What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries?

BACKGROUND: Patients sustaining maxillofacial fractures are at risk for associated injuries (AIs) to other body regions. The incidence of AIs is reported to be from 20 to 35%. AIs may be life-threatening and play a key role in considering first-line management at the emergency department, as well as planning the definitive treatment of maxillofacial fractures. PURPOSE: The study aimed to determine the frequency and risk factors for AIs in patients with maxillofacial fractures. STUDY DESIGN, SETTING, SAMPLE: The investigators designed and implemented a retrospective cohort study of patients with facial fractures treated at Central Hospital (Lahti, Finland) from January 1, 2009 through December 31, 2019. All adult patients with verified maxillofacial fractures were included. Patients under 18 years of age were excluded from the study. PREDICTOR VARIABLE: The predictor variable was the location of the maxillofacial fractures grouped into three categories: mandible alone, midface alone, and both midface and mandible. MAIN OUTCOME VARIABLE(S): The primary outcome variable was associated body region injuries coded as present or absent. The secondary outcome variable was the location of the AI categorized as skull, neck, thorax, pelvis, or extremity injuries. COVARIATES: Other study variables included demographic data (age, sex, alcohol use), Glasgow Coma Scale, and etiology (fall, traffic- and bicycle accident, assault, pedestrian hit by motor vehicle, work-related, or sports/free-time injuries). ANALYSES: Continuous variables were analyzed for normal distribution using the Shapiro-Wilks test and compared with categorical variables using the Mann-Whitney test. The univariate analyses of categorical variables were analyzed by the χ2 test (P ≤ .05 was considered statistically significant). RESULTS: During the study period, 443 adult (≥18) patients had maxillofacial fractures. AIs were present in 88 subjects (20%). The mean age was 47.6 years (range 18-91); 52 years with AIs (range 19-91), and 47 years (range 18-92) without AIs (P = .03). Subjects with midface and mandible + midface fractures had greater risk to AIs compared to mandibular fractures (relative risk 2.0, P = .002, relative risk 2.8, P = .009). CONCLUSION AND RELEVANCE: Every fifth maxillofacial trauma patient had an associated injury. Trauma patients should be evaluated in institutions with trauma protocols and imaging modalities before determining and executing the treatment plan for maxillofacial fractures.

A 5-year comprehensive evaluation of maxillofacial injuries in polytrauma patients at a tertiary hospital - an epidemiological study.

OBJECTIVES: To report and analyze the pattern of maxillofacial injuries in trauma victims and to define the role of a maxillofacial surgeon in an emergency trauma care team. MATERIALS AND METHODS: Trauma patients reported and reporting to the casualty of a tertiaryhospital with facial injuries and other suspected concomitant injuries in the body were included in this study. The complete medical and radiographic records of each patient were reviewed and data was collected in a standard proforma in this 5-year clinical study (3 year of retrospective and 2 year of prospective study). The complete data related to the facial injuries and associated systemic trauma was recorded and statistical analysis conducted. RESULTS: A total of 18,369 patients with trauma were admitted to the hospital from May 2018 to April 2023. Out of these, 11,277 (61.4%) were males and 7,092 (38.6%) were females. Seventy percent of the reported cases with trauma were in the age group of 14-40 years. The incidence of trauma during the monsoon season was highest (n = 7,927, 43%). The commonest etiological factor leading to trauma was road traffic accident (n = 4,510, 40%). Among facial injuries, the mandibular fractures (n = 1,821, 41%) were predominant. CONCLUSIONS: The management of polytrauma patients should be undertaken by a team of specialists which should include a maxillofacial surgeon as facial injuries were common. This data is essential in developing and assessing the preventative strategies aimed at decreasing the frequency of facial and other injuries.

The Correlation of Age and Patterns of Maxillofacial Bone Fractures and Severity of Associated Injuries Caused by Motorcycle Accidents.

