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Background: Naso-orbitoethmoid fractures associated with ipsilateral zygomaticomaxillary complex fractures are more challenging injuries than zygomaticomaxillary complex fractures alone. However, there is a paucity of information on this complex fracture pattern in the pediatric population. This study investigated the cause, treatment, and outcomes of combined zygomaticomaxillary complex and naso-orbitoethmoid fractures versus isolated zygomaticomaxillary complex fractures in pediatric patients., Methods: This was a 25-year retrospective cohort study of pediatric patients who presented to a single institution with zygomaticomaxillary complex fractures. Baseline patient demographics and clinical information, and concomitant injuries, treatment/operative management, and postoperative complications/deformities were recorded and compared between patients with combined zygomaticomaxillary complex and naso-orbitoethmoid fractures and patients with isolated zygomaticomaxillary complex fractures., Results: Forty-nine patients were identified to have had zygomaticomaxillary complex fractures in the authors' 25-year study period, of whom 46 had adequate clinical documentation and follow-up. Seventeen patients had combined zygomaticomaxillary complex-naso-orbitoethmoid fractures, of whom six had panfacial fractures. Both patient groups (zygomaticomaxillary complex only and combined zygomaticomaxillary complex-naso-orbitoethmoid fractures) were similar in terms of demographics. However, a significantly greater proportion of combined fracture patients experienced postoperative complications compared to isolated zygomaticomaxillary complex fracture patients, even after excluding those with panfacial fractures (87.5 percent versus 35.3 percent; p < 0.001). Enophthalmos (37.5 percent) and midface growth restriction (37.5 percent) were the two most common complications/deformities in all combined fracture patients., Conclusions: High-impact trauma can lead to zygomaticomaxillary complex fractures with associated naso-orbitoethmoid fractures in children. This injury pattern was found to cause significantly greater postoperative morbidity than isolated zygomaticomaxillary complex fractures alone. Thus, pediatric patients presenting with this complex facial fracture pattern should be closely monitored., Clinical Question/level of Evidence: Risk, II., (Copyright © 2021 by the American Society of Plastic Surgeons.)

Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

Morbidity and mortality among children is usually the result of trauma. Because a child's face is retruded relative to the protecting skull, has a thicker layer of adipose tissue, more elastic bones, flexible sutures lines, the presence of tooth buds within the jaws, and the lack of pneumatisation of the sinuses, the facial bones fracture less commonly than in adults. Our aim was to assess the patterns of such fractures in children who presented to the department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan. All 535 eligible children between the ages of 1-16 years who presented during the two years December 2009 - December 2011 were included in the study. Facial fractures were diagnosed by clinical examination, plain radiographs, and computed tomography, and the pattern of fractures of the facial bones including the frontal bone, orbital bones, maxilla, zygoma, naso-orbito-ethmoidal complex, mandible, and dentoalveolar region was documented. The male:female ratio was 2:1 with 369 male (70%) and 166 female (31%) patients. Fall was the cause in 212 (39%), and in 167 (31%) it was road traffic accidents, while sports were the cause in 135 (25%). The naso-orboto-ethmoid complex was fractured in 37 cases (7%) while 104 children (19%) presented with isolated fractures of the zygomatic bone. The maxilla was fractured in 195 cases (36%), the mandible in 380 (71%), and dentoalveolar trauma was the cause in 256 (50%). The mandible was the bone that was most often fractured (mostly in boys and usually as a result of falls during summer vacations), with the peak occurring in those aged 8-12 years., (Copyright © 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: This study examined a single center's experience with regards to etiology and distribution of fractures treated from July 2015 to August 2016 in Shanghai, China., Methods: The medical records of 621 patients with craniomaxillofacial fractures were reviewed. Patient notes and radiographic images were analyzed for detailed injury data. Age, gender, etiology, and site of fracture were examined. Chi-square test was used to analyze the causes of single and multiple fractures. p < 0.05 was considered statistically significant., Results: This study included 426 male and 195 female with a male-to-female ratio of 2.18:1, among which 28.3% were between 19 and 29 years (n = 176). In all the fracture sites, orbit was most commonly involved (n = 319, 51.4%). Traffic accidents (n = 304, 49%) were the most common cause of injury in this study, while ground-level falls were the most common cause of injury in children (n = 19, 41.3%). The probability of multiple fractures due to falling from height (88.6%, p < 0.05) and traffic accidents (73.3%, p < 0.05) were significantly higher than that of other injuries. Orbital fractures have the highest surgical rate (n = 288, 90.3%)., Conclusion: Craniomaxillofacial fractures predominantly occur in young men, due to traffic accidents. Orbit was involved in most cases. Falling from height and traffic accidents is more likely to cause multiple fractures.

