Multidetector CT of Midfacial Fractures: Classification Systems, Principles of Reduction, and Common Complications.

The advent of titanium hardware, which provides firm three-dimensional positional control, and the exquisite bone detail afforded by multidetector computed tomography (CT) have spurred the evolution of subunit-specific midfacial fracture management principles. The structural, diagnostic, and therapeutic complexity of the individual midfacial subunits, including the nose, the naso-orbito-ethmoidal region, the internal orbits, the zygomaticomaxillary complex, and the maxillary occlusion-bearing segment, are not adequately reflected in the Le Fort classification system, which provides only a general framework and has become less relevant in contemporary practice. The purpose of this article is to facilitate the involvement of radiologists in the delivery of individualized multidisciplinary care to adults who have sustained blunt trauma and have midfacial fractures by providing a clinically relevant review of the role of multidetector CT in the management of each midfacial subunit. Surgically relevant anatomic structures, search patterns, critical CT findings and their management implications, contemporary classification systems, and common posttraumatic and postoperative complications are emphasized. ©RSNA, 2018.

Prevalence and pattern of facial burns: a 5-year assessment of 808 patients.

PURPOSE: Retrospective studies on the types and causes of facial burns are important because the patterns might vary in different societies. Our aim was to assess the burn-related factors of significance that might be useful in healthcare planning and implementing preventive strategies, adding to the body of current data on the subject. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted to assess the data from a major burns referral center during a 5-year period (2009 to 2013). The data relevant to age, gender, cause, source, location, burn degree, extent (body surface area [BSA]) of the burns, and mortality were gathered from comprehensive patient medical records, recorded, and analyzed using SPSS, version 20, software (SPSS, Chicago, IL). RESULTS: Within the study period, we found 808 documented cases of second- and third-degree facial burns. These burns were more common in men (81.9%) and in the 16- to 35-year age group (42.3%). The mean hospitalization was 9.85 ± 8.94 days. In 443 patients (54.83%), 10 to 19% of their BSA was burned, and 3.06% had associated inhalation burns. The most common burn was scalding (19%), and the deadliest was burns from acid, with a mortality rate of 7.4%. Accidents accounted for 776 burns (96.03%). Other causes were attempted homicide (16 cases, 1.98%) and suicide attempts (16 cases, 1.98%). The overall mortality was 1.6%. CONCLUSIONS: The key findings were that second- and third-degree facial burns were more common in males aged 16 to 35 years with burns covering 10 to 19% of the BSA. Accidental scalding was commonly responsible for the second-degree burns, and electrical accidents were commonly responsible for third-degree facial burns. Burn accidents occurred more often at the patient's home.

Accuracy of laceration length estimation in a pediatric emergency department and its impact on billing practices.

OBJECTIVES: This study aimed to determine the accuracy of laceration length estimation in a pediatric emergency department among health care providers of varying levels of training and its impact on billing practices. METHODS: This study involves a prospective case series. Children younger than 21 years with lacerations evaluated and repaired in the pediatric emergency department between January 1 and April 30, 2012, were eligible for enrollment. Each laceration was evaluated by a trainee/midlevel provider (frontline provider) and by an attending physician; each one offered an estimated laceration length. The true measurement was then documented by 1 of 6 pediatric emergency medicine fellows on shift. Data were analyzed using descriptive statistics. The mean error of estimation (the absolute differences between the estimated and the true laceration length) of attending physicians and frontline providers were determined and compared. The proportions of lacerations whose estimated length was in a different billing category were compared using χ(2). Cost analysis was documented. RESULTS: One hundred ninety patients were enrolled. The mean age was 5.9 years. A total of 119 patients (62.6%) were male, and 134 lacerations (70.5%) were located on the face. Most repairs were simple (79%). There was no difference between the estimated and measured length among attendings and frontline providers (P = 0.583). An average of 8.2% of lacerations were misclassified and billed incorrectly with 20% (4/20) of facial lacerations up-coded. The mean overcharge was $12.04. Of 11 lacerations elsewhere on the body, 3 (27%) were down-coded, with an average difference of $6.97 for simple and $38.51 for layered repairs. CONCLUSIONS: Pediatric emergency medicine practitioners are accurate estimators of laceration length. Eight percent of lacerations are misclassified and billed incorrectly. Physicians should be required to report measured lengths for billing.

