Point-of-Care Ultrasound Diagnosis of Multiple Mandibular Fractures in an Adolescent Presenting to the Pediatric Emergency Department.

We present a case of an adolescent patient with multiple mandibular fractures diagnosed by point-of-care ultrasound in the pediatric emergency department. Sonographic findings consistent with fracture were identified in our patient, and early consultation expedited interdepartmental coordination and disposition. The role of ultrasound in identifying various traumatic orthopedic and maxillofacial injuries is discussed.

Maxillofacial gunshot wounds in peacetime.

The treatment of maxillofacial gunshot wounds in peacetime is an urgent and difficult problem. The emergence of new types of civilian weapons and relatively small current clinical experience does not allow generating recommendations for the treatment of this pathology. It presents a statistical analysis of injuries in St. Petersburg 2004-2014 restricted firearms destruction and experimental study of the harmful effect of these weapons on the fabric maxillofacial experimental animals (pigs). The features of the clinical picture, diagnosis and surgical treatment of wounds of the maxillofacial region, caused by a firearm -restricted lesions and wounds with extensive tissue damage maxillofacial caused a hunting weapon are considered.

Comparative study of four maxillofacial trauma scoring systems and expert score.

PURPOSE: To select a scoring system suitable for the scoring of maxillofacial trauma by comparing 4 commonly used scoring systems according to expert scoring. PATIENTS AND METHODS: Twenty-eight subjects who had experienced maxillofacial trauma constituted the study cohort. Four commonly used systems were selected: New Injury Severity Score (NISS), Facial Injury Severity Scale (FISS), Maxillofacial Injury Severity Score (MFISS), and Maxillofacial Injury Severity Score (MISS). Each patient was graded using these 4 systems. From the experience of our trauma center, an expert scoring table was created. After the purpose and scheme of the study had been explained, 35 experts in maxillofacial surgery were invited to grade the injury of the 28 patients using the expert scoring table according to their clinical experience. The results of the 4 scoring systems and expert score were compared. RESULTS: The results of the 4 scoring systems and expert score demonstrated a normal distribution. All results demonstrated significant differences (P < .01). The Pearson correlation coefficient between the MFISS and expert score was the greatest (0.801). The correlation coefficient between the NISS, FISS, and MISS and the expert score was 0.714, 0.699, and 0.729, respectively. Agreement between the standardized scores and the expert score was evaluated using Bland-Altman plots; the agreement between the standardized MFISS and expert score was the best. CONCLUSIONS: Compared with the other 3 scoring systems, the correlation and agreement between the MFISS and expert score was greater. This finding suggests that the MFISS is more suitable for scoring maxillofacial injuries.

A simple method for lower lip reconstruction after trauma using an advancement mucosal flap from the remaining lip.

The traumatic injury of lower lip is a frequent clinical condition, and quite often, the soft tissue loss makes the reconstruction of lower lip's defect a challenging procedure. Many methods have been described to reconstruct these defects; however, most of them lack simplicity and require advance experience in flap surgery. In this report, a simple technique is presented for lower lip reconstruction following traumatic injury using an advancement mucosal flap from the remaining lower lip. With this method pleasant cosmetic result can be achieved.

[Modern aspects of combat maxillofacial trauma (review of foreign scientific-medical publications during 2012-2013)].

The current article is dedicated to the modern aspects of combat maxillofacial trauma as they have been presented in 2012-2013 scientific publications. It has been shown that due to employment of more and more powerful explosive devices the facial trauma over the last decade has occurred more frequently and become more severe. Some new methods of facial injuries treatment are being tested now, among them KSL-W antimicrobial decapeptide, new bone regenerative biocompatible materials, scar-healing mesenchymal and adipose-derived stem cells, and a custom automated face dressing platform.

[Peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process].

The objective of the present study was to elucidate the peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process. The case report described in this paper demonstrates that the unfavourable outcome of an injury is not infrequently attributable to the inadequacy and drawbacks of the existing schemes for the provision of medical aid. However, the health status of the victim depends on the life-threatening character of the primary injury and its naturally developing infectious complications.

