Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study.

BACKGROUND: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED). METHODS: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT. RESULTS: The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases). CONCLUSIONS: This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.

A cross-sectional study of the impact of the COVID-19 lockdown on domestic violence-related oral and maxillofacial injuries.

BACKGROUND: During the COVID-19 lockdown, more domestic violence-related traumas were reported. In this study, we investigated and compared the incidence of domestic violence-related injuries-in particular oral and maxillofacial injuries-in Ulaanbaatar, Mongolia, before and during the COVID-19 lockdown. MATERIALS AND METHODS: We conducted a cross-sectional study based on 3974 domestic violence cases registered at the Public Health Department, National Traumatology and Orthopedics Research Center of Mongolia between 2018 and 2022. Descriptive and binary logistic regression analyses were conducted. The victims were categorized according to their age (child, adult, and elderly). RESULTS: The mean age of the victims was children 9.7 ± 5.4 years, adults 34.8 ± 8.3 years, and elderly 64.3 ± 8.7 years. Binary logistic regression analysis (no/yes) showed that oral and maxillofacial injuries during the lockdown increased 1.3 times (OR = 1.3; CI 95% = 1.0-1.6; p = .003) in adults and 2.5 times in children (OR = 2.5; CI 95% = 1.7-3.9; p = .001). Additionally, injuries to upper limbs increased 4.6 times (OR = 4.6; CI 95% = 3.5-6.1; p = .001) in adults and 5.2 times in elderly patients (OR = 5.2; CI 95% = 1.8-16.2; p = .01). Additionally, thorax injury in children increased 3.1 times (OR = 3.1; CI 95% = 1.7-5.7; p = .001). CONCLUSIONS: During the lockdown, injury to oral and maxillofacial regions increased in adult and child victims of domestic violence.

Comparison of characteristics of kick- and electric-scooter-related dental and maxillofacial injuries: A retrospective study.

BACKGROUND/AIM: Owing to the nearly three-year-long COVID-19 pandemic, small personal transportation devices that allow for greater freedom of movement within the cities have gained attention. Therefore, the number of people using kick or electric scooters has increased. This study aimed to compare the characteristics of kick and electric scooter-related dental and maxillofacial trauma and provide helpful information for preventing scooter accidents, appropriate treatment of patients with scooter-related trauma, and policy establishment. MATERIALS AND METHODS: This retrospective observational study analysed the medical records of 310 patients who visited the emergency room of Ajou University Dental Hospital for kick and electric scooter-related oral and maxillofacial injuries between 1 January 2017 and 31 December 2022. Sex, age, scooter type, time, and mechanism of the accident, helmet use, alcohol consumption, dental and maxillofacial injury types, and treatment were analysed. RESULTS: The average age in the kick-scooter group (5.71 ± 4.25) was lower than that in the electric-scooter group (28.24 ± 10.02) (p < .0001). There were more males in both groups. The helmet usage rates of the two groups were 2.80% and 7.88%, respectively. In the kick-scooter group, periodontal damage was more common than pulp injury, while in the electric-scooter group, pulp injury was more common than periodontal injury. There was no significant difference in soft-tissue damage between the two groups; however, bone fractures occurred significantly more frequently in the electric-scooter group (p < .0001). CONCLUSIONS: Electric scooters cause more crown and bone fractures than kick scooters and require more active treatment of dental and maxillofacial injuries. Riders should use protective equipment to prevent dental and maxillofacial injury. Although there are regulations related to scooters, the effectiveness of both kick- and electric-scooter related laws needs to be evaluated.

Traumatic maxillofacial injuries: Patterns, outcomes, and long-term follow-up of a military cohort.

BACKGROUND/AIMS: Maxillofacial trauma poses a distinct challenge on the modern battlefield, and data on its long-term implications are scarce. The aim of this study was to investigate maxillofacial injury characteristics, outcomes, and complications along the continuum of care among hospitalized military personnel from the pre-hospital setting through long-term rehabilitation. MATERIALS AND METHODS: A registry-based study was undertaken of three national trauma and rehabilitation registries: The Israel Defense Forces Trauma Registry (IDF-TR), which records pre-hospital data. The Israeli National Trauma Registry for in-hospital data and the Israel Ministry of Defense Rehabilitation Department (MOD-RD) registry contain long-term disability data. The cohort comprised IDF soldiers who suffered maxillofacial injuries between 1997 and 2020. RESULTS: A total of 672 patients with maxillofacial injuries were included in the study, and 6.4% of all trauma admissions were related to maxillofacial injuries. Of these, 366 (54%) were injured in non-military (NMC) circumstances, and 306 (46%) were wounded in military circumstances (MC). The mechanisms of injury were mainly traffic-related among the NMC group compared with an explosion in the MC group. Maxillofacial fractures were frequently associated with traumatic brain injuries with higher rates in the NMC group than in the MC group (55% vs. 30%, p < .001). In a multivariate analysis, zygomatic and orbital fractures were associated with higher odds of concomitant head injury. The most common categories of long-term disability included central nervous system disorders, skull injuries, epilepsy, hearing impairment, ophthalmologic conditions, and post-traumatic stress disorder. CONCLUSIONS: Maxillofacial injuries are often associated with concomitant traumatic brain injury. Long-term disabilities associated with these injuries included the central nervous system, hearing, ophthalmologic impairments, and post-traumatic stress disorder.

Psychiatric symptoms and pain in maxillofacial injury following motor vehicle accidents: A comparative study.

BACKGROUND/AIM: Post-traumatic stress disorders, depression, and pain are rarely discussed in the literature on maxillofacial injuries, and psychiatric symptoms and pain are not identified and managed in such patients. The aim of this study was to determine the symptoms of post-traumatic stress disorders, depression, and pain in people with maxillofacial injuries following motor vehicle accidents. MATERIAL AND METHODS: In this cross-sectional study, people injured in motor vehicle accidents from March to September 2015 who were referred to a medical educational center in the northern part of Iran for treatment follow-up were sampled. The existing symptoms of post-traumatic stress disorder by PSS, depression by BDI-II, and pain by NRS were assessed. SPSS software version 21 was used for analysis. RESULTS: Maxillofacial injured patients had significant differences in terms of post-traumatic stress disorder (p = .006), depression (p = .001), pain (p = .001), and length of hospital stay (p = .002) than patients without maxillofacial injuries. CONCLUSIONS: Motor vehicle accident victims with maxillofacial injuries suffered significantly more from post-traumatic stress disorders and depression, pain and length of hospital stay than patients with other injuries.

Association between type of fixation and a length of stay amongst maxillofacial fracture patients: A retrospective charts review.

We aimed to explore the predictors of hospital length of stay for patients admitted and with maxillofacial injuries. Patients presenting with maxillofacial trauma were included. Poly-trauma involving neurosurgery and/ or needing orthopaedics intervention were excluded. Logistic regression was applied to explore the predictors associated with the hospital stay of > 4 days. There were 241 patients with mean age 29.35 ± 12.5 years (age range 12-80 years). Mandibular fracture was the commonest observation 121(50.2%), followed by maxillary 48(19.9%), and zygomatic bone fracture 9 (3.7%). Road traffic accident 196 (81.3%) appears to be the most common etiology of maxillofacial injuries in the studied sample. The mean length of hospital stay among bone plating patients was 5.96 ±6.8 days compared to 4.15±6.2 days for ones treated without bone plating; p-value 0.05. It was concluded that longer length of stay is required in patients with more complex management including bone plates.

Maxillofacial injuries in severely injured patients after road traffic accidents-a retrospective evaluation of the TraumaRegister DGU® 1993-2014.