Clinical indicators of midface fracture in patients with trauma.

BACKGROUND/AIM: Midface fractures are commonly present and difficult to diagnose in trauma patients. The objective of this study was to determine clinically accessible indicators of midface fracture. MATERIAL AND METHODS: A case-control study design was used to determine clinical indicators of midface fracture. Population source was a level I trauma center registry for years 2007-2009. Cases had a documented midface fracture. Patient and trauma characteristics were compared between cases and controls. Multivariate logistic regression analysis determined significant indicators of midface fracture. RESULTS: Study sample included 83 cases and 83 frequency-matched controls. Cases had a total of 211 fractures with a median of two midface fractures per person. Common fractures were orbital (41%), malar and maxillary (28%), and nasal bones (19%). Patients with midface fracture were significantly different than patients without midface fracture in severity of injury and were more likely to have a traumatic brain injury. Significant clinical indicators of fracture were maxillary sinus opacification, ethmoid sinus opacification, forehead laceration, periorbital contusion, epistaxis, and injury mechanism (P < 0.05). Patients with midface fracture had a 63 times greater odds for maxillary sinus opacification. The multivariable model correctly classified the presence and absence of midface fracture in 95% of study sample. CONCLUSIONS: Determined indicators of midface fracture provided a high level of discrimination in fracture status. Indicators can be used by clinicians to help detect possible midface fractures. Future prospective research on midface fracture indicators can assist in establishing their generalizability and impact on fracture detection, care, and outcomes.

A comparison of motorcycle and bicycle accidents in oral and maxillofacial trauma.

PURPOSE: The aim of this study was to present a large series of motorcycle- and bicycle-related traumas to the face in an attempt to identify the injury pattern in motorcyclists and bicyclists. PATIENTS AND METHODS: Data were collected from patients during a 10-year period (1999 through 2009), which included demographic data, diagnosis of facial fractures, use of protective devices, dentoalveolar trauma, and facial soft tissue injuries. RESULTS: There were 556 patients with bicycle accidents and 367 with motorcycle accidents. Men were involved in 79% (436) of bicycles accidents and 82% (299) of motorcycle accidents. Young male patients were more frequent in bicycle and motorcycle accidents. Two hundred fifty bicyclists showed 311 maxillofacial fractures. Two hundred twenty-one motorcyclists showed 338 maxillofacial fractures. Motorcycle accidents caused multiple fractures in more patients. Seventy-six percent of motorcyclists were using helmets at the time of the accidents, whereas 6% of cyclists were using helmets. Motorcyclists showed a larger number of lacerations, whereas bicyclists showed a larger number of abrasions. Avulsion was the most common dentoalveolar injury for these accident types. Hospital stays were 3.8 days for motorcyclists and 1.3 days for bicyclists. CONCLUSIONS: The high-impact collisions typically observed in motorcycle accidents is directly related to larger percentages of soft tissue lacerations and facial fractures. The low-impact trauma that is observed in bicycle accidents is more commonly associated with soft tissue abrasion, hematoma, and dentoalveolar fractures. This stresses the need for compulsory legislation for helmet use with face-guards for cyclists and motorcyclists. It is important to take measures to alert the public regarding the severity of injuries likely to occur in bicycle- and motorcycle-related accidents and ways to prevent them.

Face transplant: a paradigm change in facial reconstruction.

Face transplantation is a new surgical technique that could be considered as a paradigm change in facial reconstruction. In recent years, 17 cases have been realized around the world. The author reviews these cases enlightened by his personal 7 cases.

