Assessment of quality of life in patients with surgically treated maxillofacial fractures.

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

The Epidemiology and Management of Maxillofacial Fractures at a Tertiary Care Hospital in a Conflict-Torn Region in Somalia.

ABSTRACT: The etiology of maxillofacial fractures (MFFs) varies according to the geographical location and density of the population. This study aimed to analyze the etiology, pattern, and treatment of MFFs. Epidemiological characteristics and treatment modalities of MFFs have never been evaluated in Somalia. The study included 45 patients who were operated on for MFFs at a tertiary care hospital in Somalia (2018-2019). Patient demographics, fracture causes, types, associated non-facial injuries, treatment modalities, and hospitalization-time were evaluated. The most common etiological factors of the MFFs were explosion (24.4%) and assault (24.4%), followed by gunshot (22.2%), sports accident (15.6%), motor vehicle accident (11.1%), and fall from height (2.2%) patients, respectively. The main site of injury was the mandible bone (64.4%) followed by nasal bone, maxilla, zygomatic, and orbital region. The most common non-facial injuries of the MFFs were soft tissue laceration (37.8%) followed by femoral fracture (6.7%), clavicle fracture (4.4%), and femoral fracture with chest injuries (2.2%). The most applied treatment was open reduction microplate +/- intermaxillary fixation (77.8%). Due to the size of the mandible fractures, an iliac autograft (6.7%) was performed. The mean length of the hospital stay was 11.8 ±â€Š8.4 days (range, 1-45 days), and some patients (15.6%) needed intensive care due to severe injuries. This will be the first study aiming to analyze the etiology, pattern, and treatment of MFFs in Somalia. This study deals with the social aspects of Somalia, and it shows that MFFs develop as a result of highly interpersonal violence in a young man.

Trends in Operative Complex Middle and Upper Maxillofacial Trauma: A 17-Year Study.

OBJECTIVES/HYPOTHESIS: Over 3 million incidents of facial trauma occur each year in the United States. This study aims to determine trends in operative middle and upper maxillofacial trauma in one of the largest US cities. STUDY DESIGN: Retrospective case-control study. METHODS: Retrospective chart review of all operative middle and upper maxillofacial trauma from July 1993 to July 2010 presenting to Los Angeles County Hospital, a Level I Trauma Center. Data included demographics, mechanism of injury, and fracture characteristics. RESULTS: Analysis was performed for a total of 4,299 patients and 5,549 facial fractures. Mean patient age was 34.6, and most patients were male (88%). Between the two time periods (1993-2001 and 2002-2010), there was a 42% reduction in operative maxillofacial trauma (3,510 to 2,039). Orbital floor and zygomaticomaxillary complex fractures were the most prevalent types of fractures. Panfacial fractures demonstrated the largest reduction in number of fractures (325 to 5, P<0.01). Assault and motor vehicle accidents (MVA) were the two most common mechanisms of injury. Operative fractures due to MVAs decreased (390 to 214, P = .74), whereas fractures due to assault increased (749 to 800, P<0.01). Compared to adults, pediatric facial trauma (age < 18) were caused by a higher percentage of MVAs (27% vs. 13%), auto versus pedestrian (9% vs. 5%), and gunshot wounds (8% vs. 4%) (P<0.01). CONCLUSIONS: Operative middle and upper maxillofacial trauma decreased over a 17-year period. Assault was the most significant mechanism of trauma overall. These trends suggest that focusing future prevention strategies on curtailing interpersonal violence may more effectively address the burden of facial trauma. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1985-1989, 2021.

Styloid Process Fracture Associated With Maxillofacial Trauma: Incidence, Distribution, and Management.

