COVID-19 impact on facial trauma: Insights from Mississippi's only level 1 trauma center.

PURPOSE: Our primary aim was to understand and describe the impact of COVID-19 on the incidence and etiology of facial trauma in the state of Mississippi. METHODS: Retrospective review of facial trauma-related Emergency Department encounters in Mississippi from March 11, 2019 to March 10, 2021, divided into three time periods using the state of Mississippi's Governor's Office Executive Orders. Chi-square tests and segmented linear regressions were used for analysis. RESULTS: Patients presenting with facial trauma were typically male, 18-44 years old, and lived in urban zip codes. Insurance payors significantly differed across time periods. There were no significant differences in self-inflicted assault or accidental injury between the 3 time periods, with pre- and pandemic patients more likely to be self-pay while patients during recovery being more likely to have private insurance. During the pandemic, facial trauma from a family member, partner or spouse, or other person in the household significantly increased. CONCLUSION: Similar accidental facial trauma trends may reflect lower adherence to social distancing guidelines. The increase in facial trauma perpetrated by family members is consistent with reported increases in domestic violence during the pandemic. While overall facial trauma demographic patterns did not change significantly during the COVID-19 pandemic, there were notable changes in the etiology and insurance payor of facial trauma cases. LAY SUMMARY: The COVID-19 pandemic impacted healthcare systems worldwide, and our study seeks to understand how the pandemic affected incidence of facial trauma.

Eye Trauma in Mixed Martial Arts and Boxing.

PURPOSE: To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN: Retrospective cohort study. METHODS: Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS: In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION: Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.

Craniofacial Injuries in Swimming and Water Sports: Implications for Prevention.

INTRODUCTION: Water-related recreational activities, including swimming and diving, are widespread. However, they carry a significant risk of craniofacial injuries. Despite the popularity of these activities, comprehensive data on injuries beyond drowning remain scant. This study addresses this gap by providing valuable epidemiological insight into the nature, prevalence, and demographic patterns of craniofacial injuries related to water sports activities. METHODS: The authors queried the NEISS database for craniofacial injuries related to swimming, diving, and water sports from 2013 to 2022. Data were analyzed for demographics, anatomic locations of injuries, and the activities leading to these injuries. RESULTS: Between 2013 and 2022, a total of 952,111 craniofacial injuries were associated with swimming and water sports. Of these, 510,706 (53.6%) were male patients, and 441,405 (46.4%) were female. This indicates that males were 1.16 times more likely to sustain such injuries. The age groups most affected were 0 to 9 and 10 to 19 years. Anatomic locations impacted were as follows: ears (58.1%), head (16.8%), face (13.9%), neck (4.8%), eyeballs (4.4%), and mouth (2%). Leading causes were identified as swimming and water sports activities (66.5%), swimming pools and equipment (28.2%), diving or diving boards (4.7%), and scuba diving (0.5%). Notably, 89.2% of patients with diving-related injuries and 99.1% with swimming-related injuries were not admitted to the hospital. CONCLUSIONS: This study offers critical epidemiological data to supplement targeted prevention strategies and resource allocation in managing craniofacial injuries associated with water activities. The findings highlight the urgent need for specialized care and serve as a foundation for future preventive initiatives.

Time to wound closure in facial soft tissue injuries following road traffic accidents.