[Facial dog bite injuries in children: retrospective study of 77 cases]. / Morsures de chien à la face chez l'enfant: étude rétrospective de 77 cas.

INTRODUCTION: The face is the area most vulnerable for dog bites in children. Surgical management is an emergency to prevent infection, functional and aesthetic outcomes. The aim of this study was to define a new gravity scale, and to determine a prevention policy. PATIENTS AND METHODS: In our maxillofacial and plastic surgery department, we conducted a retrospective study from 2002 to 2010, including 77 children under 16 years old, victims of facial dog bite. We analyzed epidemiological, clinical data, surgical outcomes. RESULTS: The mean age was 5.36 years. Dogs were principally represented by class I and II dogs; 27,7% of them had ever bitten before. In almost all the cases, the dogs belong to the family or closers. Twenty-one percent of children belong to an unfavourable social environment; 71.43% of dog bites interested the central area of the face. The bites were deep in 77% of cases with amputation or extensive loss of substance in 31% of cases. The healing time was 10.54 months. Nearly a third of patients required several surgeries; 41.56% of patients had aesthetic and functional sequelae; 35.1% of children had psychological problems afterward. CONCLUSION: Facial children dog bites require a multidisciplinary approach, and a long-term follow-up. We propose a new classification of dog bite severity, more appropriate to the face.

A survey of orofacial injuries among basketball players.

OBJECTIVE: To determine the prevalence of orofacial injuries among basketball players in Benin City, Nigeria and to survey the athletes' awareness, attitude and use of mouthguards. METHODS: A cross-sectional survey of basketball players in the standard basketball arena in Benin City was conducted between November 2009 and January 2010. A self-administered questionnaire elicited information on demography, the prevalence of oral and facial injuries, distribution of site and cause of orofacial injuries, athletes' knowledge, attitudes and usage of mouthguards. Data were subjected to descriptive statistics and Chi square test. RESULTS: The response rate was 78%. Of the 156 respondents, 79.5% were male and 20.5% female, with a mean age of 23.1 years. The distributions was amateurs (61.5%) professionals (38.5%). The mean number of injuries in previous 12 months was 3.7 ± 1.8. The prevalence of both facial and oral injuries among the respondents was 62.8% with the lip and gingiva most commonly involved respectively. The common causes of the orofacial injury reported were from elbows of opponents, falling and collisions with other players. The prevalence of injury was not significantly associated with demography, category, competition and duration of participation. More than half had heard and seen mouthguards and the coach was the leading source of information. The reasons for non-use of mouthguard were mostly ignorance, non-availability and non-affordability. CONCLUSION: The high prevalence of orofacial injury among basketball players reported in this study justifies the need for multidisciplinary injury prevention interventional approach with emphasis on the rules of the games.

Facial injury patterns in a UK paediatric population aged under 13 years.

BACKGROUND: The aims of this study were to present the demographics and mechanisms of facial injury in UK children, and to establish the nature and anatomical location of facial injury in this age group. METHODS: Patient data were collected retrospectively over 1 year from a paediatric Emergency Department in South East Scotland. Medical notes were examined for all patients coded on the electronic patient record as having any facial injury. RESULTS: 593 patients attended with a facial injury. The median age of patients was 4.7 years. (IQR 2.4-7.5 years.), and the male to female ratio of facial injuries was 2:1. Injuries were predominantly from falls. Assault or violence was uncommon. Most common sites of facial injury were the lower third of the face and dento-alveolar injury. Facial fractures were rare and radiographic facial imaging was infrequently performed. Only eight facial fractures were diagnosed. 4.5% of all patients were admitted to hospital; 23% of the children were referred on to other specialities for follow-up, of these over half were to a dentist. CONCLUSIONS: A large number of children presented with facial injuries during the study period. Facial lacerations, oral trauma and dental trauma were the most common injuries. The majority of patients were dealt with without admission or referral to another speciality.

