPOSE: The purpose of this study was to analyze maxillofacial fractures resulting from falls in terms of the demographics, the circumstance of injury, the site and severity of fracture, and the treatment. PATIENTS AND METHODS: Data of 457 patients treated for fall-related maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan, from 1981 to 2007 were retrospectively analyzed. RESULTS: Patients were 163 males and 116 females with an average age of 51.3 years who had fallen on a level surface (simple fall), and 110 males and 68 females with an average age of 31.9 years in falls from a greater height (fall from height), respectively. Fractures of the mandible were more frequently observed than those of the midface. In the mandible, fracture lines were exclusively observed at the condyle, especially in simple falls. In the midface, the zygoma was most frequently involved. Facial Injury Severity Scale ranged from 1 to 6, with an average of 1.78 in simple falls, and from 1 to 9, with an average of 2.04 in falls from height, respectively. These were dependent on the causes and height of the fall. Fractures at the other sites of the body were found in 14 patients (5.0%) with simple falls and 38 (21.3%) with falls from height. Maxillomandibular fixation was most frequently chosen for mandibular fractures and observation for midface fractures. Open reduction and fixation was more frequently chosen in patients with falls from height than those with simple falls and in patients with a higher Facial Injury Severity Scale score. CONCLUSIONS: Maxillofacial fractures resulting from falls showed characteristic features in the demographics, the circumstance of injury, and the site and severity of fracture. Treatment was chosen according to these features.