The impact of ageing on cranio-maxillofacial trauma-a comparative investigation.

The number of patients older than 65 is increasing in developed societies. The impact of age on injuries and their outcome has been well documented in several fields of traumatology. Data on a broad cohort suffering from oral and maxillofacial injuries are missing. In this study, the data of 12,572 such patients were collected, of which 11,798 were younger and 774 were older than 65 years. With increasing age the risk of a domestic accident increased. The accident mechanism in elderly people was most frequently a fall (72%) or was not reproducible (12%). There was a significant difference between groups regarding concomitant injuries. Additional neurological symptoms occurred in 26% of the older and 15% of the younger patients (P<0.001). Until the age of 65 the risk of concomitant neurological injury increases. Injuries in the older patients mainly affected the soft tissue and midface. No statistical differences in surgical postoperative complications were observed. Due to the changing face of society, the treatment of elderly people is of high relevance. To enable an independent life after trauma, pre- and post-therapeutic care is of major importance. These data support surgical treatment of all patients, regardless of age, driven by general health condition whenever possible.

Maxillofacial trauma due to work-related accidents.

Even though numerous reports on maxillofacial trauma exist, only a few give detailed information about work-related maxillofacial injuries. The purpose of this study was to reveal the significance of maxillofacial injuries related to accidents occurring at work by evaluating a large number of patients with maxillofacial injuries over a 9-year period. Out of the 8704 trauma patients treated between 1991 and 1999 in the Department of Oral and Maxillofacial Surgery at the University of Innsbruck, Austria, 463 (5.4%) were injured at work. All charts were reviewed and analyzed according to age, gender, cause of accident, occupation, type of injury, location and frequency of fractures. The highest incidence of maxillofacial injury was found among construction workers (a total of 124 patients, 26.8%), followed by craftsmen (102 patients, 22.0%) and office employees (69 patients, 14.9%). The sex distribution showed an overall male-to-female ratio of 11.8:1 and those in the age group most affected were between 20 and 29 years of age. The most frequent cause of injury was a blow in 48.4%, followed by falls and falls over obstacles, accounting for 27.9% and 7.1%, respectively. Of all trauma, 45.4% (210 persons) sustained 423 maxillofacial fractures, 31.7% (147 patients) suffered 232 dento-alveolar injuries, and 21.2% (98 people) showed 430 soft-tissue injuries. One-fifth (20.7%) of all patients displayed concomitant injuries with cerebral and cranial trauma being the most common. The probability of sustaining maxillofacial trauma at work is correlated to the nature of the occupation. Individuals (mostly men) using tools or machines at work are exposed to a much higher risk of work-related maxillofacial trauma.

Complications related to midfacial fractures: operative versus non-surgical treatment.

The treatment of midfacial fractures depends on the dislocation of the fracture and patient-related limitations. Surgical treatment risks iatrogenic complications. In 740 patients with midfacial fractures, the age, sex, fracture type, concomitant injuries, cause of accident and the decision to use operative or non-surgical treatment were recorded. Follow-up was performed 6 and 12 months after the injury. In 41% the fractures were isolated; they were multiple in 59%. Initially, hypaesthesia of the infraorbital nerve was present in 10% of the single and 16% of the multiple fracture patients. Surgical treatment was performed in 57% of the single and in 75% of the multiple fracture patients. Women underwent surgical treatment considerably less frequently than men. After 6 and 12 months, significantly more complications were present in the surgically treated cohort. Nerve disturbances and 'meteorosensitivity' were most prominent. These results, together with previous findings, indicate that there is a need for prospective clinical investigations that fulfil the criteria of evidence-based medicine to generate guidelines for decision making in trauma surgery. In the meantime, the decision to use surgical treatment for midfacial fractures has to be made carefully.

[Dentoalveolar trauma. Analysis of 4763 patients with 6237 injuries in 10 years]. / Dentoalveoläre Traumen. Analyse von 4763 Patienten mit 6237 Verletzungen in 10 Jahren.

PURPOSE: The purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation based on the analysis of a large amount of dentoalveolar injuries over a 10-year period. PATIENTS AND METHODS: Between 1991 and 2000, 4763 of 9543 patients suffering from oral and maxillofacial injuries, sustained dentoalveolar trauma. Records of 6237 different dental injury patterns were reviewed according to the five main injury mechanisms: age, sex, type of injury, cause of accident, and frequency of dentoalveolar trauma. They were statistically analyzed using frequency distribution, chi-square test, t-test, Mann-Whitney U test, Kolmogorov-Smirnov test, and logistic regression analysis. RESULTS: Household and play (2117), sports (1533), traffic accidents (438), acts of violence (426), and work-related accidents (201) were noted. A total of 4763 patients had 2988 subluxations, 2356 showed crown fractures, 444 had avulsions, 176 root fractures, 154 intrusions, and 119 patients suffered from concussions. This number of patients accounts for the prevalence of 49.9% for dentoalveolar trauma among all facial injuries. CONCLUSION: Only the analysis of a large number of injuries reveals the risk of suffering from dentoalveolar trauma. Due to this fact, preventive methods can be recommended and demanded more effectively.