Epidemiology of Maxillofacial Trauma in Pediatric and Adolescent Population: An Institutional Experience of 6 Years

Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients. Worldwide, the major causes of fractures in children are accidents, falls, violence, and sports- related accidents. Facial trauma in children may result in injury to the facial growth centers, leading to subsequent developmental abnormalities in the injured area. Patients & Methods: Data of pediatric and adolescent patients (0 - 17 years), with a history of trauma, has been compiled over a period of 6 years. History, clinical and radiographic data records were analyzed. Compilation was done in the following categories;age and sex distribution, etiology, site of trauma and associated soft tissue injuries were recorded. The treatment rendered has also been mentioned. Results: A total of 340 patient records were assessed. Demographic data, etiology, type of fracture, associated injury and treatment rendered were recorded. It was found that males (54.7%) were more frequently affected than females (45.3%). Incidence of trauma was more in children belonging to the pre-school age group (38.5%) and the most common etiology was sports-related injuries (43.8%). Dentoalveolar fractures were the most common type (58.5%) of fractures seen in the patients. Most of the patients were managed by conservative treatment (35%) or closed reduction (48%), while a few required open reduction (7.9%). Conclusion: It is felt that this data will be useful in determining the pattern and etiology of maxillofacial trauma in pediatric patients in an Indian setting. Additionally, an outline of the treatment plan in different types of fractures is also summarized.

The use of recombinant human bone morphogenetic protein-2 （rhBMP-2） in maxillofacial trauma

In recent years, recombinant human bone morphogenetic protein-2 （rhBMP-2） has been introduced as a therapeutic option in the treatment of several congenital and acquired craniofacial defects. Although there have been promising clinical results, the international literature still lacks complete guidelines, including limits and indications for the use of rhBMP-2. The possible indications for rhBMP-2 in patients undergoing facial trauma are discussed in this article.

A serial case study of the combined use of intraoperative CT and surgical navigation system for the removal of small foreign bodies in the maxillofacial region

Purpose:The removal of small foreign bodies embedded within the deep soft tissues of the maxillofacial region is a complex and challenging task for maxillofacial surgeons.The purpose of this study was to explore the efficacy of the combination of intraoperative CT and surgical navigation for the removal of small foreign objects in the maxillofacial region.Methods:A serial case study was conducted involving all consecutive patients who underwent surgical removal of small foreign bodies in the maxillofacial region.The combination of intraoperative CT and a surgical navigation system was used at a single medical institution from January 2018 to December 2022.Comprehensive data,including patient demographics,characteristics of the foreign bodies,previous surgical interventions,duration of the surgical procedure,and removal success rate were collected for this study.Relevant data were recorded into Microsoft Excel sheet and analyzed using SPSS version 22.0.Results:Nine patients(6 males and 3 females)were included in this study,with an average age of 37 years.Each patient had previously undergone an unsuccessful removal attempt utilizing conventional surgical methods based on preoperative CT imaging or C-arm guidance at a local healthcare facility.Four patients also experienced unsuccessful attempts with preoperative CT image-based navigation systems.However,by employing the combined approach of intraoperative CT and surgical navigation,the foreign bodies were successfully removed in all 9 patients.The mean duration of the surgical procedure was 59 min,and the average size of the foreign bodies was approximately 26 mm^(3).Postoperative follow-up exceeding 6 months revealed no complications.Conclusion:The combined use of a surgical navigation system and intraoperative CT represents a potent and effective strategy for the precise localization and subsequent removal of small foreign bodies from the soft tissue structures of the maxillofacial region.This integrative approach appears to increase the success rate of surgical interventions in such cases.

Evaluation of the Severity of Maxillo-Facial Injuries by Motorcycle Road Accident in the Teaching Hospital of Conakry: A Case-Control Study

Introduction: Maxillofacial injuries caused by motorcycle road accidents are serious and represent a real public health issue. They mainly affect young adult males. The objectives of this study were to determine the frequency of motorcycle road accidents, describe the socio-demographic characteristics of the injured, determine the degree of severity of motorcycle injuries compared to car injuries, and describe the therapeutic modalities. Materials and Method: This study was a prospective case-control study carried out in the Department of Odontostomatology, Maxillofacial Surgery and Surgical Emergencies at the National Hospital of Donka. The data was collected over a period of six months from January 1st to June 30th, 2017. All victims of road accidents by motorcycle (cases) or car (controls) that received care and post-surgical follow up were included. Results: A total of 505 patients with maxillofacial injuries were reviewed during the period of the study. From the review, 205 (40.6%) motorcycle accidents were recorded as “cases” and 109 (21.58%) car accidents were classified as “controls” group. Men were the most affected in both groups, n = 254 (177 males in the case group and 77 in the control) (p = 0.01). There was a proportionate relationship between helmet use and death (p = 0.015). A motorcycle accident victim is more likely to develop a mandibular fracture (p = 0.029) and limb injury (p = 0.034) when compared to a car accident victim. However, there was no significant difference between cases and controls for head trauma (p = 0.4878), Facial Injury Severity Scale (FISS) (p = 0.130), and Glasgow score (p = 0.709). Conclusion: Maxillofacial injuries caused by motorcycle accidents are increasing in Guinea. Young adult males have the highest incidence of motorcycle accidents. The death rate related to motorcycle road accidents is high, and mandatory use of a helmet for all drivers and passengers is recommended. These preventative actions could reduce the mortality and morbidity of motorcycle road accidents in Guinea.

Maxillofacial and concomitant serious injuries： An eight-year single center experience

Purpose： Maxillofacial injuries are frequently associated with multiple trauma and can determine func- tional and aesthetic bad outcomes.The severity ofmaxillofacial injuries may be considerable and can divert clinicians＇ attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department （ED） of the University Hospital of Messina （North-East Sicily, Italy） for maxillofacial traumas. Methods： We retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different in- stitutions, pediatric trauma patients and adult patients who were transferred in accordance with pre- existing agreements in case of paucity of beds were excluded. Finally we included 447 （0.2%） patients over the 8 years. Data were evaluated with emphasis on epidemiology （age, gender, mechanism of trauma）, primary survey and abnormalities and pattern of trauma. Results： The most frequent cause of maxillofacial trauma was road accidents （319 patients, 71.4%）, among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients： 443 （99.1%） patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries （x^2 = 557.2, p 〈 0.0001）. Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas （x^2 = 17.13, p 〈 0.0001 vs minor lesions）. All of the neglected lesions occurred in pauci- symptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hema- toma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms. Conclusion： Among the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit. diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial maior lesions.