Temporomandibular Dysfunction After Surgery of Mandibular Fractures Not Involving the Mandibular Condyle: A Prospective Follow-Up Study

Purpose: Facial trauma can lead to temporomandibular dysfunction (TMD). The aim of this study was to clarify the occurrence and characteristics of TMD in patients surgically treated for mandibular fractures not involving the mandibular condyle.Materials and Methods: This prospective single-center follow-up study was composed of patients who underwent surgery for non-condylar mandibular fracture. Patients were evaluated at presentation and 6 months after surgery to assess the function of the masticatory system using the Helkimo index. Specifically, this index incorporates 2 complementary subindices: the subjective symptomatic (anamnestic) index (Ai) and the objective clinical dysfunction index (Di). The Ai score was recorded at presentation and 6-month follow-up. The Di score was recorded at 6-month follow-up.Results: Thirty-one patients completed the study. All patients were men (mean age, 26.2 yr; range, 18 to 47 yr). Four (12.9%) developed severe symptoms of dysfunction during the study period according to the Ai. Clinical findings (Di) were observed in 25 patients (80.6%), but these were not associated with symptoms of dysfunction.Conclusions: TMD is common 6 months after surgery in patients with non-condylar mandibular fractures. Patients with such fractures should be evaluated for dysfunction during follow-ups and referred for further treatment if necessary.</p

Health-related quality of life of patients with zygomatic fracture

Background: The objective was to evaluate health-related quality of life (HRQoL) before and after surgical treatment of zygomatic complex fracture and assess patients’ perceptions of the aesthetic and functional outcomes of surgery. Material and Methods: A prospective study of 79 adult patients before and after surgery for zygomatic complex fracture was conducted. HRQoL was measured using the generic 15-dimensional (15D) instrument, and patient satisfaction was assessed by an additional questionnaire. Results: The mean preoperative 15D score for patients was lower than for general population that was matched for age and gender (p=0.011). The mean 15D score was lowest on the first postoperative day (p<0.001) when patients were worse off for 6 of the 15 dimensions of the HRQoL instrument and better off for three dimensions. However, patients achieved, and even exceeded, the mean 15D score of the general population during the first month following surgery. Infraorbital sensory loss at the end of the six-month follow-up appeared to be the single most important factor that plagued the patients. Conclusions: HRQoL is significantly reduced after trauma but improves a few weeks after surgery. Infraorbital nerve sensory loss is a notable long-term factor that affects patients after zygomatic complex fracture. Key words:Zygomatic fracture, maxillofacial trauma, health-related quality of life, disturbance of infraorbital nerve, facial sensation

Urban drinking and driving:comparison of electric scooter and bicycle related accidents in facial fracture patients

In recent years, electric scooters (e-scooter) have emerged as an alternative mode of urban transport due to their availability and effortless use. However, e-scooter-related trauma and injuries, especially to the head, have received wide media coverage and raised public concern about their safety. We aim to determine and compare clinically relevant variables, incidence, and severity between bicycle and e-scooter-related facial fractures and potential protective measures for injury prevention. This retrospective study comprised all patients admitted to a tertiary trauma center with bicycle or e-scooter-related facial fractures between January 2019 and October 2020. Patient- and injury-related variables, including demographics, injury mechanisms, helmet use, influence of alcohol, types of facial injuries, types of other injuries, given treatment, and hospital stay, were collected, analysed, and compared between bicycle and e-scooter injuries. Altogether 169 patients with facial fractures, 124 bicycle-related injuries (73.4%) and 45 e-scooter-related injuries (26.6%) were included. Alcohol involvement was significantly higher in e-scooter patients (88.9%) than in bicycle patients (31.5%) (p<0.001). Driving under the influence of alcohol was associated with driving without a helmet in both groups (p<0.001). In multivariate analyses, e-scooter accidents were 18 times more likely to occur under the influence of alcohol (OR 17.85, p<0.001) and were more likely to involve collision with a stationary object (OR 3.81, p=0.028). E-scooter patients were significantly younger (OR 0.95, p<0.001) and had significantly more cranial fractures (OR 10.15, p=0.014) than bicycle patients. Compared with patients in bicycle accidents, facial fracture patients injured in e-scooter accidents are younger, are more likely under the influence of alcohol, and sustain more severe craniofacial skeleton fractures. Our results for both groups of patients advocate stricter adherence to helmet and road safety legislation as well as public education for injury prevention