The 6-hour (6-h) time to wound closure was a controversial issue as studies have shown that time was not a substantial factor. Wounds in the face are often considered to have a lower infection risk. Despite this, the cause of injury was not extensively discussed in relation to this context. The primary objective was to investigate the association between the 6-h time to wound closure and wound complications following emergency management of facial soft tissue injuries (STIs). Additionally, the secondary objective was to explore other factors contributing to wound complications. A retrospective record review was conducted in our hospital in Kuala Lumpur, Malaysia, from 1 January 2017 to 31 December 2021. Medical records of patients with facial STIs due to road traffic accidents were included. Simple random sampling was used to select records meeting inclusion criteria. Data on demographic, injury, and treatment characteristics were collected using a standardized proforma. Descriptive, univariate and multivariate analyses were performed, including chi-square tests and binary logistic regression. A total of 295 patient records were included, with most patients being males (77.3%) and of Malay ethnicity (54.9%). The median age was 31.0 years. Majority of patients were treated within 6 h of injury (93.9%). Complications were documented in 6.1% of cases, including wound dehiscence and infection. Multivariate analysis revealed a significant association between 6-h time to closure and wound complications (OR: 7.53, 95% CI: 1.90-29.81, p = 0.004). Grade of surgeon on duty (OR: 4.61, 95% CI: 1.25-16.95, p = 0.02) and diabetes mellitus (OR: 6.12, 95% CI: 1.23-30.38, p = 0.03) were also shown to have a statistically significant association with wound complications. A 6-h time to wound closure, grade of surgeon on duty and diabetes mellitus were three major factors involved in facial wound complications following road traffic accidents.

Facial Injuries in the National Basketball Association.

BACKGROUND: Sport injuries can negatively impact physical and psychological aspects of athletes. There is a gap in the literature regarding facial trauma present in basketball. PURPOSE: The purpose of this study is to identify and describe facial trauma present in the National Basketball Association (NBA). STUDY DESIGN, SETTING, SAMPLE: This is a retrospective cohort study in which the sample (n = 206) consists of players that missed games due to facial injuries in the NBA, the data were collected from a public access online resource. INDEPENDENT VARIABLE: The predictor variables were player position (center, point guard, shooting guard, small forward, and power forward), team conference (Eastern/Western), and if played games occurred in playoff season. MAIN OUTCOME VARIABLES: The primary outcome variable was the injury location (upper, middle, and lower facial third), and the secondary outcome was type of injury (soft tissue/bone fracture). COVARIATES: Player's age, height, weight, and body mass index were collected. ANALYSES: χ2 and logistic regression were calculated to determine associations between predictor and outcome variables. Logistic regression was used to determine if variables were predictive for injury. Odds ratio was also computed for significant results. P value less than .05 (95% confidence interval) was considered statistically significant. RESULTS: A total of 206 players missed games due to facial injuries, and a total of 212 injuries were quantified. The mean age of the injured players was 27.24 ± 4.06 years, mean height (centimeters) was 201 ± 59.31 cm, mean weight (kilograms) was 99.48 ± 12.41 kg, and body mass index was 24.52 ± 1.75 kg/m2. Of the 212 injuries, none of them occurred in the upper facial third, 158 (75%) were in the middle third, and 54 (25%) were in the lower third; 151 of them were fractures (61%) and 61 were soft tissue injuries (29%). Most injuries were concentrated in centers (23%) and power forwards (23%). The most common fracture occurred in the nasal bones (39.2%), and most soft tissue injuries occurred in the eye globes (25%). Almost all injuries occurred during regular season games (97%), and the Eastern conference was slightly predominant (52%). CONCLUSION AND RELEVANCE: Significant facial trauma in the NBA has risen in recent years. The player's position, height, and weight were the primary factors associated with facial trauma in the NBA.

Facial Fracture Patterns and Severity of Associated Injuries After Motorcycle Accidents.

