Etiology, Outcome and Mortality Risk Factors in Children Burn

Mortality rate of burn patients can serve as an objective criterion for quality control and as a measure for research and preventive programs. A prospective study of burn victims, from data of burn registry program, was conducted to determine the etiology, risk factors of mortality and outcome of pediatric burns. We had 514 patients below 15 years old. Burns caused by scalding were the most frequent (55.4%) followed by flames (35.8%). Mean (SD) of age was 3.72 (3.19) years. Male to female ratio was 1.62:1. Mean hospital stay was 14.17 days (range 0 - 46 days). The mean TBSA (SD) was 15.22% (14.31%). Fifty three patients had inhalation injury (11.25%). Inhalation injury increases the risk of death (Odds Ratio: 8.75, p = 0.009). Length of stay increased in accordance with burn area (p < 0.002). Burn wound infection was present in (35.4%) of our patients. The univariate statistics analysis and a pooled, cross-sectional, multivariate logistic regression were done. The major risk factors were: Inhalation injury (OR = 8.75, p = 0.009) and lack of intra-venous fluid resuscitation before reaching the hospital (OR = 40.5%, p = 0.001), cause of burn (flame and chemical) and referral cases from other centers (OR = 3.66, p < 0.0001). The minor risk factor was age. About 83% of our patients discharged with partial recovery, 10% with complete recovery, 0.1% referred to other hospitals and 1.36% died.

Acute electrical injury: A systematic review

Objective: To review low-voltage, high-voltage and lightening electrical burns in adults and children, identify novel areas that are not recognized and improve treatments results and outcome. Methods: An extensive literature search on electrical burn injuries was performed using Ovid Medline, PubMed and Embase databases from 1976 to 2016. Studies related to electrical injury in the adult and children (< 15 years of age) population were included in our study. Fifty-one research papers and review articles were identified and included in this study. Results: Total occurrence of electrical injury among burn injuries ranged from 3.5% to 15.0%. Most of them were low voltage (73%) and one fourth were high voltage and percentage of lightening injuries were very low around 2%–4% of total cases of electrical injury. Mortality is somehow higher among high voltage electrical injuries and lightening. Most of complications of them were morbid in kidney, heart, extremities (including amputations) and nervous systems. Long-term psychological problems were reported with greater incidence rates in high-voltage injuries. Psychological and posttraumatic stress disorders were also reported. Mortality rates from electrical injuries were 2.6% in low voltage and 5.2% in high voltage. Conclusions: High-voltage injury leads to greater morbidity and mortality than low-voltage one. Lightening has mortality of about 32%, higher rates of complications and specialty long-term complications. Strict multi-specialty treatment and rehabilitations are required for proper treatment of electrical injuries.

Horizontal Chin Bar

Background: Correction of long face and chin retrusion has a significant effect on facial aesthetic and symmetry. Bimaxillary (Bimax.) Operation has been performed for long face and bimaxillary dentoalveolar protrusion. But bimaxillary surgery cannot address all of complex deformity of mandible. The new technique using horizontal chin bar can treat mandibular dentoalveolar protrusion and chin retrusion in one setting. Objectives: To evaluate the results of mandible segmental osteotomy and jumping genioplasty;To illustrate the versatility and the ease of this procedure and to confirm the good to excellent clinical results obtained with minimal complications. Design: Retrospective study setting, all of the patients of university hospital and private practice who seek medical attention for long face and retruded (and/or deviated) chin were included in the study. Patients and surgeons satisfaction were evaluated. Results: 45 patients, aged 19 - 30 years (mean age, 24 ± 6 years) underwent the creation of a horizontal chin bar (4 - 7 mm wide) as an axis for two opposite bone movement (and a place for fixation) of mandibular dentoalveolar segment and lower chin segment [segmental lower jaw (Kolle’s) operation and genioplasty], and/or with concomitant Bimax. operation. The mean chin advancement was 8 mm (4 - 10 mm). Average setback for mandible was 3 mm (2 - 6 mm). No bone resorption was identified. No permanent nerve paresthesia was noted. There was one case of the bar fracture due to narrowness of the bar. 37 patients were highly satisfied and 8 were satisfied with the results. There was no dissatisfaction in our patients and surgeons. Conclusion: For long face and retruded chin one of the best treatments is horizotal chin bar method with very good long-term results. EBM: Level IV.

Frequency of Blindness Due to Zygomatic Fracture in Hazrat Fatemeh Hospital

Background: Zygomatic fracture is one of the most prevalent one among facial fractures caused by vehicle accident, motorcycle accident, fighting, fall and sport injuries. Materials & Methods: This study was a retrospective study of our patients during past 6 years. Results: We had 1277 facial fractures, of whom 9 patients had blindness. We had 193 patients with Zygomatic fracture. 98 patients had pure zygomatic fracture and other had complicated fractures. Frequency of blindness due to zygomatic fracture in a period of six years was 4.7% in all and in pure zygomatic fractures was 2.04%. Blindness was most prevalent in age group 20 - 29 years old (55.6%). The most prevalent cause of zygomatic fracture which causes blindness, was motor vehicle accident (77.8%). Blindness was more common in males (77.8%) than females (22.2%). Discussion and Conclusions: One of the most disastrous complication of zygomatic fracture is transection of optic nerve. Very careful examination of fractured bones careful examination of optic nerve and visual acuity and urgent operation and decompression of optic nerve must be performed. About 4% - 5% will have blindness purely due to fracture.

Maxillary Distraction Osteogenesis

Background: Distraction Osteogenesis is popular for long bones. And nowadays it has found its role in facial bone deficiency treatments. Purpose: We used our special designed Distractor for advancement of Maxillary deficiencies in cleft lip and palate patients. The purpose of this paper is to compare the treatment of hypoplastic, posteriorly retruded maxillary of cleft palate patients using distraction osteogenesis vs. Le fort I orthognathic surgery for length of advancement, stability and relapse, growth after distraction and soft tissue expansion and soft tissue profile changes. Meterial & Methods: In group A only Le fort I and surgical maxillary advancement sometimes with bone graft were done. In group B we used our special Distractor for Distraction Osteogenesis and advancement of the Maxillary bone. Demographic data, length of retrusion of maxilla, time length of treatment, length of advancement and relapse, SNA and SNB angles were measured and included in the study. The results were compared in each group before and after advancement and between both groups. The rate of distraction was 0.5 mm twice per day to achieve normal occlusion with 2 mm overcorrection more than calculated measures. The devices removed after 10 weeks as latency period. Results: The SNA increased at the end of distraction (p < 0.001), with no significant relapse indicating stability at 1 year after treatment. The total length of advancement in group A was 17 ± 4 mm and in group B was 20 ± 3 mm. The difference between before and after measurements in each group was significant (p = 0.002, p = 0.003 respectively). The mean length of relapse in group A was 3 ± 1 mm and in group B was 1 mm. Discussion: For the deformities and retrusions less than 7 - 8 mm, the Orthognatic surgery is the treatment of choice, however for more retrusions (>10 mm) we recommend Distraction Osteogenesis, and it preferred to start it soon in younger ages.