Cutaneous wound metallic residues pattern analysis with SEM-EDX in a forensic case of overkill.

The term overkill identifies the infliction of massive injuries that greatly exceed those needed to kill the victim both in number and intensity. We present the case of a Peruvian transsexual, who was choked and hit by 11 sharp-force wounds all in the facial area. The scanning electron microscopy with energy dispersion X-ray analysis carried out on the skin of the facial wounds proved crucial in proving that two different point-and-edge weapons were used, following the finding of metallic micro-traces of heterogeneous composition. This discovery and the autopsy highlighted the use of two distinct types of injury (mechanical asphyxia and sharp-force trauma) showed that this murder amounted to overkill.

Influence of different types of guns, projectiles, and propellants on patterns of injury to the viscerocranium.

PURPOSE: Gunshot injuries to the oral and craniomaxillofacial region vary with the type of gun used. Computed tomography (CT) is the standard diagnostic tool for assessing tissue damage in patients with gunshot injuries. Cone-beam computed tomography (CBCT) is a new imaging technique that has recently become available for clinical diagnosis. The objective of this study was to characterize injury patterns with a focus on gun types and identify the imaging modality that is best suited to assessing injuries caused by different gun types. PATIENTS AND METHODS: We present the cases of 14 patients who sustained gunshot injuries to the viscerocranium during the past 10 years. The injuries were caused by 8 basic combinations of handguns or long guns with soft lead core projectiles, partial or full metal-jacketed bullets, and different propellants. Diagnosis was based on clinical and radiological findings (including CT and CBCT). RESULTS: We found a direct correlation between the gun/projectile combination on the one hand and the diameter of the wound track, tissue contamination, and tissue destruction on the other. Entrance and exit wounds are indicative of certain gun/projectile combinations. High-density projectiles cause severe artifacts in CT, unlike CBCT, making it difficult to evaluate anatomic structures in close proximity to the projectile. CONCLUSIONS: Every gun/projectile combination is associated with a typical pattern of injury. Even in the absence of the offending projectile, it is thus possible to narrow down the likely gun and/or projectile. In the diagnostic imaging of injuries caused by high-density projectiles, CBCT is more suitable than CT.

Management of injuries of the orbital skeleton.

These clinical studies were carried out in maxillofacial unite, 10th floor, Surgical Specialties Hospital, Medical City, Baghdad. These orbital injuries included 236 patients during 15 years of experience. Their ages ranged from 2 to 72 years (mean, 37 years); 172 were male, and 64 were female. Orbital injuries are classified into isolated orbital walls, roof, floor, lateral wall, and zygoma and medial wall and complex wall injuries, as orbital skeleton injuries, or as part of cranio-orbito-facial injuries. There were 110 cases (46.6%) with orbital floor, and 85 cases (36%) with lateral wall and zygomatic complex injuries; 6 cases (3.6%) had isolated roof injuries; there were 15 cases (6.3%) with medial wall fractures and dislocation of medial canthal ligaments; 8 cases (3.3%) were orbital skeleton injuries with superior orbital fissure syndrome in 2 cases and eyeball laceration in 1 case, and 12 cases (5.08%) were cranio-orbito-facial injuries. These cases were treated and reconstructed by chrome-cobalt mesh for orbital floor, and also, Silastic rubber silicone was used in the floor and roof. Bone graft was used for reconstruction of large defect of the floor and medial wall, and Silastic was used for secondary operation for reconstruction of the floor as additional layer in cases with slight resorption of bone graft to correct residual enophthalmos, and lyophilized dura was used for reconstruction of the roof. Follow-up of the cases was extended for 15 years. The aim of these studies was to show some interesting clinical cases and surgical challenges for the management of these cases.

The CFI score: Validation of a new comprehensive severity scoring system for facial injuries.