PURPOSE: Fracture of the styloid process of the temporal bone has been infrequently reported. The present study evaluated the incidence, causes, distribution, and management of styloid process fracture in association with other maxillofacial fractures. MATERIALS AND METHODS: A prospective evaluation of patients with maxillofacial trauma over a period of 1 year was carried out and patients' characteristics, mode and distribution of injury, and length of styloid process were recorded. Patients were divided into 5 groups based on the site of maxillofacial fracture and into 2 groups based on styloid process length to evaluate their association with styloid process fracture. The authors' unit protocol was carried out for management of styloid process fracture. RESULTS: Of 84 patients with maxillofacial trauma, 27 patients (14 men, 13 women; mean age, 25.7 ± 8.92 yr) had styloid process fracture. The most common cause of injury was road traffic accidents. Mandibular and multiple facial fractures accounted for most concomitant styloid process fractures. The mean length of the styloid process in patients with fracture was 2.46 ± 0.89 cm and no relevant association was present between the length and fracture of the styloid process. All patients responded well to initial conservative management. CONCLUSION: Styloid process fractures are relatively common injuries in developing countries and a meticulous examination is essential for prompt diagnosis and adequate care.

Facial Fractures in Patients With Firearm Injuries: Profile and Outcomes.

PURPOSE: Firearm injuries (FAIs) are a major public health issue in the United States. The objective of this study was to examine characteristics and outcomes of patients presenting to emergency departments (EDs) with facial fractures attributed to FAIs. MATERIALS AND METHODS: The Nationwide Emergency Department Sample for the years 2008 to 2013 was used. All patients who visited EDs with FAIs and facial fractures were selected. The study focused on the following variables: 1) demographic characteristics, 2) types of facial fractures, 3) disposition status after ED visit or subsequent hospitalization, 4) charges (ED and hospitalization), and 5) patient outcomes. The inclusion criteria were a visit to a hospital-based ED with facial fractures and an external cause of FAI. Descriptive statistics were used to summarize findings. Multivariate logistic regression analysis was used to examine the simultaneous effects of patient-related factors on ED death. RESULTS: During the study period, a total of 15,469 patients (mean age, 34 years) visited hospital-based EDs with facial fractures attributed to FAIs. Most were uninsured male patients. The most common etiology of FAIs was assault. The most common facial fractures were open mandibular fractures and open maxillary and/or malar bone fractures. Approximately 27% of patients had a concomitant intracranial injury. After the ED visit, 74% were admitted. The mean ED charge per patient was $6,403, and the total ED charge across the United States was $76.48 million. The mean hospitalization charge per patient was $167,203. The total hospitalization charge across the United States was $1.9 billion. Patients with intracranial injuries (odds ratio [OR], 21.21; 95% confidence interval [CI], 7.16 to 62.85; P < .01), uninsured patients (OR, 4.24; 95% CI, 1.44 to 12.51; P < .01), and patients residing in areas with high household incomes (OR, 5.60; 95% CI, 2.51 to 12.46; P < .01) were high-risk groups for ED death. CONCLUSIONS: FAIs require substantial resources for stabilization and treatment by EDs. This study highlights the burden and impact of facial fractures in patients with FAIs in the United States.

Transfer of children with isolated linear skull fractures: is it worth the cost?

OBJECTIVE Children with skull fractures are often transferred to hospitals with pediatric neurosurgical capabilities. Historical data suggest that a small percentage of patients with an isolated skull fracture will clinically decline. However, recent papers have suggested that the risk of decline in certain patients is low. There are few data regarding the financial costs associated with transporting patients at low risk for requiring specialty care. In this study, the clinical outcomes and financial costs of transferring of a population of children with isolated skull fractures to a Level 1 pediatric trauma center over a 9-year period were analyzed. METHODS A retrospective review of all children treated for head injury at Riley Hospital for Children (Indianapolis, Indiana) between 2005 and 2013 was performed. Patients with a skull fracture were identified based on ICD-9 codes. Patients with intracranial hematoma, brain parenchymal injury, or multisystem trauma were excluded. Children transferred to Riley Hospital from an outside facility were identified. The clinical and radiographic outcomes were recorded. A cost analysis was performed on patients who were transferred with an isolated, linear, nondisplaced skull fracture. RESULTS Between 2005 and 2013, a total of 619 pediatric patients with isolated skull fractures were transferred. Of these, 438 (70.8%) patients had a linear, nondisplaced skull fracture. Of these 438 patients, 399 (91.1%) were transferred by ambulance and 39 (8.9%) by helicopter. Based on the current ambulance and helicopter fees, a total of $1,834,727 (an average of $4188.90 per patient) was spent on transfer fees alone. No patient required neurosurgical intervention. All patients recovered with symptomatic treatment; no patient suffered late decline or epilepsy. CONCLUSIONS This study found that nearly $2 million was spent solely on transfer fees for 438 pediatric patients with isolated linear skull fractures over a 9-year period. All patients in this study had good clinical outcomes, and none required neurosurgical intervention. Based on these findings, the authors suggest that, in the absence of abuse, most children with isolated, linear, nondisplaced skull fractures do not require transfer to a Level 1 pediatric trauma center. The authors suggest ideas for further study to refine the protocols for determining which patients require transport.

