How good is good enough? Lessons learned from review of outcomes of 50 patients following extraoral open reduction and internal fixation of condylar neck and base fractures at a regional major trauma centre.

The management of mandibular fractures is routine owing to their frequency, particularly those of the mandibular condyle, which are invariably common. Notwithstanding disparities in the literature, the international consensus towards which fractures of the mandibular condyle benefit from open surgical intervention is almost universally accepted. Closed reduction or non-operative management may be utilised in certain circumstances. Whilst outcome research has addressed complications with respect to operative side effects, outcomes related to the quality of bone repair and the setting in which this is delivered have not been universally addressed. The aim of this study was to determine the predictability of translating an indicated operative treatment plan into an acceptable functional result. We evaluated the outcomes of 59 extracapsular condylar fractures in 50 patients who were treated by extraoral open reduction and internal fixation (ORIF) between March 2021 and August 2022. We reviewed demographic data, surgical approach, and plating strategy, and critically evaluated the clinical and radiological outcomes. Whilst we found that the quality of reduction was not universally perfect, the majority were within tolerance, which we set according to the Strasbourg Osteosynthesis Research Group (SORG) definition for minimal displacement (<2 mm overlap and 10° angulation). The cohort had good functional occlusion and minimal long-term postoperative complications. Two patients required re-operation for non-union, and we discuss causality in these cases. In conclusion, we found that ORIF of condylar neck and base fractures is predictable in real-time surgical practice with respect to functional outcome. However, if imperfectly reduced, there is a small risk of non-union.

Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients.

ABSTRACT: The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.

Toward a consensus view in the management of acute facial injuries during the Covid-19 pandemic.

In these unprecedented times, OMFS surgeons are faced with dilemmas over the priority of treatment, safety of staff, safety of patients and the most appropriate use of available resources. Efforts should be made to provide the best evidence-based care, which will mean revisiting old techniques, and risk stratifying patients on a case by case basis. Recent experience from colleagues internationally has shown that even the wealthiest health care infrastructure is at best fragile. We hope this paper will add to the debate and hopefully provide a framework for decision making in OMFS trauma care during this difficult time.

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

OBJECTIVES: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures. STUDY DESIGN: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1. RESULTS: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures. CONCLUSIONS: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.

Singly-qualified medical senior house officer in oral and maxillofacial surgery: perspectives from a unit.

Despite constituting a minority of senior house officers (SHO) in oral and maxillofacial surgery (OMFS), the number of singly-qualified medical trainees is growing. We describe the experience of a singly qualified medical trainee in OMFS and the unique benefits and opportunities for potential trainees and the department. Overall, the advantages of synergistic training outweigh any deficiencies in knowledge, and in our experience, having both medical and dental trainees in our unit has maximised training opportunities and provided a more holistic approach to patient care. Increased exposure to conditions in the head and neck also benefits trainees who wish to pursue careers in other specialties such as ear, nose, and throat (ENT), neurosurgery, ophthalmology, and plastic surgery.

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

OBJECTIVE: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. STUDY DESIGN: Demographic and injury data were recorded for each patient who was a victim of an assault. RESULTS: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. CONCLUSIONS: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

OBJECTIVE: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. STUDY DESIGN: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. RESULTS: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. CONCLUSIONS: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.