At the time of writing there is no measuring scale for the severity of facial trauma that can effectively summarize its clinical relevance, and can therefore be proposed as a definitive tool in trauma center decision making. This paper introduces a new, simple, comprehensive, and reproducible score for facial trauma, in which its severity is expressed in relation to the surgical duration necessary for definitive treatment. This parameter is identified as the most significant in expressing the commitment of care required. Statistical validation of this comprehensive facial injury (CFI) score involved a sample of 1050 patients, treated by the same team in two highly specialized trauma centers. It demonstrated a linear regression between CFI score and surgical duration, and a high degree of accuracy in forecasting overall surgical time for each type of facial injury. The descriptive capacity of CFI score, and its extremely simple use, make it a perfect tool for widespread application and for facilitating communication inside trauma centers. It also allows the classification of homogeneous groups of patients - a prerequisite for benchmarking and effective analysis of results. The CFI model is definitively proposed for the classification of facial injuries, and therefore for the integration of maxillofacial skills, within the trauma team.

Maxillofacial trauma with emphasis on soft-tissue injuries in Malaysia.

Soft-tissue injuries with or without facial bone involvement are the most common presentation following maxillofacial trauma. The objective of this study was to look at the distribution, pattern and type of soft-tissue injury in relation to aetiology. Records of patients over a period of 5 years (1998-2002), who sustained maxillofacial injuries and were treated at Kajang Hospital, a secondary referral hospital, were reviewed. Out of 313 patients with maxillofacial injuries, 295 patients sustained soft-tissue injuries. Males (79%) between 21 and 30 years old (34%) were the majority of patients. Road-traffic accident was the main cause of soft-tissue injuries (75%) with motorcycle accident being the most frequent (40%). The upper lips (23%) and the lower lips (18%) were the most common extraoral site involved, while the labial mucosa and sulcular areas, both accounting for 21%, were the most common intraoral sites. Stringent road-traffic regulations should be practiced in developing countries, as morbidity arising from road-traffic accidents poses a national economic and social problem.

Acute injury patterns of intimate partner violence victims.

Although millions of women receive injuries from intimate partner violence (IPV) each year in the United States alone, there has been only limited research of acute injury patterns and the types, locations, and mechanisms of IPV injuries. The mechanism of being punched to the face with a fist resulting in blunt trauma-related injuries is most commonly reported. Strangulation, especially manual strangulation, is a frequently cited mechanism of injury; however, less is known about the types of injuries that result from strangulation. In general, clinicians should assess all patients who present for treatment of head, neck, and face injuries for IPV. There is little consistency between and much inaccuracy with medical terms used to describe types of injuries. To increase the accuracy and generalizability of findings from studies of acute IPV injuries, researchers need to use more standardized medical forensic terminology.

Overlooked but critical: traumatic brain injury as a consequence of interpersonal violence.

Despite evidence that more than 80% of female victims of intimate partner violence, seen for medical treatment of violence-related injuries, have sustained facial injuries, traumatic brain injury is often overlooked as a consequence of those injuries. This article reviews the scant literature available and examines research on equivalent injuries sustained by athletes. Practical domains of symptoms are described, as is a review of literature pertinent to culturally relevant rehabilitation for victims sustaining traumatic brain injuries.

[Permanent essential defacement--remarks on the possibilities of verification of the accepted criteria in medico-legal certification in criminal and civil law proceedings]. / Trwale, istotne zeszpecenie - uwagi o mozliwosci weryfikacji kryteriów w opiniowaniu sadowo-lekarskim w sprawach karnych i cywilno-odszkodowawczych.

