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Purpose: It is hypothesized that facial trauma-associated injuries (AIs) are more frequent and severe in elderly than in younger adult patients. The purpose of this study was to determine the occurrence of, reasons for, and severity of AI in geriatric facial fractures and to compare the differences between geriatric and younger adult patients., Materials and Methods: Two patient cohorts were included in this cross-sectional retrospective study. Geriatric patients were at least 65 years old (n = 117) and younger controls were 20 to 50 years old (n = 136). The main predictor was age, the primary outcome was AI, and secondary outcomes were affected organ system, multiple AIs, polytrauma, and mortality during hospitalization. The other explanatory variables were gender, trauma mechanism, and type of facial fracture. Statistical methods included χ(2) tests, risk analyses with 2 × 2 table, and logistic regression analyses., Results: AIs were significantly more common in geriatric patients (44.0%) than in younger controls (25.0%; P < .001). Also, multiple AIs (P = .003), polytrauma (P = .039), mortality (P = .008), limb injuries (P = .005), and spine injuries (P = .041) were significantly more common in the elderly. In the risk analyses, geriatric patients had a 1.8-fold risk for AI, a 2.6-fold risk for multiple AIs, and a 2.2-fold risk for polytrauma., Conclusions: AIs are much more frequent and severe in geriatric patients, and the elderly die more often of their injuries. The results emphasize that elderly patients require specific attention and multi-professional collaboration in the diagnosis and sequencing of trauma treatment., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to compare and characterize 2 cohorts of patients with maxillofacial fractures within the same institution over 2 6-year time frames 20 years apart., Materials and Methods: A retrospective review of patients with maxillofacial fractures at the authors' institution from 2004 to 2010 was performed, and a comparison was made with the authors' experience from 1984 to 1990., Results: The 1990 study showed 458 maxillofacial fractures (152 midface and 306 mandibular fractures). In the 2010 study, there were 1,731 maxillofacial fractures (1,313 midface and 418 mandibular fractures). There were significant differences in the mechanism of injury between the 1990 and 2010 studies: assaults decreased from 48.8% to 29.7%, motor vehicle collisions decreased from 39.1% to 29.6%, and falls increased from 3.6% to 22.1%. Comparison by age categories showed major changes in the following groups: maxillofacial fractures in patients 21 to 40 years old decreased from 61.7% to 35.3%, those in patients 41 to 65 years old increased from 13.1% to 35.4%, and those in patients at least 66 years old (elderly) increased from 0.2% to 14.5%. All these changes were statistically significant (P < .0001)., Conclusion: Maxillofacial trauma has changed significantly over the past 2 decades in the authors' institution. A decrease in assault-related injuries in the younger populations and an increase in the incidence of falls in the elderly were the main differences. There was a significant increase in elderly patients with maxillofacial trauma. This change emphasizes the need for adequate prevention programs and appropriate maxillofacial surgery teams to manage these injuries in the older patient., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate whether complex midface fractures have a greater association with death and intracranial injury than simple midface fractures., Materials and Methods: A retrospective chart review was performed for patients with blunt-mechanism midface fractures who had presented to an urban trauma center from 1998 to 2010. The survival and intracranial injury status was evaluated for patients with simple and complex midface fractures, including Le Fort, naso-orbitoethmoid, and/or zygomaticomaxillary fractures. Intracranial injury included hemorrhage and brainstem injury. Patients with upper face fractures were excluded to minimize confounding. Adjusted relative risk estimates were obtained using multivariate regression analysis., Results: Of 3,291 patients with midface fractures, 213 (6.3%) died and 693 (21.3%) had an intracranial injury. The cumulative mortality reached 11.6% in patients with complex midface fractures and 5.1% in those with simple midface fractures (P < .001). Patients with complex midface fractures were 57% more likely to die (relative risk = 1.57; P < .005). Specifically, Le Fort II fractures independently conferred a 94% increased risk of death (relative risk = 1.94; P < .01), but Le Fort I and III fractures were not significantly associated with death. Among patients presenting without neurologic impairment, those with Le Fort II and III fractures remained 2.88-fold (P < .01) and 2.54-fold (P < .001) more likely to have an underlying intracranial injury, respectively., Conclusions: Le Fort II fractures are associated with increased mortality. Furthermore, Le Fort II and III fractures are associated with serious intracranial injury, even in the absence of alterations in consciousness. These patients should be monitored with heightened vigilance and followed up closely during hospitalization, regardless of the presenting clinical findings., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this retrospective