OBJECTIVES: It was the aim of the study to analyse the prevalence of maxillofacial trauma (MFT) in severely injured patients after road traffic accidence (RTA) and to investigate associated factors. MATERIALS AND METHODS: In a retrospective study, data from patients after RTA by the TraumaRegister DGU® from 1993 to 2014 were evaluated for demographical and injury characteristics. The predictor variable was mechanism of injury and the outcome variables were type of injury, severity and hospital resources utilization. RESULTS: During the investigation period, n = 62,196 patients were enclosed with a prevalence of maxillofacial injuries of 20.3% (MFT positive). The injury severity score of MFT-positive patients was higher than in the MTF-negative subgroup (27 ± 12.8 vs. 23.0 ± 12.7). If MFT positive, 39.8% show minor, 37.1% moderate, 21.5% serious and 1.6% severe maxillofacial injuries. Injuries of the midface occurred in 60.3% of MTF-positive patients. A relevant blood loss (> 20% of total blood volume) occurred in 1.9%. MFT-positive patients had a higher coincidence with cervical spine fractures (11.3% vs. 7.8%) and traumatic brain injuries (62.6% vs. 34.8%) than MFT-negative patients. There was a noticeable decrease in the incidence of facial injuries in car/truck drivers during the study period. CONCLUSIONS: Every 5th patient after RTA shows a MFT and the whole trauma team must be aware that this indicates a high prevalence of traumatic brain and cervical spine injuries. CLINICAL RELEVANCE: Even if sole injuries of the face are seldom life threatening, maxillofacial expertise in interdisciplinary trauma centres is strongly recommended.

Transnasal endoscopic ultrasound-guided reduction of maxillary sinus wall fracture.

Surgical morbidity from open reduction and internal fixation (ORIF) of maxillary sinus wall fracture often surpasses the benefits of ORIF. Hence, the authors devised transnasal endoscopic-assisted reduction of maxillary sinus wall fracture (TERM) without internal fixation as a minimally invasive surgery for maxillary sinus wall fracture. The purpose of this study was to investigate the feasibility of TERM in cadavers and patients. Six cadavers were dissected to evaluate the feasibility of TERM. In addition, 20 patients with maxillary sinus wall fractures who underwent TERM in a tertiary hospital from August of 2013 to December of 2015 were enrolled in this study. Demographic factors, type of anesthesia, computed tomography (CT) scans, clinical characteristics of patients, and patient satisfaction with surgery were analyzed. Cadaveric study showed that endoscopic inferior meatus antrostomy is a feasible method of approaching the maxillary sinus wall in cadavers. In addition, counterforce could be applied to the maxillary sinus wall by pushing packed Vaseline-soaked gauze or using a zygomatic process approach via a Gillies incision. Clinical experience revealed that patients experienced good facial contour restoration postoperatively. The extent of fractured bony segments was reduced on postoperative CT without complications. Patient satisfaction with TERM was greater than that with ORIF (p = 0.031). TERM showed its feasibility in both cadaveric study and clinical study. TERM can be a good alternative to ORIF, especially in patients who are reluctant to undergo a facial incision.

Rising incidence of fall-induced maxillofacial injuries among older adults.

BACKGROUND: Various fall-induced injuries in older adults are a major public health problem. AIM: We aimed to assess the current trends in the fall-induced severe maxillofacial injuries among older adults in Finland, an EU country with a well-defined white population of 5.5 million. METHODS: The injury trends were determined by taking into account all persons 60 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1999 and 2014. RESULTS: The number of fall-induced maxillofacial injuries among older Finnish adults doubled during the 16-year follow-up, from 434 in 1999 to 981 in 2014. The age-adjusted incidence of injury (per 100 000 persons) also showed a clear increase from 1999 to 2014: from 47.4 to 71.3 in women, and from 39.2 to 59.6 in men. In both sexes, the increase was most prominent in the oldest age group, persons aged 80 years or older. CONCLUSIONS: The number of fall-induced severe maxillofacial injuries among older Finns rose considerably between 1999 and 2014-with a rate that could not be explained merely by demographic changes. Further studies are urgently needed to better assess the reasons for the rise and possibilities for injury prevention.

Traumatic carotid-cavernous fistula in a multiple facial fractures patient: case report and literature review.

