A clinico-demographic analysis of maxillofacial trauma in the elderly.

INTRODUCTION: The elderly represent an increasing proportion of society. Management of maxillofacial trauma in this population may be complicated by coexisting medical conditions, requiring multi-disciplinary care. METHODS: This retrospective audit assesses the incidence and pattern of maxillofacial trauma in elderly patients (≥60 years) presented to the Merseyside Regional Maxillofacial Unit. Over the time period of 2003, 2004 and 2005, 7905 trauma patients presented to the accident and emergency department, of whom 757 were elderly (10%). RESULTS: Results indicated that the male to female ratio was 1:1.4. The commonest cause of injury was a fall (83%) followed by an assault (6%); the majority of falls occurring in the home. CONCLUSION: Management of maxillofacial injuries in this population should focus on targeted prevention programmes, which address known risk factors for falling. We believe that this is a public health issue. Members of the maxillofacial team should be aware of common risk factors of falls in elderly. Better collaboration with the Medicine for Elderly team should be considered at an early stage on managing these patients.

Microbiology of odontogenic infections in deep neck spaces: a retrospective study.

The primary treatment of deep neck spaces odontogenic infection (DNSOI) with suppuration is surgery. Systemic antimicrobial therapy is an important adjunct. The initial prescription of antimicrobial therapy is empirical. Over the last decade we have observed a change in practice with the use of second-generation cephalosporins, in conjunction with metronidazole, replacing benzylpencillin and metronidazole. More recently evidence has emerged suggesting that antimicrobial resistance in nosocomial infections could be related to the widespread use of second and third-generation cephalosporins. This study was therefore initiated to determine whether this change in prescribing was justified. A total of 75 cases were retrospectively identified by scrutiny of the operating theatre data. These patients presented with significant DNSOI that required surgical drainage. Streptococcus milleri and mixed anaerobes were predominant. Only in three cases (4%) there were penicillin-resistant microorganisms. The substitution of benzylpenicillin for cefuroxime as an initial empiric therapy for DNSOI seems likely to have been equally efficacious in the large majority of cases. On the other hand, studies in preference of cephalosporins are based on in vitro trials. A multi-centre randomized controlled clinical trial directly comparing initial empiric second-generation cephalosporin therapy with benzylpenicillin in non-allergic patients is justified.