Maxillofacial fractures sustained in bicycle accidents.

PURPOSE: The purpose of this study was to analyze maxillofacial fractures sustained in bicycle accidents by demographics, cause of injury, site and severity of fractures, injuries to other sites of the body, and treatment modalities. PATIENTS AND METHODS: Data on 307 patients treated for maxillofacial fractures sustained in bicycle accidents in the Department of Oral and Maxillofacial Surgery, Nara Medical University from 1981 through 2009 were analyzed retrospectively. RESULTS: The patients were 166 males and 141 females (average age, 30.9 years). Causes of injury were a fall on a level surface in 169 patients, an automobile accident in 56, fall from 1 level to another in 28, and a motorcycle accident in 24. One hundred seventy-five fractures were observed in the mandible, 117 in the midface, and 15 in the mandible and midface. In the mandible, fracture lines were exclusively observed at the condyle. In the midface, the zygoma was most frequently involved. The Facial Injury Severity Scale ranged from 1 to 7 (average, 1.88). Injuries at other sites of the body were found in 47 patients and were frequently found in automobile and motorcycle accidents. Maxillomandibular fixation was most frequently chosen in 81 patients, followed by observation in 76 and open reduction and internal fixation in 71. The Facial Injury Severity Scale was highest in patients treated by open reduction and internal fixation, followed by those treated by maxillomandibular fixation. CONCLUSIONS: Maxillofacial fractures sustained in a bicycle accident frequently occurred by falling on a level surface and were not so serious in most cases; however, in accidents with motor vehicles, injuries to other sites of the body were observed at a higher rate.

[Atypical maxillofacial shot wound]. / Atypické strelné poranenie maxilofaciálnej oblasti.

Maxillofacial shot wounds belong to the relatively less frequent injuries. The soft tissues might be affected in particular, however the most of injuries are combined with infliction of hard tissues. Shot wounds by the bow or crossbow are very rare. They might result as a consequence of either accident or suicide. In the literature some cases of a suicidal experiments had been published, all of these cases were due to arrow from the crossbow. There was no injury being documented due to arrow from the bow. The authors present a case of maxillofacial injury done by shoot of arrow from the bow in the course of a child's play.

Maxillofacial air-containing cavities, blast implosion injuries, and management.

PURPOSE: Distinctive mechanisms of primary blast effects have produced a transitional era of facial trauma. Implosion mechanism damage is one of these. Implosion mechanism damage results in injury limited to the gas-containing structures of the auditory canal, paranasal sinuses, gastrointestinal tract, and lungs. Worldwide, the victims of explosive detonations have increased and advanced dramatically. The outcome is greater mortality and morbidity and new types of injuries, especially in the maxillofacial region. Thus, the knowledge of, and experience with, their management should be shared globally by colleagues through publications. MATERIALS AND METHODS: The implosion and mini re-explosion of compressed air sinuses leads to skeletal crush injury to the nasal-orbital-ethmoidal, maxillary sinuses, and nasal bones. A variety of surgical approaches were used successfully under conditions of war. The assessment of the associated injuries to the lung and/or brain is the initial priority to any life-threatening blast injury. This article describes the biophysical results of blast injuries to the middle third facial skeleton and associated injuries and details the management and protection of crushed air containing paranasal spaces. RESULTS: Easy, simple, and fast treatment and management were used successfully on the pulverized, fragmented skeletal architecture of the facial middle part without increasing morbidity and with the avoidance of unnecessary surgical trauma. CONCLUSIONS: Injuries in one of the most difficult esthetic, physiologic, and anatomic regions of the body is best treated with an understanding of the biophysical effects of the implosion mechanism on air-containing spaces in the maxillofacial region. The introduction of new methods for the management of severe destruction of hard and soft tissue will decrease the incidence of complications and the operative time.

Death by black powder revolver: a case report.

Deaths resulting from the use of black powder handguns are relatively uncommon compared to other firearms. We report the case of a 48 year-old woman who sustained a lethal gunshot wound to the face from a black powder revolver. Autopsy revealed extensive soot and powder deposition around the entrance wound between the right eye and nose with perforation of the skull and brain. The exit wound also contained evidence of soot. Discussion of this characteristic pattern of discharge deposition from black powder weapons is presented.