Carotid-cavernous fistula (CCF) is a pathologic communication between internal carotid artery (ICA) and cavernous sinus (CS). CCF occurs most commonly in association with craniofacial trauma. Traumatic CCFs are very rare, occurring in 0.17-0.27% of craniomaxillofacial trauma cases. We present a case of the patient treated for multiple facial fractures, who developed symptoms of CCF with several days latency and was successfully treated by endovascular occlusion of ICA. Anatomy of CS, pathophysiology of CCFs and treatment options are concisely reviewed.

Post-traumatic stress disorder in maxillofacial trauma victims- A systematic review and meta-analysis.

BACKGROUND: Maxillofacial trauma often results in visible facial disfigurements and can lead to psychological complications such as post-traumatic stress disorder (PTSD). However, PTSD often remains unrecognized and un/undertreated. The goal of the current systematic review was to determine the incidence of PTSD after maxillofacial trauma, associated risk factors, assessment tools employed, and management. METHODS: A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases following PRISMA guidelines up to March 2024. Collected variables included the number of patients included, PSTD assessment tool, PTSD incidence, and risk factors and management. The meta-analysis was conducted using random effect models in STATA 16. RESULTS: The review included 14 studies (1633 patients, male=1025, female=230, not mentioned=378). Assessment tools varied widely among studies. Meta-analysis revealed a pooled incidence of PTSD of 27 % (n = 14, 95 % CI, 24 %-30 %) at 1-3 months post-trauma and 10 % (n = 3, 95 % CI, 3 %-17 %) at the 6-12 months follow-up, with a statistically significant 60 % reduction between these periods. CONCLUSION: The overall incidence of PTSD following maxillofacial trauma was 27 % at 1-3 months and decreased to 10 % after 6 months. The emphasis should be given to the importance of early intervention strategies and awareness among the treating surgeon to prevent PTSD.

Symmetry recovery in zygomaticomaxillary complex fractures compared to normal unfractured population: A new reliable 3D evaluation.

OBJECTIVE: This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes. MATERIAL AND METHODS: Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed. RESULTS: The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±0.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥0.99). CONCLUSIONS: This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.

Mapping Evidence on the Epidemiology and Cost Associated with Maxillofacial Injury among Adults in Sub-Saharan Africa: A Scoping Review Protocol.

(1) Background: Maxillofacial injury (MI) occurs universally, for it disregards preference for age, gender, and geographical region. The global incidence and prevalence of facial fractures rose by 39.45% and 54.39%, respectively, between the years 1990 to 2017. Projections indicate that the burden of injuries will persist in sub-Saharan Africa (SSA) in the next twenty years. This scoping review aims to map the literature on MI epidemiology and the economic burden on society in SSA. (2) Methods: The methodology presented by Arksey and O'Malley and extended by Levac and colleagues will be employed in the scoping review. The researcher will report the proposed review through the Preferred Reporting Items for Systematic Review, and Meta-Analysis extension for scoping reviews (PRISMA-ScR). The review will include studies encompassing MI in sub-Saharan African adults 18 years and above. (3) Results: This will be presented as a thematic analysis of the data extracted from the included studies, and the Nvivo version 12 will be employed. (4) Discussion: We anticipate searching for related literature on the prevalence, incidence, risk factors, mortality, and cost associated with MI in the adult population of SSA. The conclusion from the review will assist in ascertaining research gaps, informing policy, planning, authorizing upcoming research, and prioritizing funding for injury prevention and management.

Epidemiology of maxillofacial injury among adults in sub-Saharan Africa: a scoping review.

