The Characteristics of Facial Fractures and Associated Injuries in Geriatric Facial Trauma Patients

The aims of the present study were to identify the characteristics of facial fractures in geriatric patients and to compare them with younger adults. The hypotheses were that the causes and resulting types of facial fractures are different, and that geriatric patients are more severely injured than younger controls. The present study focused on three different patient populations, diagnosed and treated for facial fractures at a level I trauma center and at the Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland. The study included patients with all types of facial fractures (Studies I and II), with a unilateral orbital fracture (Study III), and with a unilateral ZMO fracture (Study IV). The commonest cause of facial fractures in geriatric patients was falling on the ground, whereas younger adults commonly sustained their injuries due to assault (Studies I to IV). Midfacial fractures were significantly more common in geriatric than younger adult patients (Study I). Orbital fractures were significantly more often extensive among geriatric than younger adult patients (Study III). Associated injuries (AIs) in general, multiple AIs, and mortality were significantly more frequent among the elderly when compared to younger controls (Study II). In patients diagnosed with isolated ZMO fractures, AIs in general and traumatic brain injuries (TBI) in particular were significantly more frequent among the geriatric than the younger control group (Study IV). The causes and resulting types of facial injuries differ between geriatric patients and younger adults, and midfacial fractures need to be meticulously excluded in geriatric patients. The frequency and severity of AIs in geriatric facial trauma requires systematic trauma assessment, repeated examination of patient’s condition, and care in collaboration with several specialties.Tutkimuksen tavoitteena oli selvittää vanhuspotilailla diagnosoitujen kasvomurtumien erityispiirteet sekä verrata kasvomurtumien eroavaisuuksia ikääntyneiden ja nuorten aikuispotilaiden välillä. Tutkimuksen oletuksena oli, että ikäryhmien välillä on eroavaisuuksia niin kasvomurtumien kuin vammojen vakavuuden suhteen. Tämä tutkimus analysoi kolmea eri potilasaineistoa, joita oli hoidettu kasvomurtumien takia Helsingin ja Uudenmaan sairaanhoitopiirin, suu- ja leukakirurgian päivystyspisteessä ja suu- ja leukakirurgian osastolla. Tutkimus osoitti että ikääntyneiden, vähintään 65 -vuotta täyttäneiden, potilaiden yleisin kasvomurtuman syy oli maan tasalla kaatuminen, kun taas nuorten aikuisten kasvomurtumat syntyivät väkivallan seurauksena. Vanhuspotilailla todettiin merkitsevästi enemmän keskikasvojen murtumia nuoriin aikuisiin verrattuna, jonka lisäksi silmäkuopan murtumat olivat merkitsevästi vakavampia vanhuksella kuin nuorella aikuisella. Kasvomurtuman yhteydessä todetut muita kasvojen ulkopuolisten kehon osien oheisvammoja esiintyi vanhuksella merkitsevästi useammin kuin nuorella aikuisella, jonka lisäksi oheisvammat olivat vakavampia ja vanhukset kuolivat useammin vammoihinsa sairaalahoidon aikana. Tutkimus osoittaa, että ikääntyneiden potilaiden ja nuorten aikuisten välillä on merkitsevä ero kasvomurtumien mekanismin, todettavien kasvomurtumien ja kasvomurtuman vakavuuden suhteen. Kasvomurtumien diagnostiikka ja hoito vaativat monialaista yhteistyötä, erityisesti vanhuspotilaiden osalta

"A" stands for airway - Which factors guide the need for on-scene airway management in facial fracture patients?

Background Numerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management. Methods This retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria. Results Of the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital. Conclusions Proper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.Peer reviewe

Zygomatico-Orbital Fracture-Dislocation in Surgical Treatment : Novel 3-Dimensional Software Automated Analysis