BACKGROUND: Every year, there are significant numbers of motorcycle accident casualties in Taiwan. These accidents are the leading cause of maxillofacial trauma. Age should be an important factor of maxillofacial fracture patterns yet there is limited literature on the topic. Therefore, this study aims to evaluate the correlation of age with maxillofacial fracture in motorcycle accidents. METHODS: This is a retrospective descriptive analysis conducted over 2-year period at Linkou Chang Gung Memorial Hospital. We focused on the population of maxillofacial injury caused by motorcycle accidents. Data, including demographics, age, fracture patterns of facial bones, and other associated injuries, were collected. RESULTS: Among 881 admissions, there were 179 patients in the minor group, 644 patients in the adult group, and 58 patients in the geriatric group. With patterns of maxillofacial fracture, midface fracture was the most common type. The minor group had higher incidence of mandibular fracture. The geriatric group sustained more midface fracture. Associated injuries, such as severe head injuries and c-spine injury, were more likely to occur with the old age victims. The overall mortality rate was 3.1%. CONCLUSIONS: Our study presents the different trends of fracture patterns in different age groups, which is associated with different types of treatment required. We summarized all these data in the hope of providing further assistance to trauma doctor dealing with motorcycle accidents.

Pediatric Facial Fractures.

INTRODUCTION: There are few published articles describing the epidemiology of facial fractures in South Africa, and there is only one published study in pediatric patients. MATERIAL AND METHODS: This study retrospectively reviewed all medical records in a major metropolitan pediatric hospital in Cape Town, South Africa from September 2006 through May 2014. Inclusion criteria were children aged under the age of 13 with facial fractures. Fractures were assessed through head computed tomography (CT) scans. Patient's age, sex, cause of injury, general condition, existence of concomitant injuries, location of fractures, type of interventions, and length of stay were recorded and analyzed. RESULTS: A total of 53 men and 34 women were included in the study. Motor vehicle collisions (MVC) were the most common cause of facial fractures (56.3%). One hundred thirty facial fractures were presented on CT scans. The most common fractures in this study were mandible (43.1%). Comparing unrestrained motor vehicle collisions (UMVC) patients with those of other etiologies (OE), there was an increase in the average number of fractures (OE: 1.1, UMVC: 1.9; P < 0.0001), the average length of stay (OE: 4 days, UMVC: 9 days; P < 0.003), and the probabilities of sustaining concomitant injuries (OE: 31.0%, UMVC: 68.8%; P < 0.05) and requiring an operation (OE: 42.3%, UMVC: 81.3%; P < 0.01). DISCUSSION: This study establishes MVC as the most common etiology of facial fractures in South Africa. It demonstrates an increase in the complexity of facial injuries in unrestrained MVCs, suggesting the need for public awareness campaigns to install restraint devices in automobiles in South Africa.

Dental Trauma in a Pediatric Emergency Department Referral Center.

OBJECTIVE: The purpose of this study was to describe dental and associated oral injuries in a pediatric population that presents to an emergency department. METHODS: We performed a retrospective study and identified children from January 2007 to September 2011. Charts were reviewed for any subject, age from newborn to younger than 19 years, based on International Classification of Diseases, Ninth Revision codes for any dental or oral injury. Data abstraction included demographics, time of day of presentation, location and identification of tooth (s) injured, management, and disposition. RESULTS: We identified 108 children with dental and if present, associated oral injuries. The median age was 12.3 years, the most common tooth injured were the primary (25.9%) or permanent (62%) upper central incisors, and the majority of subjects presented in the afternoon (mean time was 3:50 PM, SD ±24 minutes). A large proportion of dental injuries occurred in patients with permanent dentation (62%) and half of all children had more than 1 tooth injury. The majority of children (75%) were evaluated by either pediatric dental, oral surgery, or otolaryngology services, whereas 3.7% of the cases required multiple services. Twenty-five percent of children had an associated jaw fracture. Eighty-three percent of children were discharged home, of those, 49.1% were prescribed opioids, and 38.3% oral antibiotics. CONCLUSIONS: Emergency departments are often relied upon to evaluate and treat simple and complex dental and oral injuries. The ability to use a multidisciplinary team to manage pediatric oral and dental trauma is essential for care.

Analysis of Pediatric Maxillofacial Fractures Requiring Operative Treatment: Characteristics, Management, and Outcomes.