BACKGROUND: Injuries remain one of the leading causes of death globally. These disproportionately affect young adults and are particularly prevalent in sub-Saharan Africa (SSA). Maxillofacial injuries (MI) pose significant challenges to public health systems. However, much remains unknown regarding the epidemiology and extent of the financial burden in resource-limited areas, such as SSA, further necessitating more research and support. This scoping review aims to investigate the mechanism, distribution, and financial impact of MI in adults aged ≥ 18 years in SSA. MAIN BODY: The scoping review was guided by the methodological frameworks of Arksey and O'Malley and Levac. An electronic literature search for English-published articles on maxillofacial injuries in adults ≥ 18 years was conducted in Scopus, Medline, PubMed, Science Direct, CINAHL, Health Source: Nursing/Academic Edition, and grey literature. The PRISMA chart was used to document database searches and screening outcomes while reporting was guided by PRISMA-ScR. The data extraction process revolved around the predefined study outcomes, which encompassed the study characteristics and epidemiological parameters. The review used a narrative approach to report findings and evaluate publication quality using the STROBE checklist. The database search yielded 8246 studies, of which 30 met the inclusion criteria. A total of 7317 participants were included, 79.3% of whom were males. The peak age range for incidence was between 18 and 40 years. Road traffic collision (RTC) was the leading cause of MI, 59% of which resulted from motorcycle collisions. Assault/interpersonal violence ranked as the second leading cause of MI. The mandible was MI's most frequently affected hard tissue, followed by the midface. Factors such as alcohol/illicit drug use, poor knowledge of traffic regulations, and non-observance of these regulations were associated with MI. In our study, the cost range for mandibular fractures was $200-$468.6, borne by victims and their families. CONCLUSIONS: Maxillofacial injuries are predominantly caused by road traffic collisions and assaults in SSA. The findings can provide valuable insights into policy decisions and prevention strategies aimed at reducing injury burden. Further research is warranted to explore the psychological impact of MI, including PTSD, for tailored support and intervention. Scoping Review Registration The protocol has been registered on the Open Science Framework. Registration DOI: https://doi.org/10.17605/OSF.IO/BWVDK .

Characteristics of E-Scooter-Related Maxillofacial Injuries over 2019-2022-Retrospective Study from Poznan, Poland.

Recently, there has been a considerable rise in the popularity and use of electric scooters. Because of this, the number of accidents involving them has also risen. Head and neck injuries are the most common. The aim of the study was to determine the most frequent craniofacial injuries resulting from accidents involving electric scooters, and to identify the risk factors directly related to their placement and severity. The study carried out a retrospective analysis of the medical records of patients of the Clinic of Maxillofacial Surgery over 2019-2022, in terms of craniofacial injuries suffered as a result of e-scooter-related accidents. In the study population (31 cases), of which 61.3% were men, the median age was 27 years. At the time of the accident, 32.3% patients were under the influence of alcohol. Accidents were most common in the 21-30 age group; more often than not, they occurred during warm months and on weekends. The study identified a total of 40 fractures in the patients. The most common craniofacial injuries were mandibular fractures (37.5%), zygomatic-orbital fractures (20%) and frontal bone fractures (10%). A multidimensional correspondence analysis was also performed, which showed that at an age of under 30, alcohol consumption and female gender were associated with a higher likelihood of mandibular fracture. Proper education on the risks associated with the use of e-scooters is essential, with particular emphasis on the impact of alcohol on the driver. It is important to develop diagnostic and therapeutic algorithms for doctors, both in ED and in specialised departments.

Epidemiology of Blindness From Facial Trauma: A Multi-Centre Nigerian Study.

Study Design: This is a multi-centre retrospective study. Objective: To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians. Methods: A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by maxillofacial surgeons and ophthalmologists in 4 Nigerian public tertiary hospitals between January 2010 and December 2019 was undertaken. Data was analysed by IBM SPSS Statistics (version 21.0 for windows, IBM© Inc, Chicago, IL). Results: Of 2070 patients who presented with major facial injuries during the study period, 61 eyes of 56 (2.7%) patients were blind. Blindness was bilateral and unilateral in 5 (8.9%) and 51 (92.1%) patients, respectively. The mean age (SD) at presentation was 36.2 (16.6) years, and 47 (83.9%) of these patients were males. Road traffic accident (n = 27; 48%) was the commonest mechanism of facial trauma, the cheek (n = 18; 40.9%) was the commonest site of associated soft tissue injury and zygomatic complex fracture (n = 19; 24.1%) was the commonest related fracture. Globe rupture (n = 34; 55.7%) was the leading cause of blindness. Enucleation (n = 7; 13.2%) and evisceration (n = 22; 41.5%) were performed on 29 eyes of which 12 (41.4%) patients had ocular prosthesis post-operatively. Conclusions: Blindness was recorded in 2.7% of Nigerians with facial trauma. The commonest mechanism of trauma and cause of blindness in at least one eye were road traffic accident and globe rupture, respectively. Eye removal surgery was necessary in about half of the blind eyes.

