Urban drinking and driving: comparison of electric scooter and bicycle related accidents in facial fracture patients.

BACKGROUND: In recent years, electric scooters (e-scooter) have emerged as an alternative mode of urban transport due to their availability and effortless use. However, e-scooter-related trauma and injuries, especially to the head, have received wide media coverage and raised public concern about their safety. We aim to determine and compare clinically relevant variables, incidence, and severity between bicycle and e-scooter-related facial fractures and potential protective measures for injury prevention. MATERIAL AND METHODS: This retrospective study comprised all patients admitted to a tertiary trauma center with bicycle or e-scooter-related facial fractures between January 2019 and October 2020. Patient- and injury-related variables, including demographics, injury mechanisms, helmet use, influence of alcohol, types of facial injuries, types of other injuries, given treatment, and hospital stay, were collected, analysed, and compared between bicycle and e-scooter injuries. RESULTS: Altogether 169 patients with facial fractures, 124 bicycle-related injuries (73.4%) and 45 e-scooter-related injuries (26.6%) were included. Alcohol involvement was significantly higher in e-scooter patients (88.9%) than in bicycle patients (31.5%) (p<0.001). Driving under the influence of alcohol was associated with driving without a helmet in both groups (p<0.001). In multivariate analyses, e-scooter accidents were 18 times more likely to occur under the influence of alcohol (OR 17.85, p<0.001) and were more likely to involve collision with a stationary object (OR 3.81, p=0.028). E-scooter patients were significantly younger (OR 0.95, p<0.001) and had significantly more cranial fractures (OR 10.15, p=0.014) than bicycle patients. CONCLUSIONS: Compared with patients in bicycle accidents, facial fracture patients injured in e-scooter accidents are younger, are more likely under the influence of alcohol, and sustain more severe craniofacial skeleton fractures. Our results for both groups of patients advocate stricter adherence to helmet and road safety legislation as well as public education for injury prevention.

Health-related quality of life of patients with zygomatic fracture.

BACKGROUND: The objective was to evaluate health-related quality of life (HRQoL) before and after surgical treatment of zygomatic complex fracture and assess patients' perceptions of the aesthetic and functional outcomes of surgery. MATERIAL AND METHODS: A prospective study of 79 adult patients before and after surgery for zygomatic complex fracture was conducted. HRQoL was measured using the generic 15-dimensional (15D) instrument, and patient satisfaction was assessed by an additional questionnaire. RESULTS: The mean preoperative 15D score for patients was lower than for general population that was matched for age and gender (p=0.011). The mean 15D score was lowest on the first postoperative day (p<0.001) when patients were worse off for 6 of the 15 dimensions of the HRQoL instrument and better off for three dimensions. However, patients achieved, and even exceeded, the mean 15D score of the general population during the first month following surgery. Infraorbital sensory loss at the end of the six-month follow-up appeared to be the single most important factor that plagued the patients. CONCLUSIONS: HRQoL is significantly reduced after trauma but improves a few weeks after surgery. Infraorbital nerve sensory loss is a notable long-term factor that affects patients after zygomatic complex fracture.

Rehabilitation of the severely atrophied dentoalveolar ridge in the aesthetic region with corticocancellous grafts from the iliac crest and dental implants.

UNLABELLED: Backround: The aim of this study was to assess changes in bone volume after block bone augmentation and placement of dental implants and further evaluate the aesthetic outcome of the treatment. MATERIAL AND METHODS: 9 patients with atrophied anterior maxilla were included in this study. They received total of 21 implants. Dimensions of the alveolar ridge were measured from cone-beam computed tomography x-rays. The bone level at the implant sites was analysed from intraoral x-rays and the aesthetic outcome was assessed from clinical photographs using a pink aesthetic score (PES) scaling. RESULTS: The mean gained horizontal bone width at the marginal crest and 5 mm apically was accordingly 2.7mm and 5.0 mm. The mean PES rating was 9.8/14. The survival rate of. CONCLUSIONS: Reconstruction of the atrophied anterior maxilla with bone blocks and dental implants is a safe procedure with high survival rate and acceptable aesthetic outcome.