Maxillofacial fractures in pediatric trauma patients require significant force and frequently are associated with concomitant injuries. The anatomic and developmental differences between the adult and child that impact patterns of injury also affect management and outcomes. The aim of this study was to analyze fracture location, mechanism, concomitant injuries as well as methods of surgical treatment and outcomes, to improve management of this patient population. A retrospective review was conducted of pediatric patients with maxillofacial fractures presenting to a level-1 trauma center during an 8-year span. Only patients requiring surgical intervention, 204, were included in this study. Data pertaining to the location of injury, mechanism, associated injuries, surgical treatment, outcomes, and complications were analyzed. The most common fracture location was the mandible (36.3%), then the nasal bone (35.3%), followed by the tripod fracture (10.8%). A total of 30.7% of patients were involved in motor vehicle accidents, with the next most common mechanisms being sports (24.4%), and assault (13.7%). A total of 46% of the patients sustained concomitant injuries, with the majority involving cerebral trauma (14.7%) or the extremities (9.3%). Total 75.4% of all fractures, excluding the nose, were treated with open reduction and internal fixation (ORIF). Our complication rate was 11.2%. Pediatric craniofacial trauma remains a frequent presentation to the emergency department of trauma centers. Facial fracture patterns and mechanism of trauma observed in the pediatric population presenting to this facility are consistent with incidences reported in the literature. Knowledge of treatment options and potential complications is an important tool in the management of the pediatric trauma patient.

Ocular trauma in patients with maxillofacial fractures.

PURPOSE: The purpose of this study was to analyze and evaluate ocular injuries in patients with maxillofacial fractures. Correlation of the ocular injury and patients' age, sex, trauma mechanism, and type of maxillofacial fracture was also investigated. MATERIALS AND METHODS: From January 2000 to December 2009, a total of 1131 patients with facial fractures were registered. The information and data collected and analyzed included the following: age, sex, mechanism of injury, type of facial fracture, type of ocular injury, and the relationship between ocular injury and facial fracture. RESULTS: Ocular injury (349 injuries) was sustained by 209 patients (18.5%), with a male/female ratio of 5.33:1 (176 males and 33 females). The age range of the patients associated with ocular trauma was 3 to 68 years (mean [SD], 32.40 [11.27] y). Patients aged 30 to 39 years showed the highest risk for ocular trauma (odds ratio [OR], 1.852; P < 0.001). Children showed the lowest risk for ocular injuries (OR, 0.162; P < 0.001). Motor vehicle accidents were the most common mechanism of injury (97 patients, 46.4%). Motor vehicle accidents also had a 2.243-fold risk for ocular trauma (OR, 2.243; P = 0.021). Ocular traumas were more prone to occur in patients who sustained midfacial fractures (OR, 10.232; P < 0.001), especially the patients with multiple midfacial fractures (OR, 12.389; P < 0.001). Fracture of the mandible had the lowest risk for ocular injuries (multimandibular fractures: OR, 0.035, P < 0.001; single mandibular fracture: OR, 0.151; P < 0.001). CONCLUSIONS: The occurrence of ocular injuries was significantly related to sex, age, etiology, as well as the pattern and position of the maxillofacial fractures.

Maxillofacial and concomitant injuries in multiple injured patients at Korle Bu Teaching Hospital, Ghana.

BACKGROUND: Patients with maxillofacial injuries may sustain concomitant injuries. The presentation of other injuries may be the initial focus of attention of the primary attending surgeon who may miss the maxillofacial injuries to the detriment of the patient. OBJECTIVE: To determine the incidence of injuries associated with maxillofacial injuries at Korle Bu Teaching Hospital (KBTH) from January 2009 to December 2010. METHODS: A prospective study was carried out on patients who were referred to the Maxillofacial Unit of the University of Ghana Dental School and KBTH over the two years with maxillofacial injuries. Their age, sex, type of injury in the maxillofacial region, its aetiology and concomitant injuries were charted. The data was analysed using SPSS 16.0 software. RESULTS: Two hundred and fifty eight (258) patients were seen of which 67 (26.0%) had concomitant injuries. The average age was 29.1 years. The peak incidence was in the age group 21-30 (N=73, 28.3%). 74% were male and 26.0% female. The commonest cause of injury was road traffic accident (RTA) (N=142;55.0%). 52.7% (N=136) of the patients had injuries of the maxillofacial region. 26.7% (N=69) had mandibular fractures, 19.4% (N=50) had middle third fractures and 8.1% (N=21) had fractures of both. Concomitant injuries were mainly orthopaedic (N=31;12%) and the head and spinal region (N=29;11.2%). CONCLUSION: A significant number of patients who suffer maxillofacial injuries also sustain injuries of other parts of the body at KBTH. Prompt multidisciplinary management may contribute to improved outcomes.

Occurrence and severity of concomitant injuries in other areas than the face in children with mandibular and midfacial fractures.