Effects of alcohol consumption on maxillofacial fractures in simple falls.

OBJECTIVES: This study aimed to investigate the effects of alcohol consumption (AC) on maxillofacial fractures caused by falls on a level surface (simple falls). MATERIAL AND METHODS: Patients with maxillofacial fractures caused by falls who visited the Oral and Maxillofacial Surgery Clinic from January 2006 to December 2016 were evaluated. Patients with simple falls were subdivided into those who fell with AC (Falls with AC) and those who fell without AC (Falls without AC). RESULTS: Of 180 patients with falls with maxillofacial fractures, 155 had simple falls, and 25 patients had falls from a height. Of the simple falls, 52 were Falls with AC, and 102 were Falls without AC. Falls with AC were significantly more frequent in males (p = .0005). The average number of fracture lines in the mandible was significantly higher in Falls with AC (2.13 ± 0.99 [mean ± SD]) than in Falls without AC (1.76 ± 0.91) (p = .011). The average Facial Injury Severity Scale was significantly higher in Falls with AC (3.08 ± 1.43) than in Falls without AC (2.43 ± 1.29) (p = .007). CONCLUSIONS: Falls with AC were associated with more severe maxillofacial fractures than Falls without AC.

Current opinion in the assessment and management of ballistic trauma to the craniomaxillofacial region.

PURPOSE OF REVIEW: Ballistic trauma represents a small proportion of injuries to the craniomaxillofacial (CMF) region, even in societies where the availability of firearms is more prevalent. The aim of this article is to review current opinion in the assessment and management of ballistic injuries sequentially from primary survey to definitive reconstruction. RECENT FINDINGS: For mandibular fractures because of ballistic trauma, load-bearing fixation remains the mainstay in the treatment. The use of load sharing fixation is rarely advised, even if the fracture pattern radiologically appears to fulfil the traditional indications for its use. Clinicians must be aware of specific situations in early internal fixation is contraindicated, particularly in those unstable patients requiring short damage control surgical procedures, avulsive soft and hard tissue defects and those injuries at increased risk of infection. SUMMARY: Staged surgery for complex injuries is increasingly becoming accepted, by which injuries are temporarily stabilized by means of maxillary--mandibular fixation (MMF) or an external fixation. Patients are subsequently repeat CT-scanned, and definitive internal fixation performed a few days later. Increased access to virtual surgical planning (VSP) and three-dimensional plates has revolutionized fracture reconstruction.

Inflammatory response and macrophage polarization using different physicochemical biomaterials for oral and maxillofacial reconstruction.

Knowledge about the action of immune system in the recognition of biomaterials has been extremely helpful when it comes about understanding host response and biomaterials' fate in human body. This study aimed to investigate inflammatory response and macrophage polarization during bone healing process of rat's calvaria critical defects using different bone materials in order to evaluate their influence on bone repair and on the quality of the newly formed bone tissue. Eighty male albinus Wistar rats underwent surgical procedure for the confectioning of a 5-mm diameter bone defect in their right parietal bone, and divided in four groups (n = 20 each), according the biomaterial: AG - Control, particulate intramembranous autogenous bone graft, HA/TCP - particulate biphasic calcium phosphate with HA/TCP (60/40), DBB - particulate deproteinized bovine bone, VC - particulate bioactive vitroceramic. After 3, 7, 21, and 45 days, the specimens were removed and prepared for microcomputed tomography (microCT), light and polarized microscopy, immunohistochemical analysis, and histomorphometry. No significant differences were detected considering percentage of leukocytes among the groups and periods, as well as in relation to immunolabeling for inflammatory (M1) and reparative (M2) macrophages. However, immunolabeling for bone marker indicated a delayed osteoblast differentiation in VC group, resulting in a decrease in mineralized bone matrix parameters in this group, revealed by microCT. In addition, AG and HA/TCP presented a satisfactory bone collagenous content. Despite the distinct origins and physicochemical properties of the tested biomaterials, they presented similar immune-inflammatory responses in the present experimental model, influencing bone-related proteins and bone quality, which must be considered according to their use.