Epidemiology and resource utilization in pediatric facial fractures.

BACKGROUND: Pediatric facial fractures, although uncommon, have a significant impact on public health and the US economy by the coexistence of other injuries and developmental deformities. Violence is one of the most frequent mechanisms leading to facial fracture. Teaching hospitals, while educating future medical professionals, have been linked to greater resource utilization in differing scenarios. This study was designed to compare the differences in patient characteristics and outcomes between teaching and non-teaching hospitals for violence-related pediatric facial fractures. METHODS: Using the 2000-2009 Kids' Inpatient Database, 3881 patients younger than 18 years were identified with facial fracture and external cause of injury code for assault, fight, or abuse. Patients admitted at teaching hospitals were compared to those admitted at non-teaching hospitals in terms of demographics, injuries, and outcomes. RESULTS: Overall, 76.2% of patients had been treated at teaching hospitals. Compared to those treated at non-teaching hospitals, these patients were more likely to be younger, non-white, covered by Medicaid, from lower income zip codes, and have thoracic injuries; but mortality rate was not significantly different. After adjusting for potential confounders, teaching status of the hospital was not found as a predictor of either longer lengths of stay (LOS) or charges. CONCLUSIONS: There is an insignificant difference between LOS and charges at teaching and non-teaching hospitals after controlling for patient demographics. This suggests that the longer LOS observed at teaching hospitals is related to these institutions being more often involved in the care of underserved populations and patients with more severe injuries.

Observation for isolated traumatic skull fractures in the pediatric population: unnecessary and costly.

BACKGROUND: Blunt head trauma accounts for a majority of pediatric trauma admissions. There is a growing subset of these patients with isolated skull fractures, but little evidence guiding their management. We hypothesized that inpatient neurological observation for pediatric patients with isolated skull fractures and normal neurological examinations is unnecessary and costly. METHODS: We performed a single center 10year retrospective review of all head traumas with isolated traumatic skull fractures and normal neurological examination. Exclusion criteria included: penetrating head trauma, depressed fractures, intracranial hemorrhage, skull base fracture, pneumocephalus, and poly-trauma. In each patient, we analyzed: age, fracture location, loss of consciousness, injury mechanism, Emergency Department (ED) disposition, need for repeat imaging, hospital costs, intracranial hemorrhage, and surgical intervention. RESULTS: Seventy-one patients presented to our ED with acute isolated skull fractures, 56% were male and 44% were female. Their ages ranged from 1week to 12.4years old. The minority (22.5%) of patients were discharged from the ED following evaluation, whereas 77.5% were admitted for neurological observation. None of the patients required neurosurgical intervention. Age was not associated with repeat imaging or inpatient observation (p=0.7474, p=0.9670). No patients underwent repeat head imaging during their index admission. Repeat imaging was obtained in three previously admitted patients who returned to the ED. Cost analysis revealed a significant difference in total hospital costs between the groups, with an average increase in charges of $4,291.50 for admitted patients (p<0.0001). CONCLUSION: Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Further studies are necessary to change clinical practice, but our research indicates that these patients can be discharged safely from the ED without inpatient observation. This change in practice, additionally, would allow for huge health care dollar savings.

Cost effective use of audiograms after pediatric temporal bone fractures.