BACKGROUND: Motorcycle injuries remain a significant cause of motor vehicle-related morbidity and mortality in Taiwan. Besides, the facial region is a commonly fractured site under motorcycle accidents. To date, there are no trauma mechanism-based studies of facial fractures. AIM AND OBJECTIVES: This study aims to determine the facial fracture patterns, the severity of head trauma, and associated injuries by different motorcycle-related trauma mechanisms enabling a greater understanding of its distribution and magnitude. METHODS: This is a retrospective descriptive analysis conducted over a 2-year period at Linkou Chang Gung Memorial Hospital. We focused on the population of maxillofacial injury caused by motorcycle accidents. We divided the patient cohort into 3 main trauma mechanisms: single-motorcycle collision (SM group), motorcycle-to-motorcycle collision (MM group), motorcycle-to-vehicle collision (MV group). Data, including demographics, age, fracture patterns of facial bones, and other associated injuries, were collected. RESULTS: A total of 881 cases were identified that involved facial fractures. Most patients were male (71%), young adult (mean age, 32.49 years), and the most common fracture region is the midfacial fracture (79.5%, 700 victims). Among the 3 groups, the MM group was less likely to sustain severe injuries by trauma score system, less head injury and mortality rate. The MV group and SM group have similar mortality rates but different fracture pattern tendencies. Lower facial fractures were more likely in the MV group, but midface fractures in the SM group. Associated injuries were higher in the MV group. CONCLUSIONS: Our study presents the different trends of fracture patterns and injury under 3 main mechanisms of motorcycle casualties. We document all these data in the hope of providing insights into trauma doctors dealing with motorcycle accidents.

Epidemiological Investigation of Facial Soft Tissue Injury in Chinese Preschool Children.

OBJECTIVE: The aim of this study was to analyze the epidemiological characteristics of pediatric facial soft tissue injuries of Chinese preschool-aged children in Hangzhou Plastic Surgery Hospital. METHODS: Medical records of preschool-aged children's facial injuries, 6 years and younger, from January 2017 to December 2019 were collected. Sex; age; time of injury; length of stay; causes of injury; location, type, length, and depth of wound; anesthesia methods; and treatment and evaluation of postoperative scars were analyzed. RESULTS: There were 10,862 cases (male, 6780 cases; female, 4082 cases) in the group. The ratio of male to female was 1.66:1. Mean age was 3.4 (±1.6) years; the youngest was 1 month old. The time of injury occurred frequently between 9:00 and 13:00 and 16:00 to 21:00, with the most common incident time being between 19:00 and 20:00. Collision injury was the main cause of injury (9822 [90.43%]). The most frequently injured area was the forehead (4874 [44.87%]). The main form of injury was laceration wound (9721 [89.45%]). The depth of injuries was mainly middle layer (adipose or muscular layer) (6299 [57.99%]). The length of injuries was 1.7 (±0.9) cm, ranging from 0.2 to 10.5 cm. Furthermore, 9110 cases were repaired by plastic surgeries and 1 or more antiscar measures. After 6-month to 2-year follow-up, 9 cases of animal scratch or bite, lip penetrating wound, or bumping teeth were infected and 26 cases had scar hyperplasia. The others achieved satisfactory results, and the scars were not obvious. CONCLUSION: Preschool-aged children's facial injuries have predictable patterns of occurrence, and targeted preventive measures can reduce the incidence rates. After facial injury, children should present for timely plastic surgery treatment and accept combined antiscarring measures to minimize postoperative scarring.

The prevalence and risk factors of facial pressure injuries related to adult non-invasive ventilation equipment: A systematic review and meta-analysis.

To systematically assess the prevalence of facial pressure injuries related to adult non-invasive ventilation equipment, and risk factors of facial pressure injuries. PubMed, Cochrane Library, Web of Science, Embase, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database and Weipu Database were comprehensively searched for observational studies investigating the prevalence and risk factors of facial pressure injuries related to adult non-invasive ventilation equipment from inception to May 16th, 2022. Filter articles based on inclusion and exclusion criteria. The quality of the included studies was evaluated independently by two investigators. Meta-analysis was conducted using Stata 16.0 software package. In total, 2835 articles were screened and data from 12 studies were used in meta-analysis. The prevalence of facial pressure injuries related to adult non-invasive ventilation equipment was 25% (95% confidence interval, CI:15% to 37%, I2  = 97.34%, P < 0.0001). After controlling for confounding variables, the following risk factors of facial pressure injuries: use equipment form, with diabetes, fever, cumulative time of using equipment, facial skin oedema and Glasgow score. Understanding the risk factors of facial pressure injuries can provide the healthcare personnel with the theoretical basis for the management and treatment of the patients.

E-cigarette explosion injuries in the oral and maxillofacial region and a protocol for their management.

