Fracturas del complejo cigomático / Fractures of the zygomatic complex

Introducción: El complejo cigomático maxilar con su convexidad prominente, es muy vulnerable a las lesiones. Objetivo: Abordar elementos actuales sobre el diagnóstico, clasificación, tratamiento y complicaciones de las fracturas del complejo cigomático. Métodos: Se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (29 revistas) y 2 libros. Se consultaron las bases de datos de MEDLINE, PubMed y SciELO con los descriptores: zygomatic fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés, preferentemente de los últimos 5 años. Se obtuvieron 109 artículos. El estudio se circunscribió a 41. Análisis e integración de la información: El correcto diagnóstico basado en los hallazgos clínicos y medios auxiliares de diagnóstico, permite clasificar la fractura. La clasificación más empleada en nuestro medio es la de las Guías Prácticas de Estomatología. Las modalidades terapéuticas pueden incluir el tratamiento quirúrgico con el uso de métodos de fijación que permiten mayor o menor estabilidad. Las complicaciones pueden aparecer. Conclusiones: La proyección anatómica de los huesos malares justifica la incidencia de estas fracturas. El diagnóstico debe basarse en el interrogatorio, examen físico y los medios auxiliares de diagnóstico imaginológicos. La radiografía Waters es una buena opción de imagen. Al clasificar la fractura se establece un plan de tratamiento basado en la valoración individual de cada caso con el objetivo de evitar complicaciones posteriores(AU)

Introduction: Due to its prominent convexity, the zygomaticomaxillary complex is very vulnerable to injuries. Objective: Address current notions about the diagnosis, classification, treatment and complications of fractures of the zygomatic complex. Methods: A literature review was conducted in September 2016. The evaluation included high impact journals from the Web of Science (29 journals) and 2 books. The databases MEDLINE, PubMed and SciELO were consulted, using the search terms zygomatic fracture, treatment, epidemiology. Papers written in English were included, preferably from the last five years. Of the 109 papers obtained, the study considered 41. Data analysis and integration: Appropriate diagnosis based on clinical findings and the use of diagnostic aids allows classification of the fracture. The classification most commonly used in our environment is that of the Dental Practice Guidelines. Therapy modes may include surgery with fixation methods allowing greater or lesser stability. Complications may appear. Conclusions: The anatomical protrusion of malar bones accounts for the incidence of these fractures. Diagnosis should be based on interrogation, physical examination and the use of auxiliary diagnostic imaging. Waters radiography is a good imaging option. Upon classification of the fracture, a treatment plan is devised based on individual assessment of each case so as to prevent future complications(AU)

Fracturas del complejo cigomático / Fractures of the zygomatic complex

Introducción: El complejo cigomático maxilar con su convexidad prominente, es muy vulnerable a las lesiones. Objetivo: Abordar elementos actuales sobre el diagnóstico, clasificación, tratamiento y complicaciones de las fracturas del complejo cigomático. Métodos: Se realizó una revisión bibliográfica en septiembre de 2016. Se evaluaron revistas de impacto de Web of Sciencies (29 revistas) y 2 libros. Se consultaron las bases de datos de MEDLINE, PubMed y SciELO con los descriptores: zygomatic fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés, preferentemente de los últimos 5 años. Se obtuvieron 109 artículos. El estudio se circunscribió a 41. Análisis e integración de la información: El correcto diagnóstico basado en los hallazgos clínicos y medios auxiliares de diagnóstico, permite clasificar la fractura. La clasificación más empleada en nuestro medio es la de las Guías Prácticas de Estomatología. Las modalidades terapéuticas pueden incluir el tratamiento quirúrgico con el uso de métodos de fijación que permiten mayor o menor estabilidad. Las complicaciones pueden aparecer. Conclusiones: La proyección anatómica de los huesos malares justifica la incidencia de estas fracturas. El diagnóstico debe basarse en el interrogatorio, examen físico y los medios auxiliares de diagnóstico imaginológicos. La radiografía Waters es una buena opción de imagen. Al clasificar la fractura se establece un plan de tratamiento basado en la valoración individual de cada caso con el objetivo de evitar complicaciones posteriores(AU)