Injury to the maxillofacial region continues to place a burden on hospital care in New Zealand, with maxillofacial fractures often being associated with both a significant social cost and personal morbidity. This article describes the characteristics, aetiology and treatment patterns in a tertiary maxillofacial centre in New Zealand during a 10-year period. Over the observation period, a total of 1,975 cases were treated, with a male-to-female ratio of 4:1. The highest incidence was in the 20-29-year-age group. Interpersonal violence (IPV) was the most common aetiology, observed in 54.5% overall, and more common among males than females (58% and 38% respectively; P&lt;0.001). Falls were the most common cause of injury among older females (those aged 50+). Comparison to an earlier analysis shows that IPV-related maxillofacial trauma has increased significantly at this tertiary centre, increasing from 36.2% of cases in 1989-2000, to 54.5% in 2004-2013. There remains an urgent need for appropriate health promotion to reduce interpersonal violence, as well as an increase in the staffing numbers of maxillofacial units in New Zealand.

Maxillofacial fractures are often associated with blunt head injuries, of which skull base trauma is a common component. However, most oral and maxillofacial surgeons do not provide definitive management of temporal bone fractures involving the skull base and their sequelae. Persistent cerebrospinal fluid (CSF) leakage that is refractory to conservative measures usually requires surgical closure to decrease the risk of meningitis. In general, reduction of the displaced fragment of the skull base in temporal bone fractures is not considered a priority. We describe an unusual case of craniomaxillofacial injury exhibiting CSF otorrhea because of a temporal bone fracture with a fragment that included the zygomatic arch. The persistent traumatic leakage was stopped after C-arm-guided reduction of the depressed zygomatic arch. This technique facilitated minimal and only necessary manipulation, without overcorrection, thereby avoiding additional damage to the surrounding tissues. The present case illustrates the definitive contribution of therapeutic measures based on maxillofacial surgery as part of an interdisciplinary approach to the management of the complications of severe head injuries; more invasive neurosurgery was thus avoided., (Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Zygomaticomaxillary complex fractures associated with ipsilateral naso-orbito-ethmoidal fractures are more complex injuries than isolated zygomaticomaxillary complex fractures. This injury pattern can have significant long-term morbidity if not recognized and treated appropriately during the initial operation. The purpose of this study is to compare mechanisms of injury, treatment, and outcome between patients with zygomaticomaxillary complex fractures and those with zygomaticomaxillary complex and ipsilateral naso-orbito-ethmoidal fractures., Methods: A 5-year retrospective review of all patients treated with zygomaticomaxillary complex fractures at a level I trauma center was performed. Computed tomographic scans were reviewed to divide patients into those with zygomaticomaxillary complex fractures alone and those with zygomaticomaxillary complex and ipsilateral naso-orbito-ethmoidal fractures. Demographics, treatment protocols, outcomes, complications, reoperations, and length of follow-up were identified for both groups and compared to determine differences between these populations., Results: A total of 245 patients were identified by the Current Procedural Terminology codes for zygomaticomaxillary complex fractures. One hundred eighty-five patients had zygomaticomaxillary complex fractures and 60 patients had zygomaticomaxillary complex/naso-orbito-ethmoidal injuries. The demographics for both populations were similar. There are differences between the groups with regard to mechanism of injury, operative findings, and techniques. The patients with zygomaticomaxillary complex/naso-orbito-ethmoidal fractures had higher rates of postoperative complications and deformities., Conclusions: Patients who sustain a zygomaticomaxillary complex fracture associated with an ipsilateral naso-orbito-ethmoidal fracture have a higher incidence of postoperative complications and deformities. It is important to recognize this fracture pattern early to help minimize postoperative morbidity., Clinical Question/level of Evidence: Risk, II.

