Open reduction and internal fixation of paediatric maxillozygomatic complex fractures: An 11-year multicentric retrospective study.

BACKGROUND/AIM: Paediatric maxillozygomatic complex (MZC) fractures are uncommon, and there is a scarcity of data regarding their surgical treatment. The aim of this study was to analyse choices and outcomes of open reduction and internal fixation (ORIF) for MZC fractures among 14 maxillofacial centers around the world. MATERIALS AND METHODS: This multicentric retrospective observational study included patients ≤16 years of age with quadripod MZC fractures treated with ORIF from January 2011 and December 2022. The following data were collected: age, gender, dentition stage (deciduous, mixed, and permanent), cause of injury, type of fracture, surgical approach, site of osteosynthesis (infraorbital rim, zygomaticomaxillary buttress, frontozygomatic, and zygomaticotemporal sutures), material (titanium or resorbable) and number of plates used, and outcome. The minimum follow-up was 6 months. Statistical analyses were performed with Fisher's exact test or chi-squared test, as appropriate. RESULTS: Sixty-four patients (mean age, 12.3 years) with quadripod MZC fractures were included. Seventy-two percent of patients received a single-point fixation. The zygomaticomaxillary buttress was the most common site for fixation, both in single-point and two-point fixation schemes, especially in combination with the frontozygomatic suture. Increasing age was associated with a higher rate of plate removal (p < .001). Postoperative complications included 5 (7.8%) cases of wound infections, 2 (3.1%) infraorbital paraesthesia, 1 (1.6%) ectropion. Residual facial asymmetry was found in 5 (7.8%) patients and was not associated with the type of fixation (p > .05). CONCLUSIONS: This study highlights the possibility of using ORIF, even with a single point of fixation, for the treatment of displaced quadripod MZC fractures in the paediatric population. The zygomaticomaxillary buttress was the preferred site of fixation and allowed for adequate stabilization with no external scars and a low risk of tooth damage. Future prospective studies with long-term follow-up are needed to establish definitive surgical protocols and clarify the surgical decision-making.

A Multicentric Prospective Study on Maxillofacial Trauma Due to Road Traffic Accidents: The World Oral and Maxillofacial Trauma Project.

ABSTRACT: The purpose of this prospective multicenter study was to analyze the epidemiology, patterns, and management of maxillofacial fractures due to road traffic accidents (RTAs) worldwide.Between Monday September 30, 2019 and Sunday October 4, 2020,1066 patients with RTAs related fractures were admitted to 14 maxillofacial surgery departments. The following data were analyzed: age, gender, mechanism of injury, alcohol or drug abuse at the time of trauma, maxillofacial fracture site, facial injury severity scale (FISS) score, associated injuries, day and month of trauma, time of treatment, type of treatment and length of hospital stay. Data were analyzed using bivaried and multivaried statistical analysis.Eight hundred seventy patients were male, and 196 were female. The most common mechanism of injury was motorcycle accidents (48%). More than half of the patients had fractures of the middle third of the maxillofacial skeleton. In total, 59% of the study sample underwent open reduction internal fixation. The median facial injury severity scale (3 points) and the medial hospital stay (3 days) were significantly lower in patients with seatbelts and helmet (P  < 0.001).This first prospective, multicenter epidemiological study shows that motorcycle accidents are the leading cause of RTAs related fractures, mostly in young males. Particularly in Australia and Europe, the incidence of RTAs was significantly lower. Moreover, this study found that the severity of maxillofacial lesions was significantly higher in patients without safety devices, with consequent longer hospital stay demonstrating the efficacy of road safety policies in preventing maxillofacial injury.

A multicentric, prospective study on oral and maxillofacial trauma in the female population around the world.

BACKGROUND/AIMS: Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1-year period. METHODS: The following data were collected: age (0-18, 19-64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization. RESULTS: Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20-39 years. The main causes were falls (43% [median age, 60.5 years]), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% [median age, 29.5 years]). Assaults (15% [median age, 31.5 years]) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction. CONCLUSION: Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19-64 years, and they are related to alcohol use.

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study.

BACKGROUND/AIMS: Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1-year period. METHODS: The following data were collected: age (preschool [0-6 years], school age [7-12 years], and adolescent [13-18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. RESULTS: Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0-18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001). CONCLUSION: The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0-6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.

A multicentric prospective analysis of maxillofacial trauma in the elderly population.