OBJECTIVE: To identify the relationship of pediatric temporal fractures to the incidence and type of hearing loss present. To analyze the timing and utility of audiometric testing in children with temporal bone fractures. METHODS: Retrospective case series of 50 pediatric patients with temporal bone fractures who were treated at an urban, tertiary care children's hospital from 2008 to 2014. A statistical analysis of predictors of hearing loss after temporal bone fracture was performed. RESULTS: Fifty-three fractures (69.7%) in 50 patients involved the petrous portion of the temporal bone. The mean age of patients was 7.13 years, and 39 (73.6%) were male. A fall was the most common mechanism of injury in 28 (52.8%) patients, followed by crush injury (n=14, 26.2%), and vehicular trauma (n=10, 18.9%). All otic capsule violating fractures were associated with a sensorineural hearing loss (n=4, 7.5%, p=0.002). Three of four otic capsule sparing fractures were associated with ossicular dislocation, with a corresponding mixed or conductive hearing loss on follow up audiometric testing. The majority of otic capsule sparing fracture patients (n=19/43, 44.2%) who had follow up audiograms had normal hearing, and those with otic capsule violating fractures were statistically more likely to have persistent hearing loss than those with otic capsule sparing fractures (p=0.01). CONCLUSIONS: Patients with otic capsule violating fractures or those with ossicular disruption are at higher risk for persistent hearing loss. Cost-saving may be accrued by selecting only those patients at high risk for persistent hearing loss for audiometric testing after temporal bone fractures.

Impact of the economic recession on the etiology of maxillofacial fractures in Greece.

OBJECTIVE: The global economic crisis and the subsequent austerity measures taken in Greece in 2010 have moved the country to the epicenter of a financial storm with negative effects on the national health sector and all aspects of social life. METHODS: Records of patients admitted for treatment of maxillofacial fractures in two different periods of time were used in this study. Data concerning the etiology of fractures from 2006 to 2009 were compared with data from 2010 to 2013 to investigate whether the economic recession has significantly influenced the causality of trauma. RESULTS AND CONCLUSION: Our study demonstrates that the rate of facial fractures caused by motor vehicle accidents before the worsening of the crisis was significantly reduced in the period after 2010 but that the incidence of fractures due to interpersonal violence increased during the period of the severe economic crisis. We discuss the reasons that may have led to these changing patterns of trauma.

Assessment of the lateral pterygoid plate fractures during Le Fort I osteotomies regarding the angulation of the osteotome.

AIM. This study aimed to clarify the relation between the angulation of the curved osteotome and fracture of the pterygoid plate during Le Fort I osteotomy. MATERIAL AND METHODS. Twenty-one specimens of hemisectioned Turkish skulls were used for the study. The maxilla was sectioned transversely on the floor of the pyriform aperture and posteriorly to the lateral pterygoid plate with a mechanical saw. The pterygomaxillary junction was separated with a curved osteotome by angulating the osteotome with, 0° and -30° to the occlusal plane. The undesired fractures of the lateral pterygoid plate were determined. Among 21 specimens, 7 pterygomaxillary junctions were separated with an angle of +30° , 7 with 0° and 7 with -30° to the occlusal plane. RESULTS. In group +30°, the undesired fracture occured in 6 of the cases. In group -30°, the undesired fracture was determines in one case. In cases where the separation was performed by placing the osteotome paralell to the occlusal plane all plates remained safe. CONCLUSION. Within the limited knowledge of the current study it can be concluded that the osteotome should be placed paralell to the occlusal plane.

Head injuries following television-related accidents in the pediatric population.

OBJECT: Current data indicate the rate of head injuries in children caused by falling televisions is increasing. The authors describe these injuries and the cost incurred by them. METHODS: In a single-institution retrospective review, all children treated for a television-related injury at LeBonheur Children's Hospital, a Level I pediatric trauma center, between 2009 and 2013 were identified through the institution's trauma registry. The type, mechanism, and severity of cranial injuries, surgical interventions, outcome, and costs were examined. RESULTS: Twenty-six patients were treated for a television-related injury during the study period. Most injuries (22 cases, 85%) occurred in children aged 2-4 years (mean age 3.3 years), and 19 (73%) of the 26 patients were male. Head injuries occurred in 20 patients (77%); these injuries ranged from concussion to skull fractures and subdural, subarachnoid, and intraparenchymal hemorrhages. The average Glasgow Coma Scale score on admission was 12 (range 7-15), and 3 patients (12%) had neurological deficits. Surgical intervention was required in 5 cases (19%). The majority of patients made a full recovery. There were no deaths. The total cost for television-related injuries was $1.4 million, with an average cost of $53,893 per accident. CONCLUSIONS: A high occurrence of head injuries was seen following television-related accidents in young children. This injury is ideal for a public education campaign targeting parents, health care workers, and television manufacturers.