Concomitant head or neck injury increases risk of traumatic brain injury in facial fracture patients.

Concomitant traumatic brain injury (TBI) is common in facial fracture patients and prompt intervention is crucially important to minimise the risk of potential long-term sequalae. In order to achieve rapid diagnosis, clinicians need to be aware of the risk factors associated with concomitant TBI and facial fractures. Previous literature suggests that a facial fracture can be considered a significant indicator of TBI. Nevertheless, a large data gap remains on specific injury patterns of facial fractures and associated TBI. Therefore, the objective of this study was to estimate and compare the frequency of and risk factors for TBI in patients with and without different types of additional injuries. The retrospective cohort study included 1836 facial fracture patients aged at least 18 years. The outcome variable was TBI with radiological findings in computed tomography or magnetic resonance imaging. The primary predictor variables were associated injury outside the head and neck, associated cranial fracture and associated neck injury. Based on this study, associated cranial fracture increased the risk of TBI 4.7-fold. Patients with associated neck injury had a 2.1-fold risk of TBI. In addition, significant predictors for TBI were increasing age (p = 0.0004), high energy of injury (p < 0.0001) and anticoagulant medication (p = 0.0003). Facial fracture patients with associated injuries in the head and neck region are at significant risk of TBI. In clinical work, multiprofessional evaluation of facial fracture patients should be routine and repeated survey should be targeted especially at high-risk patients to identify TBIs.

Assault-related facial fractures: does the injury mechanism matter?

This study clarified the injury characteristics and occurrence of associated injuries in patients with assault-related facial fractures. Data from 840 assault-related facial fracture patients were included; demographic factors, facial fracture type, associated injuries, alcohol use, and injury mechanisms were recorded. Assault mechanisms most often included combinations of different mechanisms (57.5%) and resulted in the victim falling (50.1%). The perpetrator was most commonly a stranger (52.5%) and acted alone (57.7%). A total of 123 patients (14.6%) had associated injuries, with the most common being traumatic brain injury. Associated injuries occurred most frequently in patients with combined fractures of the facial thirds (24.2%) and upper third fractures (42.9%). The most significant differentiating factors for associated injuries were the number of perpetrators, falling, the use of an offensive weapon, and if the events of the assault remained unknown. In adjusted logistic regression analyses, statistically significant associations with associated injuries were found for age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.07; P < 0.001), falling due to the assault (OR 2.87, 95% CI 1.49-5.50; P = 0.002), and upper third facial fractures (OR 6.93, 95% CI 2.06-23.33; P = 0.002). A single punch also caused severe injuries and should therefore not be overlooked, as this can be as dangerous as other assault mechanisms.

Blunt cerebrovascular injuries in the craniofacial fracture population-Are we screening the right patients?

Current knowledge of blunt cerebrovascular injuries (BCVIs) in craniomaxillofacial fracture (CMF) patients is limited. The purpose of this study was to determine the occurrence of BCVIs in patients with all types of CMF. This retrospective study included CMF patients in a level 1 trauma centre during a 3-year period. Patients who were not imaged with computed tomography angiography and patients with mechanisms other than blunt injury were excluded. The primary outcome variable was BCVI. A total of 753 patients were included in the analysis. A BCVI was detected in 4.4% of the patients screened. BCVIs occurred in 8.7% of cranial fracture patients, 7.1% of combined craniofacial fracture patients, and 3.1% of facial fracture patients. The risk of BCVI was significantly increased in patients with isolated cranial fractures (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.18-5.50; P=0.017), those involved in motor vehicle accidents (OR 3.42, 95% CI 1.63-7.17; P=0.001), and those sustaining high-energy injuries (OR 3.17, 95% CI 1.57-6.40; P=0.001). BCVIs in CMF patients are relatively common in high-energy injuries. However, these injuries also occur in minor traumas. Imaging thresholds should be kept low in this patient population when BCVIs are suspected.