DATA SOURCES: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Embase and Web of Science along with the reference lists from select articles. STUDY SELECTION: Retrospective or prospective cohort studies, randomised controlled trials, case series, case-control studies and case reports on e-cigarette explosion-related facial injuries published in the English language were included. Review articles, nonclinical studies, commentaries, published abstracts and editorials were excluded. Also were excluded, those studies which did not specify injury location or if the injury did not pertain to the maxillofacial region. DATA EXTRACTION AND SYNTHESIS: Data pertaining to bibliographic information, device characteristics, patient details, facial injuries, factors precipitating explosion, complications at follow-up, management and other injuries were extracted. An association between the predictor variables of injury type and location with outcomes of surgical management and intubation was determined by utilising a Chi-squared analysis. RESULTS: A total of 28 studies met the inclusion criteria. A total of 105 facial injuries in 32 patients from 32 e-cigarette explosions were recorded. 73.3% of the injuries were projectile in nature with 26.7% being characterised by burns. 43.8% of all patients suffered both burn and projectile injuries. The eye (10.7%), oral cavity (25%) and face (64.3%) were involved with burn injuries. Projectile injuries mostly involved the lower third of the face (81.8%). 62.5% of patients suffered from a tooth or bone fracture. A 44.4% rate of complications was reported amongst the studies which reported on follow-ups. Surgical management or intubation were found to have no statistically significant relationship with explosive oral injuries. No other statistically significant associations were observed between outcomes and other injury types. CONCLUSIONS: There is a risk of spontaneous combustion with e-cigarettes, which can cause injuries of a serious nature to the oral and maxillofacial region, specially the lower third of the face, commonly necessitating surgical management. Increased regulation along with user education are required in order to improve the safety profile of these devices.

Retrospective Study of the Epidemiological Profile of Facial Trauma Related to Violence.

ABSTRACT: Facial trauma is now considered an epidemic due to its high incidence. This type of injury represents an impact on the social, psychological and professional life of the victim. It may be associated with poor protection and exposure of this region of the body, as well as with the attempt to disfigure the face of victims of aggression, to affect their identity and self-image. This study aims to carry out an epidemiological survey on the profile of facial trauma related to violence at the First Aid Hospital of Porto Alegre from November 2015 to July 2016. In this retrospective descriptive cross-sectional study, data such as age and sex of the patient, type of trauma, anatomical region, etiology, and reasons for the aggression of patients' records were analyzed using the Chi-Square test in Paws Statistics 18 software, evaluating P  < 0.05. During the period evaluated, 1224 cases were recorded. The most prevalent sex was male. The age group with the most injuries varied from 21 to 40. The most affected type of lesion was soft tissue injury. Scalp regions (parietal, occipital, temporal) and multiple regions were the most affected in males, differing from females, where the frontal and nasal regions were the most predominant. Violence is a major risk factor for facial trauma in adult patients and it is from epidemiological studies like this that we have the possibility to know the magnitude and severity of the results of violence, allowing the definition of public policies for coping.

Baseball-Related Craniofacial Injury Among the Youth: A National Electronic Injury Surveillance System Database Study.

BACKGROUND: Baseball is 1 of the most played sports among adolescents in the United States. Yet, youth baseball players experience the greatest numberoforal and facial injuries, compared to other athletes involved in other sports. METHODS: The National Electronic Injury Surveillance System was analyzed for all hospital admissions for youth baseball athletes (5-19-year-old) experiencing a baseball-related craniofacial injury. These included concussions, head contusions, head lacerations, facial contusions, facial fractures, facial hematomas, face lacerations, eye contusions, mouth lacerations, dental injuries, and neck contusions. Descriptive statistics were performed, and injury incidence was described by sport, injury type, and age group. RESULTS: Nearly half of the injuries (45.0%) occurred among 10- to 14-year-old patients, followed by 5- to 9-year-olds and 15- to 19-year-olds. Of all age groups, the most common type of injury was facial contusions, compromising one fourth of the injuries. Other frequent injuries included facial lacerations (19.9%), facial fractures (19.7%), and concussions (13.4%). CONCLUSIONS: Overall, this analysis underscores the need for increased implementation of protective equipment, such as faceguards and safety balls. Although facial fractures are less common amongst the pediatric population, physicians and coaches need to be better educated about the most frequent injury patterns and management. Further prospective studies are warranted to better characterize these findings and to prevent injuries.

