New trends and insights in facial fracture treatment in the United States

Aim:Facial fractures have multiple etiologies,including motor vehicle collisions,interpersonal violence,falls,and sports-related accidents.The objectives of this study are to reassess,compare,and expand the epidemiologic analysis and postoperative complication rates of facial fracture treatment.Additionally,we sought to compare the length of stay and operative time outcomes between plastic surgeons and non-plastic surgeons.Methods:NSQIP(National Surgical Quality Improvement Program)participant databases were queried to identify all patients undergoing facial fracture operations.Epidemiological data was divided into two groups and compared by surgeon specialty:patients operated on by a plastic surgeon and patients operated on by a non-plastic surgeon.Our primary outcomes of interest were operation time and length of stay.Postoperative complications included wound complications,mortality,return to the OR,and major bleeding.Results:3,354 patients underwent facial fracture repair(2012 to 2016).In men,the most common fracture was mandibular(40.9%);in women,the most frequent was orbital(32.4%).79.6%had single facial fractures and 20.4%had multiple facial fractures.Plastic surgeons’operating time was less than that of non-plastic surgeons(P=0.0007).The average length of stay was higher for the plastic group(mean=1.65 days,plastic)(P<0.00001).Postoperative complication variables showed no statistically significant differences between the plastic and nonplastic groups.Conclusion:Continuous epidemiologic analysis is vital for the proper allocation of healthcare resources to the most affected facial fracture patients in the US.Assessment of complication rates between surgical specialties allows a better understanding of the management of facial fracture patients on a national level.Our data analysis may allow surgeons to better counsel patients preoperatively and improve inter-specialty collaboration.

Operative technique for a combined transcaruncular-transconjunctival approach to double-walled orbital fractures

Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma.Operative intervention is indicated in the presence of persistent diplopia,significant enophthalmos,or muscle entrapment.Surgical repair of these injuries may be challenging due to large fracture sizes or loss of bony supports.The transconjunctival and transcaruncular approaches have been popularized to reconstruct isolated floor and medial wall fractures,respectively.However,surgical approaches for fractures involving both these walls have not been well described in the literature.In this technical note,we detail a combined transcaruncular-transconjunctival approach that is safe,effective,and aesthetically sensitive.