BACKGROUND/AIMS: The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world. METHODS: The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non-parametric and association tests, as well as linear regression. RESULTS: Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2-7.2). Statistical analysis showed that women were more involved in fall-related trauma compared with males (p < .001). It was also shown that road traffic accidents cause more fractures in the lower third (p < .001) and in the middle third-lower third complex compared with upper third (p < .001). CONCLUSIONS: Maxillofacial fractures in the elderly were more frequent in European and Australian centres and affected men slightly more than women. Falls were the leading cause of fractures, especially among women. The middle third of the face was most often affected, and conservative treatment was the most common choice for the management of such patients.

The Importance of Early Diagnosis of Retrobulbar Hemorrhage.

Midface fractures usually affect the orbital cavity. This trauma may result in severe and rare consequences such as retrobulbar hemorrhage. This condition requires immediate diagnosis and early intervention to avoid blindness. The treatment usually requires evaluation of an oral and maxillofacial surgeon. This patient report aims to describe a facial trauma resulting in blindness after 4 days. An 83-year-old woman fell and hit her face on the floor. The initial evaluation only found a contusion on her left orbit, and an ophthalmologic examination was not made. After 72 hours, the patient searched for the oral and maxillofacial surgeon, showing blindness of her left eye. Despite the treatment, the vision was not recovered. Blindness can become irreversible 90 minutes after trauma, and this condition must be treated as an emergency.

Policy of fourteen maxillofacial divisions towards titanium plates removal after internal fixation of paediatric maxillofacial fractures: A World Oral Maxillofacial Trauma (WORMAT) project.

INTRODUCTION: The aim of this 11-year retrospective multicentric study is to evaluate the policy of 14 maxillofacial surgery divisions in terms of titanium plate removal from paediatric patients who had undergone open reduction and internal fixation (ORIF) to treat maxillofacial fractures. MATERIAL AND METHODS: Patients ≤ 16 years undergoing surgical treatment for fractures of middle and lower third of the face between January 2011 and December 2022, with a minimum follow-up of 6 months, were included. Age (group A: ≤ 6 years, B: 7-12 years, C: 13-16 years), sex, fracture location and type, surgical approach, number, and location of positioned and removed plates, timing and indications for removal were recorded. RESULTS: 191/383 (50 %) patients (median age, 10 years; M:F ratio 2.1:1) underwent removal of 319/708 (45 %) plates. Maxillary dentoalveolar process (91 %), angle/ramus (63 %) and mandibular body (61 %) had a significantly higher removal rate than other fracture sites (p < 0.001). A significant decreasing trend in removal with increasing age was observed, from 83 % in Group A to 24 % in Group C (p < 0.001). On the total of positioned plates, 11 % were removed for symptomatic reasons (5 % infections, 6 % discomfort/pain) and 34 % for other reasons (28 % scheduled removal). DISCUSSION: This multicentric study showed that plate removal was not performed routinely in the paediatric population. The incidence and causes of symptomatic plates removal were consistent with the literature, while the plate removal rate from asymptomatic patients was lower. A correlation was found between increasing age and a reduction in the frequency of plate removal procedures.

Management of Mandibular Condyle Fractures in Pediatric Patients: A Multicentric Retrospective Study with 180 Children and Adolescents.

Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment-stand-alone maxillomandibular fixation (MMF)-in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry.

In vitro mechanical test of grid plates for mandibular angle fractures.

This study evaluated, by mechanical testing, the strength of four-hole grid plates used for mandibular angle fracture fixation. Much has been discussed about the treatment of mandibular fractures with straight or curved plates. However, there are few studies about the use of grid plates. The geometry of such plates provides three-dimensional stability, resistance against torque associated with a low profile. Ninety polyurethane hemimandibles were used as substratum. The hemimandibles were divided into nine groups and fixation of the fractures was performed varying the type and position of plate and type of screw. An intact hemimandible group was used as control. It was possible to observe that plates positioned at the tension zone present the highest load values, both for dislocations of 3 and 5 mm. There was no statistical difference when plates with or without an intermediate bar were tested. The locking screws were more efficient than the non-locking screws when the plates were positioned at the neutral zone. Results allowed us to conclude that grid plates installed at the tension zone presented greater mechanical efficiency. If grid plates are positioned at the neutral zone, they should have an intermediate bar and be fixed with locking screws.