Despite the fact that some criteria of medico-legal certification in criminal and civil proceedings have been established, there are still some topics which are controversial and thus require modification. This is also true of the notion of "permanent essential defacement". In the opinion of the authors, changes in social conventions that are occurring nowadays, as well as a highly diversified, subjective perception of esthetic values indicate the need for discussing a possible modification of the presently obligatory criteria. Apart from the assessment of posttraumatic changes, an important problem is posed by defining the notion of "a part of the body customarily open to the view ". Additionally, the authors bring up for discussion the issue of experts taking into consideration the age and sex of the victims while assessing damages. A separate problem lies in difficulties in assessing the degree of detriment to health because of defacement due to the fact that official tables for evaluating permanent or long-term detriment to health do not include relevant information.

Caracterización y retos en la clasificación de fracturas malares. Serie de casos en un hospital de tercer nivel en la ciudad de Cali, Colombia / Characterization and challenges in the classification of malar fractures. Case series in a third level hospital in the city of Cali, Colombia

Introducción y objetivo: Las fracturas del malar son las fracturas faciales más frecuentes después de las nasales y se asocian preferentemente a accidentes de tránsito. En nuestro medio no disponemos de trabajos que exploren las caracteriticas de esta condicion. Nuestro objetivo es caracterizar las condiciones asociadas a las fracturas malares en la ciudad de Cali, Colombia. Material y método: Estudio observacional descriptivo en pacientes que consultan en el Hospital Universitario del Valle y atendidos por Cirugía Plástica entre agosto de 2019 y marzo de 2020 con diagnóstico de fractura malar por escáner facial. Registramos las variables edad, sexo, origen, procedencia, escolaridad, ocupacion, estado civil, mecanismo de trauma, ciudad del trauma, clasificacion de fracturas del malar, lateralidad, fractura del arco cigomático y fracturas faciales asociadas. No incluimos análisis sobre el manejo de las fracturas. Resultados: Identificamos 25 fracturas malares en 24 pacientes. El 88% en mayores de 18 años; 83.3% varones; el grupo etáreo con más casos fue el de 21-30 años (25%). La causa más común fue el trauma contuso (50%), seguido por las caídas (21%) y accidentes de tránsito (21%). La fractura malar tipo 3 impactada según Knight y North fue la más común (36%). Conclusiones: Encontramos que, en nuestro estudio, el trauma contuso fue la causa más frecuente de fractura malar. Consideramos que la información obtenida puede ser util para que la autoridad local se plantee estrategias para reducir su incidencia. Al clasificar el patron de fractura no se encuentra un tipo único de fractura, sino de combinaciones, lo que nos lleva a pensar que se requiere una nueva clasificación. (AU)

Background and objective: Malar fractures have been described as the most frequent facial fractures after nasal ones. These are frequently associated with traffic accidents. In our environment we do not have studies that explore the characteristics of this condition. Our objective is to characterize the conditions associated with malar fractures in the city of Cali, Colombia. Methods: A descriptive observational study is carried out in patients who consult at the Hospital Universitario del Valle and are cared for by the Plastic Surgery Section between August 2019 and March 2020, with a diagnosis of malar fracture in the facial scan. The variables age, sex, origin, education, occupation, marital status, mechanism of trauma, city of trauma, classification of malar fractures, laterality, fracture of the zygomatic arch and associated facial fractures were recorded. Analysis of the management of fractures is not included. Results: We identified 25 malar fractures in 24 patients; 88% in people over 18 years old; 83.3% were men; the age group with the most cases were 21-30 years old (25%); the most common cause was blunt trauma (50%), followed by falls (21%) and traffic accidents (21%). Type 3 malar fracture impacted according to Knight and North was the most common (36%). Conclusions: Blunt trauma is the most frequent cause of malar fracture in our study. The information obtained can be useful for the local authority to consider strategies to reduce its incidence. When classifying the fracture pattern, a single type of fracture is often not found and, on the contrary, there were combinations which leads us to think that a new classification is required. (AU)

Classifying and Standardizing Panfacial Trauma With a New Bony Facial Trauma Score.