Patterns of craniomaxillofacial trauma among helmeted cyclists.

BACKGROUND/AIM: The head and face are prone to injury in bicycle accidents and helmets are proven to be helpful in decreasing injuries to some extent. The aim of this study was to determine whether certain craniomaxillofacial regions are at increased risk of injury (fracture) during bicycle accidents among helmeted cyclists. MATERIALS AND METHODS: This retrospective cohort study was conducted using data from the National Electronic Injury Surveillance System (NEISS). Data concerning craniomaxillofacial injuries as a result of cycling accidents between 2019 and 2020 were reviewed. The primary predictor variables were the craniomaxillofacial region and a craniofacial bone. The co-variates included patient characteristics (age, gender, race) and injury characteristics (location, season). The primary outcome variable was a fracture. Logistic regression was used to determine any independent risk factors for a fracture. RESULTS: Five hundred patients reported helmet use at the time of injury. Fractures of the face region were 75 times (p < .01) more likely than the head region. No particular craniofacial bone was at greater risk of fracture relative to the maxilla. Adults (OR 24.0, p < .01) and seniors (OR 38.6, p < .01) were each at greater risk for fracture relative to children. CONCLUSIONS: The facial region was at increased risk of fracture relative to the head during a bicycle accident. Adults and seniors were at increased risk of suffering craniofacial fractures relative to children.

The prevalence of facial pressure injuries among nurses during COVID-19 pandemic and its relationship to COVID-19 infection.

AIM: The aim of this study was to investigate the prevalence of facial pressure injuries related to personal protective equipment use in nurses and the relationship with getting COVID-19 infection. DESIGN: The study used descriptive and correlational online survey design. METHODS: Nurses in Turkey were recruited via an electronic link sent to their social media platforms (e.g., Facebook, Instagram, Twitter), WhatsApp, and e-mail during the study: March-April 2021. Of them, 603 participants completed the survey form from all over Turkey. RESULTS/FINDINGS: Facial pressure injuries develop in nurses due to use of personal protective equipment. The rates of facial pressure injuries were higher in the nurses who were younger (p=0.002) and those who had less experience years (p=0.005) than the other nurses. The statistically significant variables were determined as age, status of using face shield, status of wearing overalls and status of wearing shoe covers (p<0.05). We determined that facial pressure injuries were not significantly associated with getting COVID-19 infection (p>0,05). CONCLUSIONS: This study showed that facial pressure injuries associated with personal protective equipment use among nurses, who work on the frontlines in the COVID-19 pandemic period, is highly prevalent. Experiencing facial pressure injuries did not have a significant effect on the participants' statuses of getting infected with COVID-19. Providing training in health institutions may present an effective strategy in lowering problems.

Facial pressure injuries and the COVID-19 pandemic: skin protection care to enhance staff safety in an acute hospital setting.