Impact of facial fractures and intracranial injuries on hospitalization outcomes following firearm injuries.

IMPORTANCE: Firearm injuries (FAIs) play a major role in unintentional injuries, suicides, and homicides. It is important that policy makers, public health authorities, physicians, and the public are kept abreast of current trends in FAIs so that preventive programs can be tailored to the needs of cohorts that are at highest risk for such injuries. OBJECTIVES: To provide nationally representative longitudinal estimates of outcomes associated with hospitalizations attributed to FAIs in all age groups in the United States during the years 2003 to 2010; to obtain prevalence estimates of skull and/or facial fractures and intracranial injuries among those hospitalized owing to firearm injuries; and to examine the association between the occurrence of skull and/or facial fractures and/or intracranial injuries and in-hospital mortality. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective analysis of the largest all-payer hospitalization data set in the United States, we evaluate a Nationwide Inpatient Sample of patients hospitalized for FAIs during the years 2003 to 2010. EXPOSURES: Face and/or skull fracture and/or intracranial injuries due to firearm injuries. MAIN OUTCOMES AND MEASURES: The main outcome of interest was in-hospital mortality. The primary independent variables included occurrence of face and/or skull fracture and/or intracranial injuries. RESULTS During the study period, 252,181 visits were attributed to FAIs. Adolescents and young adults accounted for nearly 80% of all hospitalizations, with more than half of these in the 18- to 29-year-old, high-risk group. Male patients consistently accounted for 89% of the hospitalizations. The uninsured population accounted for nearly a third of hospitalizations. A total of 214,221 FAI hospitalizations did not involve facial and/or skull fractures or intracranial injuries; 13,090 involved a facial and/or skull fracture without a concomitant intracranial injury; 20,453 involved an intracranial injury without a concomitant facial and/or skull fracture; and 4417 involved both a facial and/or skull fracture and intracranial injury. Those with intracranial injuries without concomitant facial and/or skull fractures (odds ratio [OR], 58.40; 95% CI, 50.08-68.11) (P < .001) and those with both facial and/or skull fractures and intracranial injuries (OR, 17.45; 95% CI, 13.98-21.79) (P < .001) were associated with higher odds of in-hospital mortality than those without these injuries. Teaching hospitals were associated with higher odds of in-hospital mortality than nonteaching hospitals (OR, 1.31; 95% CI, 1.14-1.49) (P < .001). Teaching hospitals also tended to treat a higher proportion of complex cases. The uninsured had higher odds of in-hospital mortality than those with private insurance (OR, 1.55; 95% CI, 1.35-1.78). CONCLUSIONS: AND RELEVANCE Occurrence of intracranial injuries was an independent risk factor for poor outcomes. Teaching hospitals had higher mortality rates but also treated more complex cases than nonteaching hospitals.

Changing characteristics of facial fractures treated at a regional, level 1 trauma center, from 2005 to 2010: an assessment of patient demographics, referral patterns, etiology of injury, anatomic location, and clinical outcomes.

INTRODUCTION: Despite improvements in automotive safety, motor vehicle collision (MVC)-related facial fractures remain common and represent preventable injuries. This study examines the changing characteristics of facial fractures treated at a regional, level I trauma center, from 2005 to 2010. METHODS: We identified all patients with facial fractures admitted to our hospital, from 2005 to 2010, by querying the North Carolina Trauma Registry, using International Classification of Diseases, Ninth Revision codes. Prospectively collected data, sorted by year, were descriptively analyzed for demographics, referral patterns, etiology, anatomic location, and clinical outcomes. RESULTS: Number of patients with facial fractures increased from 201 per year to 263 per year (total n = 1508). Although transport distances remained constant at ∼85 miles, standard deviation increased from 37 to 68 miles. Transport time increased from 87 to 119 minutes. Referrals came from 28 surrounding counties in 2005 and 43 counties in 2010. Regarding etiology, MVCs decreased from 40% to 27%, all-terrain vehicle crashes decreased from 6% to 2%, falls increased from 8% to 19%, and bicycle accidents increased from 3% to 6%. Regarding anatomic location, frontal sinus fractures increased from 8% to 37%, zygomaticomaxillary fractures increased from 9% to 18%, nasoethmoid fractures decreased from 12% to 6%, orbital floor fractures decreased from 6% to 3%, and mandible fractures decreased from 28% to 18%. Single-site fractures increased from 75% to 90%. Length of intensive care unit and hospital stay remained stable at 3 and 7 days, respectively. CONCLUSIONS: Despite a decrease in MVC-related facial fractures, the overall increase in facial fractures referred to our trauma center is due to a growing number of patient transfers from rural hospitals, where a paucity of qualified surgeons may exist.