Background/aim: Domestic violence has been identified as a cause of maxillofacial fractures especially among women. The present study investigated the maxillofacial fractures in Tehran, Iran, with special focus on injuries related to domestic violence., Material and Methods: Records of patients with maxillofacial fractures who were referred to Shariati hospital, Tehran, from June 2004 to June 2006 were considered to extract required data. The extracted data included the patients' gender, age, cause of fracture, and type of fracture. For patients with domestic violence recorded as their fracture cause, complementary data were also recorded. Chi-square test served for statistical analysis., Results: Totally, the records of 257 patients (188 men, 69 women) were considered. Of the 257 records studied, 188 records (73%) belonged to men. The most common fracture cause was vehicle accidents (55.3%) among both men (52.1%) and women (63.8%). The domestic violence stood for 3.5% of cases (all women). It was the fracture cause among 13% of women. One-third of women with domestic violence as fracture cause had previous history of fracture. The spouses of one-third of domestic violence victims were drug addicted., Conclusion: Prevalence of domestic violence as a cause for maxillofacial fracture is relatively high among women. Because these fractures can be life-threatening, appropriate strategies at both community and family levels should be implemented to prevent and reduce these types of fractures., (© 2011 John Wiley & Sons A/S.)

Injuries in civil aviation can occur as a consequence of work-related accidents happening in airport. The ground crew can sustain slips, trips, falls, and machinery accidents. Most such accidents are observed when aircraft is departing. This clinical report describes a case of an airport ground assistant severely injured by a helicopter after the strike with a main rotor blade that was slowing after that the craft was landed and the engine was stopped, and reports surgical emergency treatment of life-threatening facial lesions.

Objective: To review the 2461 cases of maxillofacial fractures., Methods: From 2003 to 2009, 2461 maxillofacial fracture cases were treated in Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine. Data regarding sex, age, cause of injury, occupation, geographic distribution, blood type, fracture site, multiple associated injuries, injury severity, the patient's first admitted department, treatment results were reviewed., Results: The male and female ratio was 4.28:1, 1424(57.86 %) patients were between 20 and 40 years of age. The most common cause of injury was road traffic accident (938 cases, 40.98%). People in tertiary industry (900 cases, 78.53%) were most vulnerable to injuries. The zygomatic complex (22.08%), nasal bone (20.67%) and mandible (16.35%) were the most frequent fracture sites, which were often associated with skull (21.74%), brain (38.36%) and soft tissue contusion injury (48.84%). 85.98% (2116/2461 cases), of patients' AIS score was less than 2. Orthopaedics (939/2461 cases, 38.16%) was the first admitted department., Conclusions: The traffic accidents are the main cause of the maxillofacial fractures. Most injuries are found in the young and middle-aged people.

Purpose: Interpersonal violence is a major health hazard that contributes to the high volume of trauma seen in the emergency department. It is also one of the principal causes of maxillofacial fractures., Materials and Methods: The present study was a retrospective analysis of patients referred to, and treated at, the Oral and Maxillofacial Surgery Unit at Christchurch Hospital during an 11-year period (1996 to 2006). The variables examined included patient demographics, fracture types, mode of injury, and treatment delivered., Results: An increase was found in the number of fractures due to interpersonal violence in the second half of the study, although the proportion remained the same. The age of the patients ranged from 9 to 89 years (mean 28). The male-to-female ratio was 9:1. Of the patients, 87% had alcohol involvement. The mandible was the most common site of fracture, followed by the zygoma. Other midface fractures, including Le Fort fractures, were less frequently observed. Of the patients, 59% were hospitalized and 56% required surgery, with internal fixation necessary in 41% of patients., Conclusion: An increase occurred in the number of facial fractures associated with interpersonal violence during the study period. Young male adults were the most affected demographic group, with alcohol a main contributing factor. Violence-related facial fracture is a health hazard that deserves more public awareness and implementation of preventive programs.