OBJECTIVES: The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries (PI) among frontline healthcare workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. The primary outcome of interest was the incidence of facial PIs. The secondary outcomes of interest were facial pain while wearing PPE and ease of use of the care bundle. METHODS: This study used a voluntary survey by questionnaire, supplemented by a qualitative analysis of interviews from a small purposive sample that took place in one large Irish hospital over a two-month period in 2020. The hospital was a city-based public university teaching hospital with 800 inpatient beds. The intervention was a care bundle consisting of skin protection, face mask selection, material use, skin inspection, cleansing and hydration developed in line with international best practice guidelines. All staff working in COVID-19 wards, intensive care units and the emergency department in the hospital were given a kitbag containing the elements of the care bundle plus an information pamphlet. Data were collected via a survey and interviews. RESULTS: A total of 114 staff provided feedback on the use of the care bundle. Before using the care bundle 29% (n=33) of the respondents reported developing a facial PI, whereas after using the care bundle only 8% (n=9) of the respondents reported developing a facial PI. The odds ratio (OR) of skin injury development was 4.75 (95% confidence interval (CI): 2.15-10.49; p=0.0001), suggesting that after the care bundle was issued, those who responded to the survey were almost five times less likely to develop a skin injury. Interviews with 14 staff determined that the bundle was easy to use and safe. CONCLUSION: Among those who responded to the survey, the use of the bundle was associated with a reduction in the incidence of skin injury from 29% to 8%, and respondents found the bundle easy to use, safe and effective. As with evidence from the international literature, this study has identified that when skincare is prioritised, and a systematic preventative care bundle approach is adopted, there are clear benefits for the individuals involved.

Survival Following Self-Inflicted Gunshot Injuries to the Face Using the National Trauma Data Bank.

INTRODUCTION: Self-inflicted gunshot wounds to the face frequently result in devastating injuries; however, there is a paucity of large experiences describing determinants of mortality and outcomes. METHODS: Using the National Trauma Databank from 2007 to 2015, patients suffering self-inflicted firearm facial injuries were included. RESULTS: Over 9 years 7869 patients were included: 87.7% were male, 46.4% suffered traumatic brain injury (TBI) and overall in-hospital mortality was 44.7%. The majority (67.8%) of in-hospital mortality occurred within the first 24 hours. Using multiple regression, advanced age (>65 years), presence of TBI, admission hypotension, and decreased Glasgow coma score were each independently associated with increased odds of mortality (all P < 0.001). Mandible or combined mandible/midface fracture injury patterns were most likely to survive (P < 0.001). Of those surviving to hospital discharge, the median [interquartile range] length of stay was 13 [6, 23] days, 86.6% required an intensive care unit stay with 67% requiring intubation and 42.5% tracheostomy. Among survivors, the combined mandible and midface fracture pattern resulted in the highest rates of tracheostomy (70.5%), gastrostomy tube placement (50.5%), and facial operations (87.0%) with a median [interquartile range] of 5 [3, 7] operative trips (all P < 0.001). CONCLUSIONS: Self-inflicted facial firearm injuries are highly morbid injuries with the majority of in-hospital deaths occurring the first hospital day. Differences including concomitant TBI, facial injury pattern, neurologic status, and presence of hypotension on admission were independently associated with survival/death. More extensive facial injuries (combined mandible and midface fracture patterns) were more likely to survive and required more intensive interventions.

Rolling With the Punches: A National Electronic Injury Surveillance System Database Study of Craniofacial Injuries in Boxing.

INTRODUCTION: Boxing is a popular combat sport in which competitors may sustain high impact blows to the face. For this reason, they are at high risk for craniofacial injuries; however, data on facial injuries specific to boxing remains sparse. Studies on safety measures, such as headgear, to prevent such injuries in boxing have been inconclusive. Boxing is popular with a wide audience. However, there is no consensus on safety measures across different populations involved in boxing due to lack of data. The objective of this study is to characterize the demography and incidence of injury types of patients presenting to emergency departments with boxing-related craniofacial injuries on a national scale in order to facilitate the establishment of evidence-based safety guidelines for prevention of boxing-related injuries. METHODS: The National Electronic Injury Surveillance System database was searched for boxing-related craniofacial injuries from the last 10 years (2010-2019). Injuries involving boxing were isolated and organized into 5-year age groups. Information on demographics and injury type was extracted from the National Electronic Injury Surveillance System database. Statistical analysis was performed between different age and gender groups. RESULTS: A total of 749 boxing-related craniofacial injuries treated in US emergency departments between 2010 and 2019 were recorded. The 19 to 34-year-old age group had the highest number of cases (54%), followed by the 12 to 18-year-old age group (31%). The most common injury types within both of these age groups were concussions and lacerations. This difference was found to be significant when compared to other craniofacial injury types (P < 0.05). The majority of athletes in these age groups were male (93% and 91%, respectively). Analysis of sex differences demonstrated concussions were more common in females compared to other injury types, whereas lacerations in males were more common compared to other injury types; these differences were found to be significant (P < 0.05). CONCLUSIONS: The high incidence of boxing-related craniofacial injuries such as concussions and lacerations incurred in young adults (19-34 years) and adolescents (12-18 years) indicate that protective measures such as community-based safety interventions and revised guidelines for protective equipment may be indicated in these groups to protect against craniofacial injuries such as lacerations and concussions. Further studies are required to develop algorithms for management of boxing-related craniofacial injuries and to evaluate the safety and efficacy of protective equipment such as boxing headgear on concussions.