Paediatric mandibular fracture-a diagnostic challenge?

The purpose of this study was to clarify the frequency of missed mandibular fractures and to identify possible predictive factors for missed diagnosis. This was a retrospective study that included patients <20 years of age with a recent mandibular fracture. The outcome variable was missed mandibular fracture, which was determined when a fracture was not suspected or diagnosed during the patient's first assessment in primary healthcare. The primary predictor variable was age group (i.e. children <13 years or teenagers/adolescents aged 13-19 years). The explanatory variables were sex, mechanism of injury, and type of facial facture. Other variables were clinical symptoms and findings. Mandibular fracture was missed at first contact in 27 of 182 patients (14.8%). Fracture was missed significantly more often in patients <13 years than in older patients (33.3% vs. 8.8%, P<0.001). The only significant symptom or clinical finding that was associated with missed fractures was skin wound of the jaw (P=0.009). There was no association between missed fracture and sex or mechanism of injury. Mandibular fractures in children are often missed at the first healthcare contact. Careful examination is necessary in paediatric mandibular injuries, particularly in the youngest age groups. Consultation should be smooth between paediatric trauma units and maxillofacial surgeons.

Long-term quality of life after surgery of head and neck cancer with microvascular reconstruction: a prospective study with 4.9-years follow-up.

PURPOSE: The aim of this study was to evaluate the long-term health-related quality of life (HRQoL) of head and neck cancer patients with microvascular surgery. Surgical treatment causes great changes in patient HRQoL. Studies focusing on long-term HRQoL after microvascular reconstruction for head and neck cancer patients are scarce. METHODS: We conducted a prospective study of 93 patients with head and neck cancer and microvascular reconstruction in Helsinki University Hospital Finland. HRQoL was measured using the 15D instrument at baseline and after a mean 4.9-years follow up. Results were compared with those of an age-standardized general population. RESULTS: Of the 93 patients, 61 (66%) were alive after follow-up; of these, 42 (69%) answered the follow-up questionnaire. The median time between surgery and HRQoL assessment was 4.9 years (range 3.7-7.8 years). The mean 15D score of all patients (n = 42) at the 4.9-years follow up was statistically significantly (p = 0.010) and clinically importantly lower than at baseline. The dimensions of "speech" and "usual activities" were significantly impaired at the end of follow up. There was a significant difference at the 4.9-years follow-up in the mean 15D score between patients and the general population (p = 0.014). After follow up, patients were significantly (p < 0.05) worse off on the dimensions of "speech," "eating," and "usual activities." CONCLUSIONS: Long-term HRQoL was significantly reduced in the whole patient cohort. Speech and usual activities were the most affected dimensions in head and neck cancer patients with microvascular reconstruction at the end of the 4.9-years follow up.

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.

Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study.

PURPOSE: The aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP. PATIENTS AND METHODS: A 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference. RESULTS: A total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm2) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP). CONCLUSION: GMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

Postoperative temporomandibular dysfunction in patients with fractures of the zygomatic complex: a prospective follow-up study.

The aim of this prospective follow-up study was to clarify the incidence and characteristics of dysfunction of the temporomandibular joint (TMJ) in patients treated surgically for fractures of the zygomatic complex. Patients were evaluated on presentation and six months after injury to assess the function of the masticatory system using the Helkimo index, which incorporates two complementary subindices: the subjective symptomatic (anamnestic) index (Ai) and the objective clinical dysfunction index (Di). Forty-five patients (12 women and 33 men, mean (range) age 44 (21-83)years) completed the study. Six patients developed subjective symptoms of dysfunction of the TMJ during follow-up, in four of whom they were severe. Clinical findings were noted in 38 patients but without significant association with subjective symptoms. Dysfunction of the TMJ is common six months after surgical treatment of a fracture of the zygomatic complex, and patients with such fractures should be evaluated for temporomandibular dysfunction during follow-up and referred for treatment when necessary.