IMPORTANCE: The practice of facial trauma surgery would benefit from a useful quantitative scale that measures the extent of injury. OBJECTIVE: To develop a facial trauma scale that incorporates only reducible fractures and is able to be reliably communicated to health care professionals. DESIGN AND SETTING: A cadaveric tissue study was conducted from October 1 to 3, 2014. Ten cadaveric heads were subjected to various degrees of facial trauma by dropping a fixed mass onto each head. The heads were then imaged with fine-cut computed tomography. A Bony Facial Trauma Scale (BFTS) for grading facial trauma was developed based only on clinically relevant (reducible) fractures. The traumatized cadaveric heads were then scored using this scale as well as 3 existing scoring systems. Regression analysis was used to determine correlation between degree of incursion of the fixed mass on the cadaveric heads and trauma severity as rated by the scoring systems. Statistical analysis was performed to determine correlation of the scores obtained using the BFTS with those of the 3 existing scoring systems. Scores obtained using the BFTS were not correlated with dentition (95% CI, -0.087 to 1.053; P = .08; measured as absolute number of teeth) or age of the cadaveric donor (95% CI, -0.068 to 0.944; P = .08). MAIN OUTCOME MEASURES: Facial trauma scores. RESULTS: Among all 10 cadaveric specimens (9 male donors and 1 female donor; age range, 41-87 years; mean age, 57.2 years), the facial trauma scores obtained using the BFTS correlated with depth of penetration of the mass into the face (odds ratio, 4.071; 95% CI, 1.676-6.448) P = .007) when controlling for presence of dentition and age. The BFTS scores also correlated with scores obtained using 3 existing facial trauma models (Facial Fracture Severity Scale, rs = 0.920; Craniofacial Disruption Score, rs = 0.945; and ZS Score, rs = 0.902; P < .001 for all 3 models). In addition, the BFTS was found to have excellent interrater reliability (0.908; P = .001), which was similar to the interrater reliability of the other 3 tested trauma scales. Scores obtained using the BFTS were not correlated with dentition (odds ratio, .482; 95% CI, -0.087 to 1.053; P = .08; measured as absolute number of teeth) or age of the cadaveric donor (odds ratio, .436; 95% CI, -0.068 to 0.944; P = .08). CONCLUSIONS AND RELEVANCE: Facial trauma severity as measured by the BFTS correlated with depth of penetration of the fixed mass into the face. In this study, the BFTS was clinically relevant, had high fidelity in communicating the fractures sustained in facial trauma, and correlated well with previously validated models. LEVEL OF EVIDENCE: NA.

A Novel Classification System for Injuries After Electronic Cigarette Explosions.

Electronic cigarettes (e-cigarettes) contain lithium batteries that have been known to explode and/or cause fires that have resulted in burn injury. The purpose of this article is to present a case study, review injuries caused by e-cigarettes, and present a novel classification system from the newly emerging patterns of burns. A case study was presented and online media reports for e-cigarette burns were queried with search terms "e-cigarette burns" and "electronic cigarette burns." The reports and injury patterns were tabulated. Analysis was then performed to create a novel classification system based on the distinct injury patterns seen in the study. Two patients were seen at our regional burn center after e-cigarette burns. One had an injury to his thigh and penis that required operative intervention after ignition of this device in his pocket. The second had a facial burn and corneal abrasions when the device exploded while he was inhaling vapor. The Internet search and case studies resulted in 26 cases for evaluation. The burn patterns were divided in direct injury from the device igniting and indirect injury when the device caused a house or car fire. A numerical classification was created: direct injury: type 1 (hand injury) 7 cases, type 2 (face injury) 8 cases, type 3 (waist/groin injury) 11 cases, and type 5a (inhalation injury from using device) 2 cases; indirect injury: type 4 (house fire injury) 7 cases and type 5b (inhalation injury from fire started by the device) 4 cases. Multiple e-cigarette injuries are occurring in the United States and distinct patterns of burns are emerging. The classification system developed in this article will aid in further study and future regulation of these dangerous devices.