Craniofacial Trauma Due to Stone-pelting - Patterns of Injury and Management.

AIM: The aims of the study were to elucidate the pattern of stone-pelting induced cranio-facial injuries and to document soft and hard tissue injuries, their management, and complications. METHODS: A retrospective descriptive study was conducted using a sample of patients reporting to our department in the years 2015 to 2020. Cranio-facial injuries were assessed for soft and hard tissue injuries, including tissue loss, and corresponding management. Follow up ranged from 18 ±â€Š6 months. & A standardized surgical regime was followed for patient management, which included primary survey, debridement of wounds, and routine primary repair of soft tissue. Bony defect reconstruction was performed by open reduction and internal fixation. Cranial bone was used as split calvarial graft in postcraniectomy cranioplasty procedures, which were performed after 6 months. Local flaps were used for the reconstruction of soft tissue defects. RESULTS: Being a military hospital, majority of cases fell in the 20 to 30 age group with a male preponderance. The etiology in all cases was stone-pelting. Among cranio-facial injuries, cranial vault injuries and mid-face injuries (71%) were most prevalent, mandibular fractures (24%) and remaining were soft tissue injuries (5%). & Frontal & parietal bone injuries were seen in 23.6% cases (n = 9) and orbito-zygomatic complex injuries were seen in (36.8%) cases (n = 14). Isolated blow-out fractures were seen in 4 patients of our series. 52.6% of patients of our series suffered associated soft tissue injuries to the head, face, and neck region. The most common cause of injury was due to the direct impact of stone hitting the mid-face/cranial vault and the most common pattern of injury was gross comminution of the skeleton. & 2 patients suffered ocular injuries that required management and 6 patients of our series who suffered head injuries to the cranium required a secondary cranioplasty procedure (n = 4) &The most commonly used technique for treatment was open reduction internal fixation, which was used in 89% of patients. Soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin which was managed by primary suturing. CONCLUSIONS: Cranial vault injuries & orbito-zygomatic complex fractures are most commonly seen in patients with stone-pelting injuries. Early management of such injuries improves outcomes in terms of function and restitution of preinjury skeleton structure. The most common patterns seen is gross comminution to the cranio-facial skeleton that can be treated with immediate primary wound repair after meticulous wound debridement and open reduction and internal fixation. Importance of stone-pelting as a cause of craniofacial injuries is highlighted as it leads to significant disruption of craniofacial skeleton.

Study of Pediatric Operative Recreational Trauma: A Retrospective Analysis of Pediatric Sports-Related Facial Fractures.