Purpose: The study purpose was to assess the changes in the pattern of maxillofacial fractures in 2 different study periods., Patients and Methods: We conducted retrospective study of 341 patients treated for maxillofacial fractures between January 1978 and December 1982 and a prospective study of 483 patients treated between January 1995 and December 1999 at the Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria. Data were collected on age, gender, etiologic factor, and site of injury., Results: The male-to-female ratio reduced in the second period by a factor of 2.0. Patients in the age groups of 21 to 30 years and older than 60 years increased by a factor of 1.8 and 2.9, respectively, in the second period. Assaults, falls, sporting injuries, and industrial accidents in the second period increased by a factor of 1.4, 1.5, 3.5, and 1.5, respectively. The ratio between road traffic accidents and other causes changed from 3.4:1 to 2.2:1 in the second period. Mandibular fractures increased by 2% in the second study period., Conclusion: The data confirmed that although other etiologic factors are increasing in number, road traffic accidents remains the major etiologic factor of maxillofacial fractures in Nigeria. There is a need to enforce seat belt use, speed limit, and drink driving laws to reduce maxillofacial injuries caused by road traffic accidents; to organize preventive programs to minimize assaults, and to legislate the wearing of headgear by industrial workers.

Objective: Paediatric maxillofacial fractures are not common and carry different clinical features when compared with adults. To clarify the differences of aetiology and patterns of fractures in paediatric patients, a clinical retrospective analysis was performed., Patients: One hundred seventy-four paediatric patients younger than 16 years of age treated in the First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital during a 15-year period were analysed., Study Design: Age, sex, fracture patterns, incidence, common locations of the mandibular fractures and treatment were studied according to the patients' charts and radiographs., Results: The ratio of boys to girls was 2:1 and the largest age subgroup was 15-years old. The most common cause of injury was bicycle accidents (26%), followed by falls (25%). The distribution of causes and ages revealed that the incidence of the fall-related injuries decreased in patients older than 10 years, and assaults became a common cause in patients older than 12 years. The yearly distribution showed a decrease of the group between 6 and 10 years and of bicycle-related accidents in the last 5-year period (1992-1996). Mandibular fractures were most common (56%), followed by fractures of the alveolar process (31%). Condylar fracture was common in children younger than 14 years, especially in those below 6 years. Fractures of the mandibular angle were the most common in those above 13 years., Conclusion: These results document that the aetiological characters and patterns of paediatric maxillofacial fractures gradually shifted towards those found in adolescents., (Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd.)

Objective: The occurrence of trauma in older people is well-documented; however the incidence of maxillofacial trauma is scarcely reported. Therefore, the objective of this study is to determine the causes and consequences of maxillofacial trauma in older people., Design: A five-year (March 95 - March 2000) retrospective study was carried out of all patients over the age of 65 years with facial trauma presenting to Accident and Emergency Department (A&E). The information was collected using the medical notes and discharge summaries., Setting: The Departments of A&E and Maxillofacial Surgery., Subjects: A total of 42 patients' records were examined for study related data., Results: A total of 42 patients were seen during the study period. Thirty-six gave a history of a fall, of which 15 had tripped, 5 had slipped, 3 resulted from a Transient Ischaemic Attack (TIA), 1 as a result of alcohol abuse, in 1 a prosthetic knee gave way and 11 gave no cause for the fall. Of the remaining 6 patients, 5 were assaulted and 1 had a wardrobe fall on top of him. The majority of the falls occurred during the winter months. Maxillofacial injuries were noted in 27 of the 42 patients. Sixteen patients had cheekbone fractures, 8 mandibular fractures, 2 midface and 1 orbital complex fracture. Twenty-five percent of cheekbone fractures and 50% of mandibular fractures were treated surgically. Medical history was noted in 27 patients., Conclusions: This study clearly demonstrates the majority of the facial trauma in the older people can be treated conservatively unless the patients complain of functional problems.

Maxillofacial fractures and associated lesions following airbag deployment were studied in six patients who suffered frontal or fronto-lateral car crashes. Installation of airbags in motor vehicles has reduced the morbidity and the mortality following motor vehicle accidents, but the appearance of new types of trauma directly related to airbag deployment raise questions about the potential danger of these devices when used improperly. The results of this limited study suggest that airbag injuries can be aggravated if: (1) seat belts are not worn; and (2) if the driver's chest is too close to the steering wheel as can easily happen with small people (in our study, two women). There needs to be a way of disconnecting the system.

A review of biomechanical studies that have attempted to measure fracture tolerances of facial bones has been carried out. The particular bones of interest were the mandible, the zygoma, the maxilla and the nasal bones. Numerical values have been given for the peak force and pressure fracture tolerances for these bones. A study of these values illustrates just how variable the bone strength of various individuals is. A review of various methods that have attempted to measure and quantify the physical effects of a blow to the face has also been carried out. Three major types of test procedure exist, namely frangible elements, peak force and pressure sensing elements and deformable elements. Frangible and deformable elements generally replace the face of a standard test dummy, fracturing and deforming at appropriate impact force levels, respectively. These surrogate face forms are used for two different reasons; either they are used to measure the damage to the human face for some impact scenario or they are simply used to better simulate the response of the whole head to impact by simulating the compliance of the face. Peak force and pressure sensing elements take the form of piezoelectric sensors and pressure-sensitive, colour 'Fuji film'. Both these methods are complicated and really only suitable for research purposes only. Finally, it is recommended that a mathematical model approach be used to establish the principal injury mechanism and support further development of an acceptable face form test.

In the years 1968 to 1987 a total of 1484 patients were treated for facial bone fractures at the Hospital for Stomatology and Maxillofacial Surgery of Neuruppin. Most of them were aged between 16 and 25 years. In the majority of the cases, the injuries resulted from acts of violence (40%) and road accidents (35.7%), although the number of care accidents is decreasing. The ratio of mandibular to midfacial fractures is 2.2: 1. Multiple injuries were found in 60% of the patients. The use of surgical treatment methods increased to 30%.

The incidence, aetiology and trends in fractures of the facial bones occurring in the years 1965, 1970, 1975 and 1980 in the Grampian Region of Scotland are reported. A 2.7 fold increase in incidence occurred during this period. Males are seen to be most at risk and an increase in assault and sports-related trauma is seen. Offshore oil exploration developed during this period and its effects are discussed. Attention is drawn to the differences in the aetiology of right and left malar fractures.

The use of conventional radiography, complex motion tomography, and computed tomography for evaluation of eight patients with orbital floor fractures indicates that CT scans in an axial plane with coronal and sagittal reformations offer the best radiographic evaluation of the orbit.

Selected facial bone locations were impacted to simulate clinical trauma conditions. Locations selected included the nose, zygoma, mandible, maxilla, and frontal bone. The experiment clearly delineate tolerance bands for the facial bones for both sexes. These data should permit the improved design of injury producing structures.

One hundred cases of facial mass fractures observed in the period April-September 1988 have been assessed using a clinico-anamnestic type investigation. Among trauma patients there is a prevalence of male patients aged between 10 and 30. Fractures located at the middle third and mandible occur in a practically equivalent number. Most traumas are the result of road accidents, following by falls. A good degree of correlation was observed between trauma aetiology and dynamics on the one hand and type and gravity of fractures on the other. Direct fractures, with greatest comminution of fragments prevail in high speed traumas; indirect fractures are most frequent in low speed traumas (cyclists and accidental).

A ten-year review of 2,067 cases of zygomatico-orbital fractures is presented. The age and sex distribution, anatomical types of fractures, associated maxillofacial and nonmaxillofacial trauma, and causes of the injuries are described. The majority of fractures were sustained by males and resulted from trauma inflicted in altercations. The most common associated facial fractures were mandibular; the most common associated nonmaxillofacial trauma was extremity fractures. Motorcycle accidents caused the most significant amount of associated trauma, followed by motor vehicle accidents in which no seat restraint was used by the victim. Treatment, when indicated, consisted of elevation via a temporal approach followed by fixation where necessary. The fixation methods used are presented and discussed.

Children are frequently admitted to a hospital with injuries sustained as a result of being attacked by a dog. Over a 5-year period (1977 to 1981), 57 such patients have been treated at the Winnipeg Children's Hospital. Half of the dog attack victims were 5 years or younger with injuries occurring more often in boys (55%). The majority of patients (95%) sustained puncture wounds and lacerations to the face (77%) and extremities (23%). In three of the cases, the dog attack victims presented with peritonitis secondary to bowel perforation and were treated successfully. A fourth child died as a result of his injuries prior to reaching the hospital. In the past, much attention has been focused on soft tissue injuries and their cosmetic repair. It is also important to recognize that the small child is particularly vulnerable to dog maulings from which the injuries sustained may be life threatening or lethal. Prevention seems to be the only rational approach to solving this problem.