Complications and loss of free flaps after reconstructions for oral cancer.

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005-2010. The patients' clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n=86, 45%) and the anterolateral thigh free flap (ALTFF) (n=48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n=25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41-50 years (p=0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p=0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.

Neurosensory recovery after trauma to the orbital floor: a prospective trial with dexamethasone.

Our aims were to document the occurrence of neurosensory disturbances of the infraorbital nerve six months after operation for an orbital blow-out fracture, and to find out whether dexamethasone facilitates neurosensory regeneration. Patients were randomly assigned to one of two groups: the study group was given a total of dexamethasone 30mg, whereas the control group were given neither glucocorticoid nor placebo. Each patient's infraorbital neurosensory state was recorded preoperatively, immediately postoperatively, and six months later. A total of 18 patients were included, eight of whom had neurosensory disturbances six months after the initial trauma that was not affected by dexamethasone. Six of the seven patients who had a delay of seven days or more between trauma and operation had significantly prolonged disturbance at the 180-day clinical follow up compared with those in whom it was less than seven days (p=0.005). Other possible predictors made no significant difference. Although dexamethasone did not facilitate sensory recovery, its benefits in the management of pain and reduction of swelling may justify its use in the management of facial trauma in selected patients.

Postoperative nausea and vomiting in facial fracture patients: A Randomized and controlled trial on the effect of dexamethasone.

This study aimed to establish the incidence of postoperative nausea and vomiting (PONV) in facial fracture patients. The specific aim was to investigate the effect of perioperative dexamethasone on PONV. A total of 119 adult patients with facial fractures were analysed in this prospective study. Patients were randomized to receive perioperatively either a total dose of 30mg of dexamethasone i.v. and i.m., or no glucocorticoid (control). PONV was evaluated every 6hours during the first postoperative 24hours and when pain medications were given. PONV occurred in 20 out of 119 patients (16.8%). The only significant (P=0.016) association with PONV was postoperative administration of opioids. Slightly more cases of PONV occurred for patients who had not received dexamethasone (20%) compared to those who had (13.6%). PONV was also non-significantly more common in patients ≥40 years (21.3%) than in patients < 40 years (12.1%), after orbital floor reconstruction (28.0%) compared with mandibular (11.6%) and zygomatic (15.6%) fractures surgeries, and also after anaesthesia lasting >97minutes (21.7%) compared with a shorter duration (11.3%). Alternative medications should be used for prevention of post-surgery nausea and vomiting in facial fracture patients.

Midfacial fractures in pediatric patients. Frequency, characteristics, and causes.

OBJECTIVE: To determine the frequency, characteristics, and causes of midfacial fractures in children. DESIGN: A retrospective review of the patients' medical charts and radiographs. SETTING: Tertiary referral center. PATIENTS: Fifty-four patients under 16 years of age, with midfacial fractures diagnosed and treated in the Helsinki (Finland) University Central Hospital from 1980 through 1992. MAIN OUTCOME MEASUREMENTS: The data examined included sex, age, time and cause of the accident, type and location of the fractures, the presence and location of associated injuries, complications, and treatment methods. RESULTS: The male-to-female ratio was 1.16:1. Motor-vehicle accident was the most common cause of injuries. The frequency of injuries was in decreasing order: (1) maxillary alveolar bone, (2) zygoma, and (3) Le Fort fractures of the maxilla. The majority of injuries occurred in subjects who were 13 to 15 years old. In children less than 6 years old, only alveolar fractures occurred. For the other age groups, no significant difference in the fracture pattern was found. No fatalities occurred in this patient series. CONCLUSIONS: Midfacial pediatric fractures are rare. A high velocity force, such as that from a motor-vehicle accident is a factor producing the injury. Owing to the high impact, associated injuries are common. The severity of the insult is more essential than the age of the patient and the development of the paranasal sinuses.

Different patterns of mandibular fractures in children. An analysis of 220 fractures in 157 patients.