Introduction: Due to its prominent convexity, the zygomaticomaxillary complex is very vulnerable to injuries. Objective: Address current notions about the diagnosis, classification, treatment and complications of fractures of the zygomatic complex. Methods: A literature review was conducted in September 2016. The evaluation included high impact journals from the Web of Science (29 journals) and 2 books. The databases MEDLINE, PubMed and SciELO were consulted, using the search terms zygomatic fracture, treatment, epidemiology. Papers written in English were included, preferably from the last five years. Of the 109 papers obtained, the study considered 41. Data analysis and integration: Appropriate diagnosis based on clinical findings and the use of diagnostic aids allows classification of the fracture. The classification most commonly used in our environment is that of the Dental Practice Guidelines. Therapy modes may include surgery with fixation methods allowing greater or lesser stability. Complications may appear. Conclusions: The anatomical protrusion of malar bones accounts for the incidence of these fractures. Diagnosis should be based on interrogation, physical examination and the use of auxiliary diagnostic imaging. Waters radiography is a good imaging option. Upon classification of the fracture, a treatment plan is devised based on individual assessment of each case so as to prevent future complications(AU)

A retrospective study of isolated fractures of the alveolar process in the permanent dentition.

BACKGROUND/AIM: There is a lack of studies of fractures of the alveolar process (FAP). Only five were published in the last 50 years. The aim of this study was to analyze the risk of pulp necrosis and infection (PN), pulp canal obliteration (PCO), infection-related root resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) as well as to identify the possible risk factors for teeth involved in an isolated alveolar process fracture. In the second part, any late complications of the involved teeth were reported in patients who responded to a follow-up examination. MATERIAL AND METHOD: This study was a retrospective analysis of 126 patients with 329 traumatized permanent teeth treated in a regional dental trauma clinic. Follow-up examination was performed on 31 (24.6%) patients with 75 (22.8%) teeth. The risks of PN, PCO, RR, MBL, and TL were analyzed using the Kaplan-Meier method. Possible risk factors for PN (stage of root development, fracture position in relation to the root apex, concomitant injury, treatment delay, and antibiotics) were analyzed using univariate and multivariate Cox regression and generalized estimating equation. The level of significance was 5%. RESULTS: Pulp necrosis was observed in 43% of the teeth, and it was significantly associated with the presence of a concomitant injury and complete root formation. PCO was recorded in 2.8%, root resorption (RR, IRR, and ARR) in 4%, MBL in 8%, and TL in 0.6% of the teeth. Thirty-four percent of the teeth were assumed to have normal pulps, but they did not respond to pulp sensibility testing. At the follow-up examination, PN was found in 49%, PCO in 28%, RR (IRR and ARR) in 4%, MBL in 17%, and TL in 5%. Estimated risk after a 5-years follow up was as follows: PN: 48.2% (95% confidence interval (CI): 42.0-54.5), IRR: 7.2 (95% CI: 3.5-10.9), ARR: 33.0% (95% CI: 22.4-43.6), BL: 16.7% (95% CI: 9.6-23.8), TL: 4.0% (95% CI: 0.0-8.5). The following factors significantly increased the risk of PN: mature root development (hazard ratio [HR]: 7.50 [95% CI: 1.84-30.64], P=.005) and concomitant injury (HR: 2.68 [95% CI: 1.76-4.09], P<.001). In a logistic regression model, teeth with mature roots had a threefold risk of becoming non-responsive to pulp testing. CONCLUSION: Teeth involved in an isolated alveolar process fracture and managed with a conservative treatment approach appear to have a good prognosis. The most common complication was PN which did not negatively affect the survival of the teeth after root canal treatment.