PURPOSE: To clarify the occurrence, causes, severity, and predictors of concomitant injuries in pediatric patients with facial fractures. PATIENTS AND METHODS: Files of 339 pediatric patients who had sustained facial fractures at age 15 years or younger were reviewed. Outcome variables were injured organ systems other than the face, types of injuries in areas other than the face, and severity of injuries in areas other than the face. Explanatory variables were gender, age, mechanism of trauma, and type of facial fracture. RESULTS: Concomitant injuries in organ systems other than the face were observed in 11.0%. Limb injuries occurred in 9.1%, head and neck injuries in 5.6%, and chest injuries in 1.8%. The most common injury types were upper limb injury (8.0%), brain injury (3.2%), and lower limb injury (2.9%). Severe head and neck injuries occurred in 3.5% and severe chest injuries in 1.2%. Concomitant injuries occurred more frequently after motor vehicle accidents and falls from height compared with other etiologies (P < .001) and more frequently in association with combined mandibular and midfacial fractures than in association with other fracture types (P < .001). CONCLUSIONS: Concomitant injuries in areas other than the face should be expected first and foremost after high-speed trauma mechanisms and in association with severe facial fractures. Concomitant injuries in general occur most frequently in the limbs, with severe concomitant injuries in particular occurring most often in the head and neck region and chest, emphasizing the importance of multiprofessional teamwork in the diagnosis of pediatric patients who have sustained facial fractures.

Dental Trauma on whole Body Trauma CT-An underreported finding.

BACKGROUND: The prevalence of dental injuries (DI) in polytrauma patients is unknown. The purpose of our study was to identify the frequency of dental injuries on whole body CTs acquired in a trauma setting and to estimate how often they are correctly reported by the radiologist. METHODS: In the time period between 2006 and 2018 the radiological database of one university hospital was screened for whole-body trauma CTs. A total of 994 CTs were identified and re-evaluated. RESULTS: Dental injuries were identified in 127 patients (12.8% of patients). There were 27 women (21.3%) and 100 men (78.7%) with a mean age of 51.0 ± 18.9 years (range 10-96 years). Regarding localization, most findings involved the molars (n = 107, 37.4%), followed by the incisors (n = 81, 28.3%), premolars (n = 59, 20.6%) and canines (n = 39, 13.7%). Most common findings were as follows: luxations (n = 49, 45.8%), followed by crown fractures (n = 46, 43%), root fractures (n = 10, 9.3%), extrusions (n = 1, 0.9%), and intrusions (n = 1, 0.9%). Only 15 findings (11.8% of all patients with dental injuries) were described in the original radiological reports. CONCLUSION: DI had a high occurrence in polytrauma patients. A high frequency of underreported dental trauma findings was identified. Radiologists reporting whole-body trauma CT should be aware of possible dental trauma to report the findings adequately.

Pattern of maxillofacial fractures at a tertiary hospital in northern India: a 4-year retrospective study of 718 patients.

PURPOSE: Pattern and aetiology of maxillofacial injuries varies from one country to another and even within the same country depending on prevailing socio-economic, cultural and environmental factors. Various studies have been carried out in various countries to study the epidemiology and demographics of the maxillofacial injuries but the studies from India are few. MATERIAL AND METHODS: Retrospective study was undertaken at Christian Medical College Ludhiana (India) from January 2006 to December 2009. Treatment records of the patients was checked and age, gender, aetiology of injury, associated injuries, maxillofacial fractures and treatment offered were recorded. RESULTS: A total of 1075 fractures were recorded in 718 patients, ranging from 11 months to 85 years of age. Male:female ratio was 6.6:1. Maxillofacial injuries were most common in third decade of life. A total of 517 patients suffered injuries because of road traffic accident, 115 because of accidental fall and 67 because of interpersonal violence. A total of 184 patients had 221 associated injuries of which 56.1% head injuries, 29.0% orthopaedic injuries and 14.9% other injuries were present. Of 596 middle third fractures, 29.8% were managed conservatively; for 21.7% and 48.7% of fractures, closed reduction and open reduction were performed respectively. Of 479 mandibular fractures, 1.8% was managed conservatively; for 16.7% and 81.5% fractures, closed reduction and open reduction were performed respectively. CONCLUSION: Better socio-economic status of people, increased vehicular movements and non-implementation of road safety norms have increased road traffic accidents. Proper education of the people who are most commonly involved in the RTA can be one of the possible ways to reduce the maxillofacial injuries.