BACKGROUND: In the United States, most school-aged children participate in some form of organized sports. Despite the advantages to social and physical development that organized sports may have, these activities also place a significant number of America's youth at risk for facial injuries. Pediatric facial fractures resulting from sports trauma are well documented within pediatric literature. Despite knowledge of the importance of safety equipment, there is a continued need for increased awareness about fracture patterns resulting from sports injuries to develop better strategies for their prevention. METHODS: A retrospective review of all pediatric patients (age <18) who presented to Children's Memorial Hermann Hospital as a level 1 trauma between January 2006 and December 2015 with radiologically confirmed facial fractures was performed. Data regarding patient demographic information, mechanism of injury, facial fracture location, associated injuries, hospital course, and need for surgical intervention was collected. RESULTS: Of the 1274 patients reviewed, 135 (10.59%) were found to have facial fractures resulting from sports trauma and were included in our cohort. The median age was 14 with 77.8% of the cohort being male. The most common fractures identified were orbital (n = 75), mandibular (n = 42), nasal (n = 27), maxilla (n = 26). Fractures were more frequently related to involvement in baseball/softball and bicycling n = 46 and n = 31 respectively. Eighty-two (60.74%) patients required admission, 6 requiring ICU level care, 70 (51.85%) were found to require surgery. There were 14 patients who were found to have a concomitant skull fracture and 6 with TBI. There were no fatalities in this cohort of patients. CONCLUSION: Pediatric facial fractures occur in the same anatomic locations as adult facial fractures. However, their frequency, severity, and treatment vary because of important anatomical and developmental differences in these populations. Despite available knowledge on this subject and increased use of protective equipment, pediatric facial fractures continue to occur with similar distribution as historically described. While sports participation confers numerous benefits, it is vital that we continue researching pediatric facial trauma and associated fractures to develop protective equipment and protocols to mitigate the risks of these activities.

Craniofacial Fractures in Equine-Related Injuries: What Should a Maxillofacial Surgeon Expect?

ABSTRACT: Patients with equine-related injuries (ERI) have high rates of hospitalization and often require surgical treatment. This study aimed to clarify the injury profiles of patients sustaining ERI-related craniofacial fractures and their relationship with other severe head and neck injuries.This retrospective study included all patients with craniofacial fractures admitted to a tertiary trauma center during 2013 to 2018. Out of 3256 patients, a total of 39 patients were included in the study (1.2%). Demographic and clinically relevant variables were reported and statistically evaluated.Males represented only 7.7% of the study population. Isolated facial fractures were over-represented in this study population at 84.6% whereas only 7.7% of patients sustained isolated cranial fractures and 7.7% of patients sustained combined craniofacial fractures, respectively. Surgical intervention for craniofacial fractures was required in 48.7% of patients. In total, 17.9% of patients sustained severe head and neck injuries. Periods of unconsciousness and/or post-traumatic amnesia were seen in 41% of patients. Helmet use could only be confirmed in 17.9% of patients.As trauma mechanisms behind ERI are often multifactorial and patients are at a high risk of sustaining associated injuries, attentive examination, and exclusion of serious life-threatening injuries through a multi-disciplinary approach is imperative for this specific patient population.

Volleyball-related Adult Maxillofacial Trauma Injuries: A NEISS Database Study.

INTRODUCTION: Craniofacial trauma among athletes of various sports has been well detailed and described. Despite this research, there is a dearth of literature describing the nature of facial trauma secondary to volleyball, despite its global popularity. METHODS: A cross-sectional analysis of volleyball-related facial trauma was conducted using the National Electronic Injury Surveillance System (NEISS) database from 2009 to 2018. Patient demographics (age, sex, and race), medical injury information (injury type and location), and disposition (observed and discharged, admitted, deceased) were collected and analyzed. χ2 testing was performed to compare categorical variables. RESULTS: A total of 235 volleyball-related facial traumas were recorded with an estimated 10,424 visits occurring nationally. The majority of injuries were among young adults aged 20 to 29 years (52.3%) and was evenly distributed for men and women. Lacerations were the most frequent injury type (37.9%), whereas the face was the most common site of injury (41.7%). The majority of fractures involved the nose (71.4%) and among individuals aged 20 through 49 (90.5%). Males had significantly more lacerations than females (75.3% vs 24.7%), whereas females had significantly more contusions/abrasions (64.5% vs 35.5%) and concussions (72.9% vs 27.1%). CONCLUSIONS: Volleyball-related craniofacial injuries can vary depending on patient demographics. This information can help with the development of safety and preventative measures for individuals participating in the sport.