Aspectos generales del trauma maxilofacial / Overall aspects of maxillofacial trauma

Introducción: en el trauma encontramos al huésped (paciente) y a un vector de transmisión (vehículo de motor, arma de fuego, etc.). Objetivo: realizar una revisión bibliográfica sobre aspectos generales del trauma maxilofacial, incluyendo conceptos generales, características de la región y del trauma maxilofacial, epidemiología y registro estadístico del trauma. Métodos: se realizó una revisión bibliográfica de noviembre a diciembre de 2014. Se evaluaron revistas de impacto de Web of Sciencies (40 revistas), 1 cubana y 3 libros. Se consultaron las bases de datos de MEDLINE, PubMed y ScieELO con los descriptores: trauma, maxilofacial trauma epidemiology. Se incluyeron artículos en idioma inglés y español, preferentemente de los últimos 5 años. Se obtuvieron 132 artículos. El estudio se circunscribió a 55. Análisis e integración de la información: conceptos como el de trauma, y el abordaje de las características de la región y su traumatología, son punto de partida en este tema. Se observa una tendencia al cambio en los patrones epidemiológicos. La implementación de un registro estadístico de trauma es esencial en un sistema de atención a estos pacientes. Conclusiones: la revisión de la bibliografía permite revisar conceptos como el de trauma, que se define como la experiencia de un individuo de un evento o condición perdurable que es una amenaza real o percibida para su vida e integridad personal, o la de un cuidador o familiar. Las principales causas de este tipo de fractura mundialmente son los accidentes de tráfico, agresiones, caídas y lesiones relacionadas con el deporte. Las lesiones maxilofaciales varían de simples a complejas y pueden comprometer piel, tejidos blandos, así como huesos. Las fracturas faciales a menudo implican morbilidad grave y consecuencias ocasionalmente mortales. La implementación de un registro estadístico de trauma conlleva controlar y mejorar la calidad de los programas de atención traumatológica(AU)

Introduction: in trauma there is a host (patient) and a vector of transmission (motor vehicle, gun, etc.). Objective: to conduct a literature review on general aspects of maxillofacial trauma, including general concepts, characteristics of the region and maxillofacial trauma, epidemiology and statistical registration of trauma. Methods: a literature review was conducted in the period from November-December 2014 on Web of Sciences' impact journals (40 journals) and 1 Cuban. Three books were evaluated. Databases of MEDLINE, PubMed and SciELO with the use of descriptors: trauma, maxillofacial trauma, epidemiology were consulted. Articles in English and Spanish language, preferably publications in the last five years were included. 132 articles were obtained. The study was limited to 55. Data analysis and integration: concepts such as that of trauma, as well as addressing the characteristics of the region and its traumatology, are a starting point to this topic. We observed a tendency towards changing epidemiologic patterns. The implementation of a trauma statistic record is key to a system for the management of these patients.Conclusions: review of the literature allows reviewing concepts such as trauma, defined as an individual's experience of an event or condition that is enduring a real or perceived threat to their lives and safety, or that of a caretaker or familiar. The main causes of these fractures are world traffic accidents, assaults, falls and sports-related injuries. Maxillofacial injuries range from simple to complex and can involve skin, soft tissues and bones. Facial fractures often involve serious morbidity and occasionally fatal. The implementation of a statistical register of trauma involves controlling and improving the quality of trauma care programs(AU)

Bone fractures: assessment and management.

Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques.

