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.

Temporomandibular Disorder Patients Benefit From Intramuscular Botulinum Toxin Type a Injections.

PURPOSE: The aim of this study was to analyze the clinical outcome of the use of botulinum toxin type A (BTX) intramuscular injections to the head and neck, particularly the masticatory muscles of patients with temporomandibular disorder (TMD). METHODS: The medical records of all patients who had received intramuscular BTX injections between 2005 and 2018 at Päijät- Häme Central Hospital, Lahti, Finland were analyzed retrospectively. Gender, age, previous medical history, number of injections, injection areas, and therapeutic results were collected and analyzed. The outcome was divided into three categories based on the patients' subjective reports: not beneficial, beneficial, and highly beneficial. RESULTS: A total of 68 patients had received intramuscular BTX injections in our unit for TMD symptoms. Clinical effectiveness could be analyzed from 63 patients. Overall, 87% of them reported fävorable outcomes. 8 (13%) reported BTX injections as not beneficial, 15 (24%) as beneficial, and 40 patients (63%) as highly beneficial.Most patients had already received conventional treatment with an occlusal splint (93%) combined with pain medication (60%) in the primary care units before they were referred to our hospital.There were 59 (83%) female patients, and they responded better to BTX therapy than the male patients: 91% versus 57% (P value = 0.04). Average age at the first BTX injection visit was 44.6 years (range 17.8-77.2). Most commonly (65%), BTX was divided bilaterally to the masseter and temporalis muscles. CONCLUSIONS: BTX injections had good therapeutic outcomes for our TMD patients. However, most patients require multiple injection visits.

Assessment of Craniomaxillofacial Injuries After Electric Scooter Accidents in Turku, Finland, in 2019.

PURPOSE: Since the introduction of rental electric scooters (ESs), clinicians have increasingly encountered facial trauma patients whose injuries were caused by ES use. Despite this fact, few studies have analyzed these patients, particularly in Nordic countries, where the climate may cause additional challenges. We hypothesized that ESs have caused several facial trauma cases in Turku, Finland, that might be related to the timing of ES use, that is, month, day, and hour. PATIENTS AND METHODS: The medical records of all patients in whom craniofacial fractures or dental injuries caused by ES use were diagnosed at Turku University Hospital, Turku, Finland, in 2019 were reviewed. The occurrence and characteristics of injuries, with special reference to time of the accident, intoxication, hospital stay, and additional injuries sustained were analyzed. RESULTS: A total of 23 patients were identified for this analysis. The mean age was 30 years, and most patients (n = 16) were men. Four patients had not used helmets, whereas for 19, there was no mention whatsoever about helmet use. Of the patients, 21 were intoxicated and 18 had a blood alcohol content greater than 0.1%. A great majority of the accidents occurred in the nighttime (n = 17) and during weekends (n = 19). Most injuries (n = 15) occurred between September and November. We observed craniofacial fractures in 15 patients and dental injuries in 14; brain injuries occurred in 5 patients, and multiple chest injuries occurred in 1. All patients with dental injuries and 9 of the 15 patients with craniofacial fractures required interventions. An average of 3 days of hospitalization was required for 14 patients. CONCLUSIONS: Injuries associated with ESs result from driving under the heavy influence of alcohol and occur mostly during weekend nights without helmet use.