A Naso-Orbito-Ethmoid (NOE) Fracture Associated with Bilateral Anterior and Posterior Frontal Sinus Wall Fractures Caused by a Horse Kick-Case Report and Short Literature Review.

Naso-orbito-ethmoid (NOE) fractures associated with anterior and posterior frontal sinus wall fractures are among the most challenging cranio-maxillofacial injuries. These represent a major emergency, having a potentially severe clinical picture, with intracranial hemorrhage, cerebrospinal fluid (CSF) leak, meningeal lesions, pneumocephalus, contusion or laceration of the brain matter, coma, and in some cases death. In this article, we present the case of a 30-year-old patient with the diagnosis of NOE fracture associated with bilateral anterior and posterior frontal sinus wall fractures caused by a horse kick, with a fulminant post-traumatic alteration of the neurological status and major impairment of the midface bone architecture. Despite the severity and complexity of the case, early initiation of correct treatment both in terms of intensive care and cranio-maxillofacial surgery led to the successful rehabilitation of the neurological status, as well as to the reconstruction and redimensioning of midface architecture and, not least, to the restoration of the patient's physiognomy.

Clinical Patterns and Treatment of Pediatric Facial Fractures: A 10-Year Retrospective Romanian Study.

Pediatric facial fractures have different clinical patterns and require different therapeutic approaches in comparison with those of facial fractures that occur among adults. The aim of this study was to describe the main clinical characteristics of pediatric facial fractures (such as fracture location, fracture pattern, treatment, complications and evolution) in a group of pediatric patients from NW Romania. This research was a retrospective study that was conducted for 10 years in a tertiary hospital for oral and maxillofacial surgery from NW Romania. A total of 142 pediatric patients were included in this study, with ages between 0 and 18 years. Mandibular (66.2%), midface (25.4%) and combined fractures (8.5%) were identified, and patients from the 13-18 years age group were more frequently affected by facial fractures (78.9%). Most of the diagnosed fractures among all three types of fractures were total fractures, and most mandibular (92.6%) and midface (80.6%) fractures were without displacement. Hematomas, lacerations and abrasions were identified as associated lesions. Patients with associated lesions were more frequently associated with combined fractures or midface fractures than mandibular fractures. The instituted treatment was, in general, orthopedic, for all three types of fractures (mandibular-86.2%; midface-91.7%; combined-66.7%). Most fractures, mandibular (96.8%), midface (100%) and combined (91.7%) fractures, had a favorable evolution. Most fractures did not present any complications at the follow-up. Pediatric facial fractures have unique patterns and must be treated with caution, considering the particularities of pediatric facial anatomy.

Patterns of Mandibular Fractures through Human Aggression: A 10-Year Cross-Sectional Cohort Retrospective Study.

The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and guide these patients. This retrospective study was conducted in 478 patients with mandibular fractures caused by interpersonal violence over 10 years in a university clinic. The most affected were male patients (95.19%), 20-29 years of age (46.86%), under the influence of alcohol (83.26%) and without education (43.9%). The majority of mandibular fractures were displaced (89.3%) and intraorally open (64.0%). The most frequent location was the mandibular angle (34.84%). The most frequent soft tissue lesions were hematomas (45.04%) and abrasions (34.71%), being associated frequently with closed (p = 0.945/p = 0.237), displaced (p = 0.001/p = 0.002), single angle fractures (p = 0.081/p = 0.222). Educating the population and fighting alcohol consumption would decrease the occurrence of mandibular fractures through aggression. Clinical diagnosis should be made, keeping in mind that the severity of associated soft tissue lesions is directly proportional to the pattern and number of underlying fracture lines.

Patient's perception of recovery following surgical removal of mandibular third molars. A prospective european multi-center study.

This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.

The Etiology and Epidemiology of Pediatric Facial Fractures in North-Western Romania: A 10-Year Retrospective Study.

Pediatric facial fractures are not as common as facial fractures occurring in the adult population. Their therapeutic approach is different because they affect patients with active growth, and have an etiology and epidemiology that vary depending on different cultural, religious and demographic factors. This research aimed to identify the main factors involved in the etiology of pediatric facial fractures, as well as the epidemiology of pediatric facial fractures in a sample of children and adolescents from North-Western Romania. This 10-year retrospective study was performed in a tertiary center for oral and maxillofacial surgery in North-Western Romania. Medical files of patients that were admitted between 1 January 2002 and 31 December 2022 were analyzed. Pediatric patients aged 0 to 18 years were included in this study. The final sample consisted of 142 children and adolescents diagnosed with facial fractures, with this number representing 14.1% of all patients affected by facial fractures. Most frequently, fractures were identified in the 13-18 age group (78.9%, n = 112), which were more often associated with fractures caused by interpersonal violence than caused by road traffic accidents, falls or animal attacks. Boys were more affected (88%, n = 125), and were more frequently associated with fractures caused by interpersonal violence. The most frequently identified etiological factors included interpersonal violence (50%, n = 71), falls (18.3%, n = 26) and road traffic accidents (11.3%, n = 16). In terms of location, the mandible was the most affected facial bone structure (66.2%, n = 94), and patients with mandibular fractures were more frequently associated with fractures caused by interpersonal violence. The incidence of pediatric facial fractures should be lowered because they may interfere with the proper development of the facial skeleton. Establishing measures aimed at preventing interpersonal violence, as well as other causes involved in the etiology of facial fractures is imperative.