Revisão de 150 casos de fratura de mandíbula entre os anos de 2010 e 2013 no Hospital Universitário Cajuru - Curitiba, PR / Review of 150 cases of mandible fracture between 2010 and 2013 at the Cajuru University Hospital, Curitiba, PR

Introdução: As fraturas mandibulares correspondem ao segundo tipo de lesões faciais mais frequentes na maioria dos estudos. Contudo, os dados epidemiológicos desta fratura podem variar conforme o país, o mecanismo de trauma e a época em que foram avaliadas, uma vez que são influenciadas por fatores culturais, tecnológicos, ambientais e socioeconômicos. Consistem em importante fator de custo e morbidade. Delinear o perfil epidemiológico dos casos de fratura de mandíbula tratados no Hospital Universitário Cajuru no período entre 2010 e 2013. Método: Foi realizado um estudo retrospectivo, observacional e descritivo de 236 pacientes internados no Hospital Universitário Cajuru, no período de janeiro de 2010 a julho de 2013, diagnosticados com fratura de mandíbula. Foram incluídos no trabalho apenas os pacientes que apresentavam os prontuários contendo informações completas, totalizando 150 pacientes. Resultados: Dos 150 prontuários analisados, encontrou-se prevalência das fraturas de mandíbula no sexo masculino, média de idade de 29,9 anos. Em relação ao mecanismo de trauma, as mais comuns foram a agressão interpessoal (36,7%), acidentes automobilísticos (36,7%), ferida por arma de fogo (16%). Com relação ao tratamento, o uso de placa e parafuso foi a forma mais realizada (111 pacientes). Conclusões: As fraturas de mandíbula são causadas principalmente por agressão interpessoal, são mais incidentes em homens e jovens. As fraturas múltiplas estão presentes em quase metade dos pacientes. Nas fraturas únicas, a região do côndilo e parassínfise foram, ambas, as mais acometidas. O tratamento cruento foi o mais empregado, sendo a reconstrução com placa de titânio a forma mais comum.

Introduction: Mandible fractures are the second most frequent type of facial injury according to most studies. However, the epidemiological data on mandible fractures may vary between countries, or according to the trauma mechanism and the period of injury evaluation, owing to the influence of cultural, technological, environmental, and socioeconomic factors. This type of trauma comprises an important cost and morbidity factor. The aim of this study was to outline the epidemiological profile of mandible fractures treated at the Cajuru University Hospital from 2010 to 2013. Methods: A retrospective, descriptive, observational study was performed with 236 patients hospitalized in the Cajuru University Hospital, from January 2010 to July 2013, in whom mandible fracture was diagnosed. Only patients with complete records were included in the study, resulting in a total of 150 patients. Results: From the 150 records analyzed, it was found that mandible fractures were more prevalent in males, and the average age of patients was 29.9 years. Concerning the trauma-causing mechanisms, the most common were interpersonal violence (36.7%), traffic accidents (36.7%), and wounds caused by firearms (16%). Plate and screw fixation was the most frequently used treatment (111 patients). Conclusions: Mandible fractures were mainly caused by interpersonal violence, and were more frequent in young males. Multiple fractures were present in almost half of the patients. In single fractures, the condyle and parasymphysis regions were the most affected. Open treatment was most commonly performed, with reconstruction with a titanium plate being the most common approach.

Alveolar process fractures in the permanent dentition. Part 1. Etiology and clinical characteristics. A retrospective analysis of 299 cases involving 815 teeth.

AIM: To describe the etiology and clinical characteristics of alveolar process fractures treated in a regional trauma clinic. MATERIAL AND METHOD: The study is a retrospective descriptive analysis of 299 patients (180 males, 119 females; 815 permanent teeth) diagnosed with fractures of the alveolar process. RESULTS: Violence was the overall most frequent cause of injury in men (44%), whereas the three most common causes of this type of injury in women were violence (33%), falls (32%), or traffic injuries (26%). Fracture of the alveolar process occurred most frequently in the maxilla (74%) and less frequently in the mandible (26%). The majority of the fractures involved only two teeth (57%) but occasionally involved up to seven teeth. The age at fracture ranged from 5 to 90 years; alveolar process fractures occurred most frequently between 15 and 25 years of age (43%). Concomitant soft tissue injuries were present in 73%. The most frequent location of the mandibular fracture line was along the periodontal ligament of the canine and in the sagittal suture between the two central maxillary incisors. This pattern appears to correlate with weak zones in the jaws. CONCLUSION: In conclusion, alveolar process fractures are rare. They occur most frequently in young males and are often associated with violence. Concomitant soft tissue injuries are frequent. This type of injury accordingly appears to result from a frontal impact transmitted through a soft tissue shield (the lips) where the zone of least resistance gives in, namely the periodontal ligament and areas where the alveolar bone is thin.