Reconstruction of the through-and-through oral cavity defect with the fibula free flap.

OBJECTIVE: To evaluate our experience with reconstruction of anterior and lateral through-and-through defects of the oral cavity using the fibula osteocutaneous flap. STUDY DESIGN: Case series with chart review. METHODS: Review of patients undergoing reconstruction of through-and-through oral cavity defects between August 2006 and July 2008. Defect size, complications, and need for additional reconstruction were examined. RESULTS: Twelve patients were identified with through-and-through oromandibular defects reconstructed with the fibula. Soft tissue defects were successfully closed using a de-epithelialized segment to create two skin paddles. Four patients required additional pectoralis major flap reconstruction for secondary fibula skin loss (1), neck skin breakdown (1), delayed flap loss (1), and need for additional tissue for closure (1). CONCLUSION: The versatility of the fibula for through-and-through defects of the oral cavity is underestimated, and in most cases it is appropriate to reserve second flaps for salvage reconstruction.

Maxillofacial injuries caused by the 2008 Wenchuan earthquake in China.

PURPOSE: To describe the pattern of maxillofacial injuries sustained by survivors of the 2008 Wenchuan earthquake in the West China Hospital of Stomatology from May 12 to June 23, 2008. PATIENTS AND METHODS: Cross-sectional data were analyzed using hospital-based records of earthquake survivors admitted to the West China Hospital of Stomatology. A self-designed form to record information about variables such as the gender and age of the survivors and type of location of soft and hard tissue injuries was used. RESULTS: The age of earthquake survivors of maxillofacial injuries ranged from 4 to 84 years. Fractures and soft tissue injuries were the most common of all injuries in the maxillofacial region, constituting 40.7% and 38.9%, respectively. Thirteen patients (11.5%) had dental injuries and 9 (8.0%) also had other organ injuries. CONCLUSION: During the Wenchuan earthquake, the incidence of maxillofacial injuries in survivors was relatively low compared with injury in other organs. However, because most injuries were maxillofacial fractures and facial soft tissue damage, special attention was paid to maxillofacial injury when planning and providing emergency treatment. The effective management of earthquake injuries and those caused by other types of disaster requires a multidisciplinary approach, and maxillofacial surgeons should form an integral part of this multidisciplinary team.

Presentation and management of maxillofacial trauma in Dar es Salaam, Tanzania.

OBJECTIVE: To describe the presentation and management of maxillofacial trauma. DESIGN: A retrospective study. SETTING: Department of Oral and Maxillofacial Surgery, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. SUBJECTS: Patients presenting with maxillofacial trauma at the oral and maxillofacial surgery department of the MNH over a six year period (2001-2007). METHOD: Information was gathered including age, gender, length of interval between injury and presentation to the hospital, aetiology, pattern of soft tissue injury and fractures, therapy, co-morbidity, complications and number of hospitalisation days. RESULTS: The 21-30-year old age group was most affected. The overall male to female ratio was 4.3:1. The major cause of maxillofacial trauma was road traffic accidents (42.3%), followed by assaults (39.1%). Over 90% of the patients sustained soft tissue injuries, with cut wounds seen most frequently (45.0%). Of the soft tissue injuries, 75% required surgical intervention. Most of the fractures were located in the mandible (52.8%). Accompanying injuries elsewhere in the body occurred in 51.5%. Complications occurred in 13.3% of the cases. The mean hospitalisation period was 4.3 days. CONCLUSION: Road traffic accidents and assaults were the most common causes of maxillofacial trauma. Males below forty years of age were the majority of the victims.

A review of forensic analysis of dental and maxillofacial skeletal trauma.

Dental and maxillofacial trauma analysis in the forensic context, includes assessment of both living and deceased persons. It is required in all cases where human abuse is suspected and where signs of skeletal trauma are detected in human remains. Skeletal trauma refers to the damage inflicted to bone, teeth and other hard tissues. An accurate analysis of the dental and maxillofacial trauma is achieved by the assessment of the remains by forensic pathologists, anthropologists and odontologists. This paper aims to review dental and maxillofacial skeletal trauma in the scope of forensic science. High-velocity projectile, sharp force, blunt force, and thermal trauma showing different traits in maxillofacial structures are discussed. Regarding non-fatal physical abuse, head and neck are the most frequently injured areas, resulting in fractures, contusions, burns and traumatic dental injuries.