157 paediatric patients with a total of 220 mandibular fractures were evaluated retrospectively. All patients had been examined with the aid of orthopantomography. 72% of the children had fractures in the condylar region. The patients were divided into four age groups according to the development of the dentition (group A: 0-5 years, B: 6-9 years, C: 10-12 years, and D: 13-15 years). Bicycle accidents and falls were the two main causes of the fractures in all age groups. However, there were significant differences in the causes and location of the fractures between groups A+B and C+D. The proportion of condylar fractures decreased and the proportion of body and angle fractures increased with increasing age; fractures in the horizontal part of the mandible were mainly observed in groups C and D. Both aetiological factors and fracture patterns in the patients older than 10 years of age resembled those of adults. The differences observed should be taken into consideration in studies concerning mandibular fractures in paediatric patients. In this respect the age limit between the adult and child should probably be lowered significantly.

Radiologic changes of the temporomandibular joint after condylar fractures in childhood.

OBJECTIVE: The purpose of this investigation was to study the radiologic outcomes of pediatric condylar fractures. STUDY DESIGN: Radiographs of 37 patients with 45 condylar fractures that had been diagnosed at the Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital were retrospectively reviewed. The frequency and characteristics of incomplete remodeling at an average of 4.1 years after the injury were studied. The influence of age and fracture type on remodeling were considered. RESULTS: Incomplete remodeling was observed after 56% of the fractures. The most frequent signs of incomplete remodeling were alteration in the configuration of the surface of the condylar head and deformation of the condylar neck. Incomplete remodeling was frequently (83%) related to fracture dislocation. For this fracture type the radiologic prognosis seems poor in all age groups. A difference in ramus height between the 2 sides was observed in 52% of the fractures, particularly frequently (80%) after fracture dislocation. CONCLUSIONS: Radiologic aberrations are frequent after pediatric condylar fractures. Dislocated fractures, in particular, need special attention and long-lasting clinical follow-up.

An epidemiological study of patterns of condylar fractures in children.

OBJECTIVE: To find out how the site and type of condylar fracture are affected by its aetiology and the age and sex of the patient. DESIGN: Retrospective study. SETTING: Tertiary referral centre, Finland. MATERIAL: Radiographs of 101 children (aged 15 years or less) with 119 condylar fractures. MAIN OUTCOME MEASURES: Site of fracture and degree of displacement. RESULTS: A total of 26 of the 119 fractures were intracapsular (22%) and 93 (78%) extracapsular. Only among patients less than 6 years of age was there a preponderance of intracapsular fractures (7/12 fractures in 10 patients, 58%). In the older children 78% (83/107) were in the condylar neck. There were few subcondylar fractures (5/119, 4%). Only 6 fractures were displaced (5%). Dislocation of the condyle from the glenoid fossa was common in all age groups. CONCLUSION: The site of condylar fracture is age related, but not associated with sex or aetiology.

Risk factors contributing to symptomatic miniplate removal: a retrospective study of 153 bilateral sagittal split osteotomy patients.

Removal of miniplates is a controversial topic in oral and maxillofacial surgery. Originally, miniplates were designed to be removed on completion of bone healing. The introduction of low profile titanium miniplates has led to the routine removal of miniplates becoming comparatively rare in many parts of the world. Few studies have investigated the reasons for non-routine removal of miniplates and the factors that affect osteosynthesis after osteotomy in large numbers of patients. The aim of the present study was to investigate complications related to osteosynthesis after bilateral sagittal split osteotomy (BSSO) in a large number (n=153) of patients. In addition to the rates of removal, emphasis was placed on investigating the reasons and risk factors associated with symptomatic miniplate removal. The rate of plate removal per patient was 18.6%, the corresponding rate per plate being 18.2%. Reasons for plate removal included plate-related complications in 16 patients and subjective discomfort in 13 patients. Half of the plates were removed during the first postoperative year. Smoking was the only significant predictor for plate removal. Patients undergoing orthognathic surgery should be screened with regard to smoking and encouraged and assisted to cease smoking, at least perioperatively.