Sistema miofuncional orofacial e trauma de face: revisão crítica da literatura / Changes in the orofacial myofunctional system after treatment for facial trauma: a critical review of the literature

Introdução: Esta revisão qualitativa da literatura levantou publicações científicas internacionais sobre a funcionalidade do sistema miofuncional orofacial nos traumas faciais, por meio da base de dados PubMed. Método: O levantamento realizado limitou-se a seres humanos, de qualquer faixa etária, no idioma inglês, entre os anos de 2005 e 2011. As publicações sem acesso completo, repetidas por sobreposição das palavras chave, estudos de caso, revisões de literatura, cartas ao editor e as não relacionadas diretamente ao tema foram excluídas. Resultados: Foram identificados 831 estudos, sendo 14 dentro dos critérios estabelecidos. Notou-se que a avaliação mais frequente foi a da função mandibular e depois análise de tratamentos; ocorreu mais fratura no côndilo que ângulo mandibular; utilizou-se mais tratamento cirúrgico juntamente com o conservador, seguido pelo somente cirúrgico e finalmente somente conservador; a maior incidência de traumas faciais foi em adultos do sexo masculino; poucas pesquisas foram realizadas com crianças e grupo-controle; utilizaram-se mais avaliações da função mandibular e clínicas, na maioria pré e pós-cirurgia; a força de mordida e a área oclusal apresentaram melhora póstratamento, no entanto a assimetria mandibular permaneceu; os valores de abertura máxima da boca atingiram a normalidade, porém inferiores ao grupo-controle; houve persistência de alterações na mobilidade mandibular e dor, mesmo após o tratamento; e a terapia miofuncional melhorou o quadro de alterações. Conclusão: É necessário mais publicações sobre o tratamento fonoaudiológico baseado na abordagem miofuncional orofacial nos traumas faciais.

Introduction: This qualitative literature review aims to highlight international scientific publications selected from the PubMed database that describe the changes in the function of the orofacial myofunctional system after facial trauma and the associated treatment outcomes. Methods: Studies published in English between 2005 and 2011 and including individuals of all age groups were included in this review. Publications that were not open access, studies appearing more than once because of overlapping keywords, case studies, literature reviews, letters to the editor, and studies that were not directly related to the subject were excluded. Results: A total of 831 studies were identified, 14 of which fulfilled the established criteria. Assessment of jaw function was the most frequent evaluation performed in the included studies, followed by the analysis of treatments. The incidence of condylar fractures was higher than that of mandibular angle fractures. The majority of cases were managed by surgery combined with conservative treatment, followed by surgery alone and conservative treatment alone. Adult men exhibited a higher incidence of facial trauma. Few studies included children or control groups. Further assessment of jaw and clinical functions before and after surgery revealed the following findings. The bite force and occlusal contact area improved after treatment, whereas mandibular asymmetry persisted even after surgery. The maximum mouth opening returned to normal after treatment, although the range of mouth opening was lower in patients with facial trauma than in controls. Persistent mobility in the mandibular teeth and pain were observed even after treatment. Myofunctional therapy resulted in an overall improvement in jaw function. Conclusions: Although the number of studies on facial trauma is increasing, few studies address the use and benefits of orofacial myofunctional therapy in this field. Further studies on orofacial myofunctional therapy combined with surgery and/ or conservative treatment for facial trauma are necessary.

Clinical characteristics and treatment of superolateral dislocation of the mandibular condyle.