Traumatic hemifacial avulsion and degloving injury: a case report.

Gross maxillofacial injuries are challenging to manage because they can be complicated by airway obstruction, injuries to the cervical spine, and cranial structures. Deformities from such injuries have lasting psychological effects which if not addressed can be devastating. We present a 21-year-old male motorcyclist who was involved in a motor traffic collision and sustained avulsion and degloving of the forehead skin, left eyebrow, left upper and lower eyelids, the nose, the left cheek and part of the right cheek, upper and lower lips, and the skin overlying the chin. His airway was compromised; hence rapid sequence intubation was done to secure it. Thereafter single-stage primary reconstruction and repair were done. A multidisciplinary team approach involving different specialties yielded good outcomes for this patient's condition.

Prevalence and patterns of maxillofacial trauma: a retrospective descriptive study.

INTRODUCTION: We aimed to describe the prevalence and pattern of maxillofacial trauma in Qatar. METHODS: This is a retrospective study of trauma registry data at Hamad General Hospital during the period from January 2011 to December 2014. The study included all traumatic maxillofacial patients who underwent CT scan and were admitted during the study period. RESULTS: A total of 1187 patients with maxillofacial injuries were included in the study and 18.5% of all trauma admissions were related to maxillofacial injuries. Young age and males were predominantly affected. Mechanisms of injury were mainly traffic-related and fall. Orbital injuries were the commonest followed by maxillary injuries. The median and range face abbreviated injury score (AIS) was 2 [1-3] with 66% had a score of 2. Maxillofacial fractures were frequently associated with traumatic brain injuries. One out of five patients was managed with surgery and had median length of stays in ICU and hospital 5 and 7 days, respectively. Overall, in-hospital mortality was 8.3%. Mortality in isolated maxillofacial was low (0.3%) in comparison to 15% in polytrauma patients (p = 0.001). Multivariable regression analysis showed that Injury Severity Score, face AIS and Glasgow Coma Scale were predictors of mortality with age-adjusted odd ratio of 1.15, 2.48 and 0.82; respectively. CONCLUSIONS: Maxillofacial trauma requiring admission is not uncommon in our trauma center and mostly it is mild to moderate in severity. Associated injuries are present in most of the maxillofacial injured patients and further diagnostic investigations should be part of the assessment in maxillofacial injuries.

Characteristics of Otorhinolaryngological Emergencies in the Elderly.

OBJECTIVE: This study was designed to characterize the distribution of otorhinolaryngological emergencies seen in the geriatric population in one year. In this article we present our results and discuss the differences between our results and those reported in the current literature. METHODS: The study was carried out in a tertiary care university hospital. All patients aged 65 years or over that were referred by the general emergency department (ED) to the otorhinolaryngology emergency room in a one-year period were retrospectively reviewed. Demographic characteristics (age, gender), findings of physical examination, accompanying systemic diseases, diagnosis, and treatment methods were documented. Hospitalization and referral needs were also analyzed. RESULTS: In the one-year period from April 2017 to April 2018, a total of 12,780 patients aged 65 or older presented to the ED and the otorhinolaryngology physician was consulted for 195 (1.5%) of these patients. The age range of the patients was 65-96 years, with a mean age of 75 years. The most common cause for presenting to the ED was maxillofacial trauma (31.7%), followed by epistaxis (18.7%). Dyspnea (9.7%) and peripheral facial paralysis (9.7%) were the third most frequent causes. The outcome analysis revealed that 9.7% of the patients were hospitalized. CONCLUSION: Identifying the characteristics of the geriatric patients presenting to EDs is important for developing proper management algorithms. Maxillofacial traumas were the most frequently seen ORL emergencies in our cohort of geriatric patients, followed by epistaxis. The distribution and the prevalence of the cases could differ according to the institutional protocols.