Etiology of facial fractures in elderly Finns during 2006-2007

Objective. The purpose of the present study was to clarify the trauma mechanisms and resulting facial fractures in geriatric patients and to compare them with those of younger adults. Study Design. A cohort of 117 geriatric patients was compared with 136 patients aged 20 to 50 years. The statistical significance of differences between the age groups was evaluated with c2 tests. Results. Falls on the ground were significantly more frequent among geriatric patients (P < .001), whereas assault was more frequent in controls (P < .001). Accident rates in geriatric patients were significantly higher during the winter months (P = .04). Fractures of the midface in general (P = .001) and of the nasal bone (P = .004) and orbit (P = .015) in particular were more frequent in geriatric patients. Conclusions. Age-related factors and preexisting medical problems predispose the elderly to falls and subsequent fractures. Footwear traction devices are recommended during the cold season. Orbital fractures should be strongly suspected in the elderly.Tutkimuksen tarkoitus on selvittää millä vammamekanismilla ja minkä tyyppisiä kasvomurtumia geriatriset potilaat saavat, sekä verrata löydöksiä nuorten aikuisten kasvomurtumalöydöksiin Tutkimukseen kerättiin 117 ikääntynyttä (ikä vähintään 65 -vuotta) ja 136 nuorta (ikä 20 – 50 -vuotta) kasvomurtumapotilasta. Tulosten ja ryhmien välistä tilastollista eroavaisuutta arvioi-tiin Chin-neliötestillä. Tutkimustuloksina todettiin että geriatrisen potilaan kasvomurtuma syntyy tilastollisesti merkittävästi useammin kaatumisen seurauksena, kun taas nuorilla aikuisilla välivalta on merkitsevästi yleisempää, (P < .001). Vammojen esiintyvyys oli huomattavasti korkeampi talvikuukausien aikana geriatrisilla potilailla kuin nuorilla aikuispotilailla, (P = .04). Keskikasvomurtumat (P = .001) ja erityisesti nenäluun (P = .004) sekä silmäkuopan (P = .015) -murtumat olivat tilastollisesti merkitsevästi yleisempiä ikääntyneillä kuin nuorilla aikuispotilailla. Yhteenvetona ikään liittyvät tekijät ja olemassa olevat perussairaudet altistavat vanhuspotilaan kaatumiselle ja sen seurauksena syntyville kasvomurtumille. Liukastumista estäviä kävelyvarusteita voidaan suosittaa kylminä vuodenaikoina kasvomurtumien estämiseksi. Potilaan tutkivan lääkärin tulisi epäillä vahvasti ja poissulkea erityisesti silmäkuopan murtumat ikääntyneellä kasvovammapotilaalla

Influence of perioperative dexamethasone on delayed union in mandibular fractures: a clinical and radiological study

Background: The aim was to clarify the occurrence of delayed union after surgical treatment of mandibular fracture and investigate whether an association exists between perioperative use of dexamethasone and delayed union. Material and Methods: Thirty-seven patients were included in a prospective randomized study. Of these patients, 19 (51.4%) were randomized to receive a total dose of 30 mg of dexamethasone and 18 (48.6%) served as controls. Patients underwent clinical and radiological investigation immediately, one month, three months and six months postoperatively. Radiographs were evaluated by an experienced, blinded senior oral radiologist. Results: Delayed fracture union was found in 9 patients (24.3%). It was associated significantly with angle fractures (p=0.012). Delayed union occurred more frequently in patients who received dexamethasone (36.8%) than in those who did not (11.1%) (p=0.068). The association of infection with delayed union was significan t ( p=0.027). Moreover, dexamethasone was significantly ( p=0.019) associated with delayed fracture union with concomitant infection. Gender, age group, smoking habit, treatment delay and duration of surgery were not associated with delayed union. Conclusions: Infection was associated with delayed union. Short-term high-dose dexamethasone predisposed to complicated fracture union, especially in patients with angle fractures. The relationship between dexamethasone and delayed bone healing without infection remains unresolve