The aim of this retrospective study was to investigate the clinical characteristics of superolateral dislocation of the mandibular condyle, and to review our experience of its treatment. Thirteen patients were included in this study. Demographic information and details of their original injury were analyzed by descriptive statistics and the treatment methods were summarized. These patients could be classified into three types: (1) unilateral dislocation with isolated condylar fracture (n=3); (2) unilateral dislocation with associated condylar fracture and other mandibular fracture (n=7); (3) bilateral dislocation with associated condylar fracture and other mandibular fracture (n=3). Treatment involved three main aspects: (1) relief of the condylar dislocation by manual manipulation or open reduction; (2) reduction of the medial condylar fragment and fixation with screws, or removal of the fragment if less than 50% of the condylar width; however, in one case with a tiny condylar fragment, this was left in situ; (3) management of the other associated mandibular fractures by open reduction and internal fixation (ORIF). Follow-up ranged from 6 to 20 months (average 13.69 months). Satisfactory functional outcomes were achieved in these cases. The results of this study indicate that superolateral dislocation of the condyle assumes many forms, and the treatment depends on the presence of fractures.

The dental trauma internet calculator.

BACKGROUND/AIM: Prediction tools are increasingly used to inform patients about the future dental health outcome. Advanced statistical methods are required to arrive at unbiased predictions based on follow-up studies. MATERIALS AND METHODS: The Internet risk calculator at the Dental Trauma Guide provides prognoses for teeth with traumatic injuries based on the Copenhagen trauma database: http://www.dentaltraumaguide.org The database includes 2191 traumatized permanent teeth from 1282 patients that were treated at the dental trauma unit at the University Hospital in Copenhagen (Denmark) in the period between 1972 and 1991. Subgroup analyses and estimates of event probabilities were based on the Kaplan-Meier and the Aalen-Johansen method. RESULTS: The Internet risk calculator shows individualized prognoses for the short- and long-term healing outcome of traumatized teeth with the following injuries: concussion, subluxation, extrusion, lateral luxation, intrusion, avulsion, crown fractures without luxation, root fractures and alveolar fractures. The prognoses for pulp necrosis, pulp canal obliteration, infection-related root resorption, ankylosis, surface resorption, marginal bone loss, and tooth loss were based on the tooth's root development stage and other risk factors at the time of the injury. CONCLUSIONS: This article explains the database, the functionality and the statistical approach of the Internet risk calculator.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

[Penetrating injuries in the face and neck region. Diagnosis and treatment]. / Penetrierende Gesichts- und Halsverletzungen. Diagnostik und Therapie.

Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

The initial management of dento-alveolar trauma in general dental practice.

UNLABELLED: Dento-alveolar trauma presents commonly in general dental practice, but may prove difficult to manage for those unfamiliar with it. Timely and well-informed intervention can significantly improve the clinical outcome for the patient. This article aims to inform the clinician on best current practice for the assessment and initial management of dental traumatic injuries, incorporating current international guidelines and practical arrangements for follow-up care. CLINICAL RELEVANCE: The dental trauma patient often presents to the general dental practitioner and the appropriate emergency management plays a vital role in relieving pain, protecting the dentino-pulpal complex, reducing displaced teeth and improving prognosis.

Treatment cost of patients with maxillofacial fractures at the University Hospital in Mostar 2002-2006.

The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients' databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar Most patients in this study were men (83%), of average age 34 +/- 19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.

Management of trauma to supporting dental structures.

Teeth, periodontium, and supporting alveolar bone are frequently involved in trauma and account for approximately 15% of all emergency room visits. The cause of the dentoalveolar trauma varies in different demographics but generally results from falls, playground accidents, domestic violence, bicycle accidents, motor vehicle accidents, assaults, altercations, and sports injuries. Dentoalveolar injuries should be considered an emergency situation because successful management of the injury requires proper diagnosis and treatment within a limited time to achieve better outcomes.