[Characteristic of the upper jaw fractures combined with facial skull bone damages].

140 patients with fractures of the upper jaw have been observed regarding terms of their admission to special department in the hospital, age, sex, and reasons of damages. The ration of fractures of the upper jaw to damages of other bones of facing part of the skull and soft tissues, as well complications from it have been studied.

Maxillofacial injuries caused by the 2008 Wenchuan earthquake in China.

PURPOSE: To describe the pattern of maxillofacial injuries sustained by survivors of the 2008 Wenchuan earthquake in the West China Hospital of Stomatology from May 12 to June 23, 2008. PATIENTS AND METHODS: Cross-sectional data were analyzed using hospital-based records of earthquake survivors admitted to the West China Hospital of Stomatology. A self-designed form to record information about variables such as the gender and age of the survivors and type of location of soft and hard tissue injuries was used. RESULTS: The age of earthquake survivors of maxillofacial injuries ranged from 4 to 84 years. Fractures and soft tissue injuries were the most common of all injuries in the maxillofacial region, constituting 40.7% and 38.9%, respectively. Thirteen patients (11.5%) had dental injuries and 9 (8.0%) also had other organ injuries. CONCLUSION: During the Wenchuan earthquake, the incidence of maxillofacial injuries in survivors was relatively low compared with injury in other organs. However, because most injuries were maxillofacial fractures and facial soft tissue damage, special attention was paid to maxillofacial injury when planning and providing emergency treatment. The effective management of earthquake injuries and those caused by other types of disaster requires a multidisciplinary approach, and maxillofacial surgeons should form an integral part of this multidisciplinary team.

Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians.

PURPOSE: To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians. PATIENTS AND METHODS: This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals. RESULTS: Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries. CONCLUSION: In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

Traumatic dental injury.

BACKGROUND: The aim of this study was to retrospectively evaluate the incidence of traumatic dental injury and consequential dental impairment following road traffic accidents and to examine the factors that can affect the monetary value of compensation for bodily injury payable pursuant to current insurance regulations. METHODS: From 2004 to 2014, 7233 persons involved in road traffic accidents in the province of Messina, eastern Sicily, were examined by insurance physicians to assess bodily injury damage. Data were collected from cases of traumatic dental injury causing malocclusion and temporomandibular joint dysfunction, either alone or concomitant with injuries to other parts of the body. Injury characteristics and consequential bodily injury damage were classified and the incidence calculated using Microsoft Excel software. RESULTS: The incidence of traumatic dental injuries was 3% of the total population (195 subjects - 127 males and 68 females); the majority of cases (56%) involved riders of two-wheeled vehicles. A high percentage of riders received injury to one or more teeth, i.e. fractures and dislocations, more frequently to the anterior teeth (68%) than the posterior teeth because of their position in the dental arch. Temporomandibular joint injuries were far fewer (8%) and resulted from either direct or indirect trauma associated with severe head and/or neck injury. The incidence of permanent bodily damage consequential to these injuries was fairly low. CONCLUSIONS: Although the incidence of dental trauma following road traffic accidents is low, the monetary compensation for consequential dental impairment based on current insurance regulatory law is far from negligible.

Distracting injuries in patients with vertebral injuries.

To describe the prevalence and types of distracting injuries associated with vertebral injuries at all levels of the spine in blunt trauma patients. A prospective cohort study was conducted at an urban Level I trauma center. All patients undergoing radiographic evaluation of the cervical, thoracic, or lumbar vertebrae after blunt trauma were enrolled. Patients had a data collection form completed by the treating physician before radiographic imaging and were evaluated for the following upon initial presentation: tenderness to the cervical, thoracic, or lumbar spine, distracting injuries, altered mental status, alcohol or drug intoxication, or neurological deficits. Patients with distracting injuries as the sole documented indication for vertebral radiographs were reviewed for the types of injuries present. A total of 4698 patients were enrolled in the study. There were 336 (7.2%) patients who had distracting injuries as the sole documented indication for obtaining radiographic studies of the vertebrae. Eight (2.4%, 95% CI 1.0-4.6%) of the 336 patients had 14 acute vertebral injuries including compression fractures (5), transverse process fractures (7), spinous process fracture (1), and cervical spine rotatory subluxation (1). There were 13 thoracolumbar injuries and one cervical spine injury. Distracting injuries in the eight patients with acute vertebral injuries included 13 bony fractures. Distracting injuries in those patients without vertebral injuries included bony fractures (333), lacerations (63), soft tissue contusions (62), head injuries (15), bony dislocations (12), abrasions (11), visceral injuries (8), dental injuries (5), burns (3), ligamentous injuries (3), amputation (1), and compartment syndrome (1). In conclusion, in patients with distracting injuries, bony fractures of any type were important for identifying patients with vertebral injuries. Other types of distracting injuries did not contribute to the sensitivity of the clinical screening criteria in the detection of patients with vertebral injuries.

Epidemiology and Outcomes of Hospital-based Emergency Department Visits with Tooth Fractures.

PURPOSE: The purpose of this study was to identify characteristics of hospital-based emergency department (ED) visits for tooth fracture and subsequent dentally related hospital admissions. METHODS: This was a retrospective analysis of the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project for the years 2008 to 2010. All children up to 21 years old, with a diagnosis of tooth fracture due to trauma, were selected. Hospital ED charges, occurrence of concurrent injuries, and hospitalization following ED visits were examined. RESULTS: A total of 199,061 ED visits were attributed to broken or fractured teeth; males comprised 63 percent of ED visits. Skull and facial fractures were present in seven percent and intracranial injuries in four percent of ED visits. The most frequent causes for ED visits and for subsequent hospitalization, respectively, were falls and motor vehicle accidents. The mean charge for each ED visit was $1,441. Total charges for the entire United States were $241.8 million. Following an ED visit, 7,233 patients were admitted as inpatients. CONCLUSIONS: Males comprised a majority of these emergency department visits. Occurrence of concomitant bodily injuries appears to be common and is a significant predictor of hospitalization and hospital ED charges.

5196 mandible fractures among 4381 active duty army soldiers, 1980 to 1998.

OBJECTIVE: We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries. METHODS: Retrospective analysis of 5196 mandible fractures in 4381 patients extracted from the Total Army Injury and Health Outcomes Database (TAIHOD), a comprehensive database developed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) that links population data to all hospitalizations among active duty army soldiers. The database is based on the ICD-9 CM coding system. RESULTS: We found the following frequencies for specific mandible fracture locations: angle 35.6%, symphysis 20.1%, subcondylar 14.2%, body 12.7%, condylar process 9.1%, ramus 4.5%, alveolar border 2.7%, and coronoid process 1%. The mechanisms of injury were separated into seven categories. Fighting accounts for 36.2%, automobile accidents for 18.6%, athletics for 13.6%, falls for 9.7%, motorcycle accidents for 3.1%, other land transport accidents for 3%, and miscellaneous causes for 15.8%. A few fracture locations appear to be associated with specific mechanisms. Of 82 alveolar border fractures with known mechanisms, 37% resulted from automobile accidents. Of 1094 angle fractures with known mechanisms, 48.6% resulted from fighting. Our data show that the majority of fractures were isolated to one location. Only one fracture was recorded for 70.6%, 29.2% have two fractures recorded, 0.2% have three or more fractures recorded. Associated injuries were common and include facial lacerations 1236 (28.2%), non-mandible facial bone fractures 733 (16.7%), intracranial injury 403(9.2%), internal injuries 229 (5.2%), fractures of the upper limb 295 (6.7%), fractures of the lower extremity 302 (6.9%), and cervical fractures 34 (0.8%). CONCLUSIONS: The mechanism of injury is important in determining the most likely resultant mandible fracture in the case of angle of mandible and alveolar ridge fractures. The clinician should maintain a high level of suspicion for associated injuries that occur more than one fourth of the time and even more frequently in motor vehicle accident victims. Associated intracranial injury is particularly important to rule out. Associated facial fractures, intracranial injury, internal injuries, and extremity injuries are all more common than cervical fractures.

Mandibular fractures in the pediatric patient.

Seventy-three patients were admitted to the Children's Hospital of Philadelphia (Pa) between January 1979 and June 1989 with a diagnosis of mandibular fracture. Data were obtained through a retrospective review of these cases. The cases were divided into three age groups that reflected the developing structure of the mandible and the maturation of the dentition. A trend toward a greater number of fractures and a predominance of males is shown with increasing age. Child abuse is a relatively frequent cause of fractures throughout all groups. Associated injuries are more common in young children, except in cases where abuse has been documented. The high osteogenic potential of the pediatric mandible allowed conservative management to be successful in 25% of younger patients and was responsible for a low complication rate overall.

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.