Clinical anatomy of the superior orbital fissure and the orbital apex.

BACKGROUND: There are discrepancies between authors as far as topography of superior ophthalmic vein in the orbital apex is concerned. OBJECTIVES: The aim was to determine the location of the structures within the posterior part of the orbit and in the superior orbital fissure. MATERIAL: One hundred preparations of orbits were derived from the corpses sectioned in Forensic Medicine Department, University Medical School in Warsaw, Poland. STUDY DESIGN: Anatomical preparation was performed with use of standard set of microsurgical equipment and operating microscope. RESULTS: Nine various morphological types of the superior orbital fissure were distinguished. Among those were two main categories: type "a" characterised by a clear narrowing within the fissure and type "b" which lacked such narrowing. The type "a" and "b" fissures were also different in length whereby type "b" fissure was significantly shorter. A diversity of positioning of the soft structures within those types was successfully noted. In type "a" the superior ophthalmic vein was located typically, however in type "b" fissures it was significantly more often the lowest structure in the posterior part of the orbital apex (except for muscles and orbital fat). A short case report of patient with superior orbital syndrome was added. CONCLUSION: Position of soft tissue structures in superior orbital fissure depended on its morphological type.

Characteristic changes of pediatric maxillofacial fractures in China during the past 20 years.

PURPOSE: The changes in the characteristics of maxillofacial fractures in pediatric patients during the past 20 years in China were investigated in an attempt to find valuable insight into the future prevention of such fractures. PATIENTS AND METHODS: In this retrospective study, all pediatric patients age 0 to 12 years treated for maxillofacial fractures at our hospital between January 1987 and December 2006 were included. The epidemiologic information, including patient's gender, age, etiology, fracture type, and fracture site were divided chronologically into two 10-year periods: period 1 (January 1987 to December 1996) and period 2 (January 1997 to December 2006). Both periods were compared and analyzed. RESULTS: The characteristics of pediatric maxillofacial fractures in our data remained relatively consistent during the past 20 years. The only confirmed significant difference was the change in proportion of maxillofacial fractures in patients 0 to 2 years of age. CONCLUSIONS: The characteristics of maxillofacial fractures can be influenced by social and economic factors; however, they are also associated with the subjects' social role in each particular age group. In China, the key to reducing occurrences of pediatric facial fractures is to prevent accidental falls in children as much as possible.

Maxillofacial injuries sustained during soccer: incidence, severity and risk factors.

A very popular sport worldwide, soccer generates a great number of maxillofacial injuries, mainly fractures, resulting in esthetic or functional problems. The aim of this retrospective study was to contribute to the knowledge of soccer-related maxillofacial injuries, and call attention to the risk factors that favor these injuries. A total of 108 patients, who attended hospital because of maxillofacial injuries during soccer within a period of 8 years, were included in this study. The relationship of the patients with soccer, the type, the site, the severity, the mechanism of the injuries and the applied treatment were analyzed. The injured were all males, and were principally amateurs. Around 89.8% of the patients suffered maxillofacial fractures while 10.2% presented only soft tissue injuries; 13.9% had multiple fractures; 50% of the maxillofacial fractures concerned the zygomatic complex and 38.2% the mandible where the majority occurred at the angle. The prevailing mechanism was the direct impact of players. Head to head impact outnumbered. Elbow to head impact caused contusions of the temporomandibular joint. Kick to head impact was the main cause of multiple fractures. The treatment of fractures was mainly surgical (68.2%). These findings support the fact that maxillofacial injuries sustained during soccer tend to be severe, demanding surgical treatment. The mandibular angle is in danger due to the usual existence of impacted and semi-impacted third molars. There should be a preventive intervention on the above contributors, and mainly coaches and sports physicians should be properly informed about the specificity of the maxillofacial injuries.