Patient self-assessment of nasal fractures and self-referral to an ear, nose, and throat department: a prospective study.

OBJECTIVE: To assess if patients can safely self-assess their need for ear, nose, and throat (ENT) review following initial emergency department attendance for nasal trauma. STUDY DESIGN: This prospective study was divided into 2 parts. The initial part evaluated an information sheet for patients to lead them through a self-assessment to establish if they require ENT review following nasal injury. The second part of the study investigated outcomes following the introduction of the self-assessment. SETTING: This work was conducted at a District General Hospital in Scotland. SUBJECTS AND METHODS: Forty-nine consecutive patients underwent self-assessment plus blinded otolaryngology assessment, after which self-assessment was introduced as routine. This was evaluated comparing outcomes of 49 new consecutive nasal injuries against the original group using subjective patient scores of nasal cosmesis and nasal airway following injury and any subsequent treatment. RESULTS: There was no significant difference in outcome between the 2 study periods. After the introduction of self-assessment, there was a large reduction in the nonattendance rate for nasal injuries and in the attendances of patients with nasal injuries not requiring manipulation. CONCLUSION: In our institution, patients can be relied on to safely self-assess their nasal injuries to decide if they need ENT review when provided with appropriate information. This reduces the outpatient burden on the ENT department with no deterioration in subjective patient outcomes.

Neuroimaging in non-accidental head injury in children: an important element of assessment.

Head injury from physical abuse is unfortunately a common occurrence in our society. It is a major cause of mortality and long-term physical and psychological disability in children. Diagnosis of non-accidental head injury may be difficult, as most infants present with non-specific clinical findings and without external signs of trauma. Neuroimaging plays a fundamental role both for medical management and medicolegal aspects of child abuse. It is therefore imperative for the radiologist to promptly recognise the radiological findings of various forms of non-accidental head injury to render a more accurate opinion. A standardised imaging protocol and good communication between professionals are essential for optimum management.

A prospective study on elderly patients with facial fractures in a developing country.

BACKGROUND: This paper describes the incidence, aetiology, treatment and complications of facial fractures seen among the elderly in a developing country. METHODS: A prospective study evaluated 85 patients over 60 years of age who were diagnosed with facial fractures over a period of 12 months in 23 public hospitals nationwide. RESULTS: The elderly accounted for 4.5% of the total number of patients seen with facial fractures during the study period. Elderly men outnumbered women by a ratio of 4.31:1. Of the elderly patients, 35.3% had at least one medical condition, the commonest of which was hypertension. Road traffic accidents were the main cause of injury. The fractures were treated in only 26.2% of cases. Complications were uncommon. CONCLUSIONS: With a low incidence, and conservative treatment often being practised, the healthcare burden of treating facial fractures among the elderly in Malaysia is at present still low.

Causes and distribution of facial fractures in a group of South African children and the value of computed tomography in their assessment.

The cases of 107 paediatric patients aged 0-12 years were retrospectively reviewed. The patients presented with facial trauma and both plain radiographs and computed tomography (CT) scans had been ordered. Sixty-five per cent of facial fractures were missed in radiography, but revealed on CT; fractures of the maxilla, the zygoma and the orbit were most frequently missed in radiography. Pedestrian motor vehicle accidents were the most frequent cause of facial fractures (37%), followed by passenger motor vehicle accidents (22%). In contrast with other studies reporting the mandible as the most frequent facial fracture site, the most common fracture sites in this study, in descending order of frequency, were the orbit, the frontal bone and the maxilla.