study is to review the incidence and etiology of frontal sinus fractures at an urban trauma center and validate a treatment protocol by assessing the outcome of a consecutive series of patients treated over a 10-year period., Patients and Methods: All patients with frontal sinus fractures admitted to our trauma service from 1995 to 2005 were managed by the same surgeons using similar treatment philosophies based on the amount of displacement or comminution of the anterior and/or posterior table, the integrity of the nasofrontal duct, and the neurologic status of the patient as determined by clinical and radiographic examination. Using information obtained from the Trauma Registry and from individual physician chart notes, a database was created for the purpose of assessing outcome, defined as complications, length of hospital stay, and death. Demographics, injury severity score, fracture pattern, mechanism of injury, length of hospital stay, the number of operations, concomitant maxillofacial injuries, treatment, follow-up, and complications were statistically described. Outcome measures were evaluated by Student's t test using continuous variables., Results: One thousand two hundred seventy-five patients with facial fractures were identified during the study period, of which 144 patients (11.3%) carried the diagnosis of frontal sinus fracture; 28 patients had inadequate records, leaving a study group of 116 patients. The majority of patients were male, had a mean age of 33.7 years, and presented with significant injuries demonstrated by a mean injury severity score of 23.7 and mean length of hospital stay of 8.9 days. The most common mechanisms of injury were blunt trauma resulting from a motor vehicle collision, fall, assault, or other accidents. Sixty-six patients presented with nondisplaced frontal sinus fractures that were managed nonoperatively; 50 patients had frontal sinus injuries that required surgical repair consisting of: 1) open reduction and internal fixation of the anterior table alone, with preservation of the sinus membrane (n = 29); 2) removal of all sinus mucosa, obliteration of the frontal sinus with autogenous abdominal fat, and reconstruction of the anterior table (n = 5); and 3) removal of all sinus mucosa, cranialization of the frontal sinus, and lining of the nasofrontal recess with a pericranial flap (n = 16). Six patients died of concomitant injuries. With follow-up ranging between 0 and 90 weeks, there were no known complications in the patients treated nonoperatively; 82% of the patients maintained normal sinus function and anatomy and the overall complication rate was 6.9%. Complications occurred in 16% of those patients treated surgically: including brain abscess, contour deformity, osteomyelitis, hematoma, meningitis, and mucocele. There was no statistically significant association between complications and other patient variables (P > .05), other than the test for injury severity score, which was different between survivors and nonsurvivors (P < .01)., Conclusion: Application of the management protocol described in this report results in functional sinus preservation for the majority of patients, with relatively few significant perioperative complications.

Purpose: The purpose of this study was to review patients who failed to survive blunt trauma and to determine whether there is a relationship between specific facial fracture patterns and death., Patients and Methods: This was a retrospective record review of patients with facial fractures admitted to a level I trauma center between January 1, 1993 and December 31, 1996. Records were reviewed for gender, age, injury severity score (ISS), Glasgow Coma Scale (GCS), revised probability of survival (RPS), cause of death, and facial fracture pattern. Facial fracture patterns were grouped as lower face (mandible), midface (maxilla, zygoma, nose, and orbits), and upper face (frontal bone). Causes of death were grouped into neurologic, visceral, combined neurologic and visceral, and other. Surviving and nonsurviving groups were compared. Parametric data were analyzed with a pooled or separate variance t-test, nonparametric data with a Mann-Whitney U-test, and categorical variables with a chi-square test (P < or = .05). The odds ratio with corresponding 95% confidence intervals was used to show the association between facial fracture patterns and death., Results: During the 4-year period, 6,117 patients were admitted with blunt trauma, 661 (11%) of whom had facial fractures. Those who died were more likely to be older than those who survived, with a lower GCS, lower RPS, and higher ISS. Although there was a male predominance in the patient population, there was no gender difference between those who died and those who survived. Surviving patients were more likely to have only isolated mandible injuries. Nonsurvivors were more likely to have isolated midface fractures or combinations of midface and other facial fractures. The odds ratio showed a 13 to 75 times greater risk of patients dying of neurologic injury with patterns other than isolated mandible injury than with any mid- or upper-facial fracture patterns., Conclusions: Compared with survivors, nonsurviving patients with facial fractures were older and had a lower GCS, higher ISS, and lower RPS. Nonsurviving patients had a dramatic predilection for mid- and upper-facial fracture patterns and death of neurologic injury.