Incidence, aetiology and pattern of mandibular fractures in central Switzerland

The two major causative factors for mandibular fractures, as stated in the literature, are either interpersonal violence or motor vehicle accidents. The purpose of this study was to describe epidemiological trends of mandibular fractures in Switzerland. A special emphasis was directed towards the potential impact of socio-economic standards on the mechanism and pattern of mandible fractures

Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction

Lower eyelid malposition (LEM) is a common sequela after orbital fracture reconstruction. This study aimed to analyse the development of LEM, specifically ectropion and entropion, following primary orbital fracture reconstruction, to identify predictive factors for LEM, and to assess the effect of the eyelid complication on patients' daily lives. The retrospective cohort comprised patients who had undergone orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type and site, surgery and implant-related variables, follow-up time and number of visits, type and severity of LEM, subsequent surgical correction, and patient satisfaction, were analysed. The overall occurrence of LEM was 8%, with ectropion in 6% and entropion in 2% of patients. Older age, complex fractures, transcutaneous approaches, preoperative traumatic lower lid wounds, and implant material were associated with the development of LEM. Of all patients, 3% needed surgical correction of LEM. Six of the 13 patients (46%) who developed LEM required surgical correction. The transconjunctival approach and patient-specific implants should be preferred, especially in elderly patients and those with more complex fractures. LEM often requires subsequent surgical correction, and the treatment period is substantially prolonged, with multiple extra visits to the clinic

Health-related quality of life in patients surgically treated for orbital blow-out fracture: a prospective study

Purpose The purpose of this study was to evaluate patients' health-related quality of life (HRQoL) before and after surgical treatment of orbital blow-out fracture. Methods This prospective study comprises of all adult patients undergoing a surgical reconstruction of an orbital blow-out fracture in 2006-2010. Their HRQoL was evaluated for 6 months postoperatively with the aid of the standardized 15D instrument and was compared with that of an age- and gender-standardized sample of the general Finnish population. A complementary questionnaire for more detailed information was also administered. Results Twenty-six patients completed the study. Mean 15D score among the patients preoperatively (0.898) was statistically significantly and clinically importantly worse than the score of the control population (0.936). Six months postoperatively, the mean 15D score was 0.920, with no significant difference compared with the control population and the significant differences on the different dimensions had disappeared. The most common complaint at 6 months postoperatively was diplopia in daily life (19%). Disturbances in facial sensation (27%) and defects in facial appearance (15%) were the most unpleasant subjective outcomes. Conclusion The HRQoL is significantly decreased after orbital blow-out fracture compared with the general population but will recover completely in 6 months. Thus, the negative impact of orbital blow-out fracture on HRQoL is only transient. Disturbances in facial sensation, defects in facial appearance, and diplopia are the most common subjective complaints after the injury and its surgical treatment. However, these do not appear to affect the overall quality of life in the long term.</div

Dental injuries in paediatric mandibular fracture patients

Purpose Dental injuries (DIs) are associated with facial fractures, particularly mandibular fractures. As paediatric mandibular fractures have special features, we sought to clarify the occurrence and types of DIs among this patient group. We assessed how age, injury type, and fracture location affects the occurrence of DIs and thereby defined which patients are most susceptible. Methods This retrospective study included patients < 18 years with a recent mandibular fracture. Predictor variables were gender, age group, mechanism of injury, type of mandibular fracture, and other associated facial fracture(s). Types and locations of DIs and tooth loss due to injury were also reported. Results DIs were detected in 34.7% (n = 41) out of 118 patients. Patients with tooth injury had on average 3.5 injured teeth. A total of 16.2% of injured teeth were lost, typically at the time of the injury. Loss of at least one tooth was seen in approximately 10% of patients. Avulsion was the most common cause of tooth loss (52.2%). Non-complicated crown fracture (50.7%) was the most common DI type. Statistically significant associations between studied variables and DIs were not detected. Conclusion DIs are common and often multiple in paediatric mandibular fracture patients regardless of background factors. DIs often lead to tooth loss. Prompt replantation of an avulsed tooth, early detection of DIs, and prevention of tooth loss whenever possible are important to avoid permanent tooth defects