Purpose The human capability to detect the degree of zygomatico-orbital (ZMO) fracture dislocation in surgical treatment is unknown. The aim of the study was to examine the association between ZMO fracture dislocation and injury etiology and treatment. Methods The investigators implemented a retrospective cross-sectional study and enrolled a sample composed of patients with an isolated unilateral ZMO fracture and analyzed fracture dislocation from computed tomography (CT) images with an automatic algorithm. The primary predictor variable was mean surface point-to-point dislocation (the mean distance of dislocation for all surface points in isolated ZMO fracture segments between the original position and after virtual repositioning). The primary outcome was the treatment choice (operative versus nonoperative). Other studied variables were gender, age group, injury mechanism, clinical asymmetry, and human-evaluated dislocation in CT images. Descriptive and bivariate statistics were computed, and the threshold for statistical significance was set at P <.05. Results The sample consisted of 115 subjects with a mean age of 66.3 years, 66.1% of whom were male, and the most common cause of injury was falling on the ground (49.6%). Operative treatment was required for 58 (50.4%) subjects. There was a significant association between mean dislocation and operative treatment. The mean dislocation of operatively vs. nonoperatively treated fractures was 2.39 vs. 1.05 mm (P <.001). Mean fracture dislocation was greatest in injuries caused by assault (2.41 mm) and smallest in MVAs (1.08 mm) and ground-level falls (1.25 mm). The threshold of human eye detection for ZMO fracture dislocation was 1.97 mm. Conclusion The results of the present study demonstrate that the threshold for operative treatment of ZMO fracture dislocation is over 2 mm, which the human eye is able to detect. True dislocation is greater in younger than elderly patients and in injuries caused by assault compared to falling.Peer reviewe

Primary reconstruction of combined orbital and zygomatic complex fractures with patient-specific milled titanium implants- A retrospective study

The aim of this retrospective study was to compare mid-facial symmetry and clinical outcomes between patients treated with patient-specific and standard implants in primary fracture reconstructions of combined orbital and zygomaticomaxillary complex fractures.Patients who underwent primary reconstruction of orbital and zygomaticomaxillary complex frac-tures during the study period were identified and background and clinical variables and computed to-mography images were collected from patient records. Zygomaticomaxillary complex dislocation and orbital volume were measured from pre-and postoperative images and compared between groups.Out of 165 primary orbital reconstructions, eight patients treated with patient-specific and 12 pa-tients treated with standard implants were identified with mean follow-up time of was 110 days and 121 days, respectively. Postoperative orbital volume difference was similar between groups (0.2 ml for patient-specific vs 0.3 ml for standard implants, p = 0.942) despite larger preoperative difference in patient-specific implant group (2.1 ml vs 1,5 ml, p = 0.428), although no statistical differences were obtained in symmetricity or accuracy between the reconstruction groups.Within the limitations of the study it seems that patient-specific implants are a viable option for primary reconstructions of combined zygomaticomaxillary complex and orbital fractures, because with patient-specific implants at least as symmetrical results as with standard implants can be obtained in a single surgery.(c) 2022 The Authors. Published by Elsevier Ltd on behalf of European Association for Cranio-Maxillo-Facial Surgery. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).Peer reviewe

Mandibular fractures in aged patients - Challenges in diagnosis

Background/Aims Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses. Material and Methods Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged >= 60 and 80 years), patient's age as a continuous variable and age sub-group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury. Results Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p = .02) and site of injury (p = .02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury. Conclusions There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder.Peer reviewe

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

Syöpäpotilaan suun ja hampaiston hoito

Vertaisarvioitu.Syöpähoitoa edeltävän suun tarkastuksen tavoite on ehkäistä infektiokomplikaatioita sekä parantaa suun terveydentilaa hoidon aikana ja sen jälkeen. Näyttö suun kroonisten infektiopesäkkeiden vaikutuksesta syöpähoidon ennusteeseen on vähäistä ja akuutit hammasperäiset infektiot hoidon aikana harvinaisia. Silti suun tarkastuksen sisällyttäminen hoitokokonaisuuteen heti diagnoosin jälkeen on suositeltavaa sairauden tai hoitojen takia suurentuneen infektioriskin vuoksi. Syöpähoitoja edeltävän hammashoidon tulee painottua sairautta ehkäiseviin toimenpiteisiin. Kroonisten infektiopesäkkeiden radikaaliin saneeraukseen on yleensä syytä suhtautua pidättyvästi. Suuhygienian omaehtoinen ja ammattimainen ylläpito hoidon aikana ja jälkeen on tärkeää, sillä kuiva suu, limakalvovauriot, karies sekä luustolääkkeiden ja sädehoidon aiheuttama kudosten heikentynyt paranemiskyky altistavat uusille suun sairauksille. Lisäksi ne vaikuttavat hoidosta toipumiseen ja elämänlaatuun.Peer reviewe

Three-Dimensional Computer-Aided Analysis of 293 Isolated Blowout Fractures - Which Radiological Findings Guide Treatment Decision?

Purpose: Our study purpose was to clarify the extent of isolated unilateral orbital blowout fracture in relation to surgical treatment and other factors behind the treatment decision. The specific aim was to determine which computer-aided measurements based on radiological images associate with treatment choice. Methods: A retrospective cohort study was implemented on patients with an isolated unilateral orbital blowout fracture. Computer-aided measurement of fracture extent was performed. The study variables included treatment as primary outcome (surgical vs nonsurgical), post-traumatic orbital volume difference (mL) compared to contralateral orbit, fracture area (mm(2)), fracture depth (mm) as predictor variables, and age, sex, injury mechanism, side and site of orbital fracture and positions of recti muscles as explanatory variables. Postoperative outcomes were reported. Logistic regression analysis was used to determine the risk factors for surgery. The statistical significance level was set at P < .05. Results: Of 293 patients, 28.0% received surgical and 72.0% nonsurgical treatment. Volume difference, fracture area and fracture depth predicted surgical outcome (P < .001). In adjusted univariate regression analyses, fractures with moderate and severe displacement of recti muscles were more likely to receive surgical treatment than fractures with mild or no displacement (OR 6.15 and 30.75, respectively, P < .001). Isolated medial wall fractures were significantly less often (OR 0.05, P = .006) and patients with older age (OR 0.97, P = .013) slightly less often treated with surgery. Patients with preoperative symptoms had more often persisting postoperative symptoms than patients without preoperative symptoms. Conclusions: Positions of the recti muscles are an independent radiological factor guiding orbital blowout fracture treatment decision. The bony fracture extent is a combination of volume difference, fracture area and fracture depth which are strongly correlated to each other. A computer-aided method significantly facilitates the systematic evaluation of bone fragments, and the extent of orbital fractures. (C) 2021 The Author. Published by Elsevier Inc. on behalf of The American Association of Oral and Maxillofacial Surgeons.Peer reviewe

Associated Injuries Are Frequent and Severe Among Geriatric Patients With Zygomatico-Orbital Fractures

Purpose: Associated injuries (AIs) are hypothesized to be frequent in geriatric zygomatico-orbital (ZMO) fractures. The study aim was to determine the relation between ZMO fractures and AIs in geriatric patients compared with younger adult patients. Patients and Methods: A retrospective case-and-control study was carried out on geriatric patients at least 65 years of age (n = 93) and younger adult patients 20 to 30 years of age (n = 68) diagnosed with pure unilateral ZMO fractures. The main exposure was age, the primary outcome was AI outside the face, and the secondary outcomes were type and severity of AI, ocular injuries, restriction of mandibular movement, and ZMO buttress asymmetry. The confounding variables were gender, trauma mechanism, type of ZMO fracture, and dislocation. Statistical analyses included chi(2) tests, risk evaluation with 2 x 2 tables, and logistic regression analysis. Results: AIs outside the face, and particularly brain injuries, were significantly more frequent in the geriatric group than in the control group (P <.001). The significant predictors of AIs outside the face were fall from a height (66.7%), motor vehicle accidents (66.7%), and absence of ZMO dislocation (59.5%; P <.001). The adjusted risk of brain injury was 2.5-fold in the absence of dislocation. The geriatric group had a more than 5-fold higher risk of brain injuries compared with the younger control group (P = .003). Conclusions: AIs in general, and particularly brain injuries, are frequent in geriatric ZMO fractures. Intra- cranial injuries should be ruled out, particularly in geriatric patients diagnosed with a non-dislocated ZMO fracture. (C) 2018 American Association of Oral and Maxillofacial SurgeonsPeer reviewe

Isolated Orbital Fractures Are Severe Among Geriatric Patients

Purpose: The purpose of the present study was to clarify the reasons for, types of, and degree of involvement of the orbital wall and the severity of orbital fractures in geriatric patients and to compare the differences between geriatric and younger adult patients. Materials and Methods: A retrospective case-control study of geriatric patients aged at least 65 years (n = 72) and younger controls aged 20 to 50 years (n = 58) with a diagnosis of a unilateral isolated orbital fracture was designed and implemented. The main exposure was age, the primary outcome was the isolated orbital fracture type, and the secondary outcomes were the associated orbital zones, fracture area (cm(2)), degree of dislocation (mm), involvement of anatomic landmarks, diplopia, altered ocular position, restricted eyemovement, and ocular injuries. The confounding variables were gender, trauma mechanism, and alcohol abuse. The statistical methods included chi(2) tests and logistic regression analyses. Results: Among the geriatric patients, the great majority of isolated orbital fractures had been caused by falls (66.7%; P Conclusions: Falling is the most common mechanism of elderly orbital fractures. Isolated orbital fractures are extensive and mainly affect the globe supporting the middle and posterior parts of the orbital floor among geriatric patients. (C) 2017 American Association of Oral and Maxillofacial SurgeonsPeer reviewe