Epidemiology of maxillofacial trauma in the elderly: a European multicenter study

ABSTRACT Introduction: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). Materials and Methods: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). Results: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (p<.005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (p <.05) and a high FISS score (p <.005) were associated with concomitant body injuries too. Conclusions: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.Peer reviewe

Relation between paranasal sinuses and surrounding bone tissue

Introduction. The formation and increase in volume of the paranasal sinuses occurs during the growth and development of the facial skull. Pneumatization of the sinuses and bone architectonics can have the variability. Understanding of the midfacial bones architectonics is a key to successes in osteosynthesis, reconstructive, orthognathic surgery, dental and maxillofacial implantation.The aim. Study the individual features of the normal anatomical structure and architectonics of the midfacial bones and to develop the objective criteria for assessing the relationship between bone elements and airways using methods of computed tomography.Materials and methods. 30 patients spiral computed tomograms with no signs of pathology were analyzed. Relations between volume and surface of the bony elements and airways, the ratio between the volume of bone and air cavities pneumatization index (PI) were determined.Results. PI ranged from 0.8 to 1.9 and averaged 1.22 ± 0.29. Range from 0.9 to 1.5 was considered a normal ratio. Index values exceeding 1.5 indicated a sclerotic type of the midfacial bone structure, and less than 0.9 indicated a pneumatic type.Conclusions. The anatomical structure, architectonics of the midfacial bones and the degree of their pneumatization are characterized by significant individual variability. For an objective integrated assessment of the bone architectonics of the midfacial area the ratio of the bone volume to the volume of the airways (PI) and the volume of bone to its surface area can be used.</p

The epidemiology of edentulous atrophic mandibular fractures in Europe

Introduction: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented. Methods: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay. Results: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I \u2013 II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries. Conclusions: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites