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Background/purpose: To retrospectively analyze the epidemiological features, clinical diagnosis, and treatment of 610 patients with maxillofacial fractures, while providing a reference for the prevention and optimized treatment of maxillofacial fractures., Methods: Data of patients with maxillofacial fractures who were treated and followed up at the Second People's Hospital of Kashi Prefecture from June 2012 to April 2018 were summarized. The epidemiological features, clinical manifestations, fracture sites, treatment methods, and results were analyzed., Results: The highest incidence was in the age range of 20 to 49 years. The main cause of fracture was traffic injury. Mandibular fractures accounted for 37.77%, zygoma and zygomatic arch fractures for 37.00%, and maxillary fractures for 21.19%. Atypical zygomatic arch fractures were more common in the maxilla, followed by Le Fort I and II fractures. Closed fractures accounted for 85.97%. Many (73.39%) patients were treated with computed tomography 3-dimensional (3D)-mediated precision modified incision internal fixation with satisfactory results., Conclusions: There is a high incidence of maxillofacial fractures among young men, especially in summer, with the most common injuries being traffic-related injuries. The most common site is the mandible, followed by the zygomatic arch, zygomatic complex, and maxilla. Computed tomography 3D-mediated precision modified incision internal fixation can achieve satisfactory results.

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.

Purpose: Zygomaticomaxillary complex (ZMC) fractures are frequent in facial trauma; only fractures of the mandible are more common. Although the frequency of these fractures is geographically consistent, the aetiology differs widely among countries and even regions. Differences in socio-economic status and the ageing population seem to be two causes. This retrospective epidemiological study evaluates patients who were surgically treated for ZMC fractures at a Swiss university clinic., Materials and Methods: This study included 471 patients who were surgically treated for ZMC fractures in an oral and maxillofacial surgery clinic at a Swiss university hospital between January 2004 and December 2012. Complicated fractures such as LeFort II/III and bilateral ZMC fractures were excluded. Data on gender, age, and type of trauma were recorded. Fractures were classified by aetiology: motorised road traffic (car or motorcycle), bicycle, interpersonal violence, sports, falls (both less than and greater than 3 m in height) and other causes., Results: A total of 350 patients were male (74%), and 121 were female (26%). The ZMC fractures were most likely to occur in the third decade (117 cases, 25%). A predominance of male patients was found in the young age groups, but an equal ratio was found in the elderly groups. Etiologically, falls of less than 3 m were the most common cause of ZMC fractures (125 cases, 27%). Interpersonal violence was second (88 patients, 19%); male patients dominated this group, which had a male-to-female ratio of 21:1. A predominance of male patients was found in every subdivision when analysing by aetiology and gender. The lowest proportion of males (57%) was found for falls of less than 3 m., Conclusion: In our study, interpersonal violence and falls outnumbered road traffic accidents among causes of maxillofacial fractures. This is probably a consequence of strict road and work laws. Additionally, the older and more active populations accounted for the highest proportion of falls, and young male patients were the predominant victims of ZMC fractures., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Previous reports indicated that there is geographic and sociodemographic variation in the epidemiology of maxillofacial fractures. Audit of maxillofacial injuries managed at any institution is therefore necessary to understand the trends and proffer strategies for prevention. We therefore embarked on this study to determine the pattern of maxillofacial fractures and concomitant injuries in our institution., Methods: We carried out a retrospective review of information on demography, aetiology and type of maxillofacial fracture, patients' status, type of crash, level of consciousness and concomitant injuries. The data collected was analysed with SPSS Version 20., Results: A total of 233 patients aged 2 to 66 years were reviewed. A higher male preponderance (M:F 3.4:1) was observed. Road traffic crashes (RTC) accounted for 78.5% of injuries. Motorcycle related crashes were responsible for 69.4% of RTC and 54.5% of all fractures. Fracture of the mandible (63.2% n=172) was the most predominant skeletal injury and the body (25% n=43) was the most common site of fracture while the zygoma (29%) was predominantly affected in the midface. Ninety three patients (40%) suffered loss of consciousness. The relationship between aetiology of injuries and consciousness level of the patients was statistically significant (p=0.001). Of the 43 patients who had concomitant injuries, craniocerebral affectation (60.5%) was the commonest., Conclusion: RTC remains the major aetiology of maxillofacial fractures. The mandible was mostly affected and nearly half of the patients have associated loss of consciousness. There is need for continual advocacy and enforcement of laws on preventive measures among road users., Competing Interests: The authors declare no competing interest.

Objectives: This study aims to investigate the epidemiological and operative characteristics of patients undergoing surgery for zygomatic fractures., Patients and Methods: Between May 2008 and October 2013, a total of 121 patients (98 males, 23 females; mean age 27 years; range, 9 to 63 years) who were operated for zygomatic fractures in our clinic were retrospectively analyzed. Age and sex of the patients, symptoms, fracture and incision sites, length of hospital stay, plate type, treatment options, and complications were recorded., Results: Assault was the leading cause of trauma (39%), followed by traffic accidents (24%). The most common symptom or clinical sign was the periorbital ecchymosis/hematoma. Conservative treatment was applied in 14 patients (12%). Surgery was performed with a closed reduction in 17 patients (14%) and open reduction in 90 patients (74%). The most common fracture site was the infraorbital rim in 76 patients (62.8%). A total of 48% patients had three-site, 35% had two-site and 12% had one-site of fixations. The major material used for the orbital floor reconstruction was porous polyethylene in 43.7% patients., Conclusion: Our study results show that surgery is required in the majority of the patients with zygomatic fractures. However, further large studies are required to determine many parameters such as incision sites, plate locations, and the material to be used in orbital floor reconstruction.

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.

Objective: To analyze the epidemiological characters of fresh maxillofacial fractures in hospitalized patients by the retrospective study., Methods: From Jan. 2008 to Dec. 2013, a total of 1 009 patients with fresh maxillofacial fractures treated at Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were investigated. The data were statistically analyzed by SPSS 21.0., Results: The male and female ratio was 2.94:1 and 33.5% of the patients aged from 20 to 30 years. The most common cause of the fresh fracture was road traffic accidents (424 cases, 42.0%), followed by tumblings (250 cases, 24.8%) and violence (128 cases, 12.7%). The number of new fracture was increasing gradually in recent years. The patients were at peak of 20-29 years old. The mandibular fracture was the most frequently seen (536 cases, 53.1%), followed by zygomatic complex fractures (233 cases, 23.1%). The simple maxillary fracture was rare and usually combined with other fractures. Infraorbital nerve injury was the most common one in nerve injuries (144 cases). The most common associated injury was extremity injuries (77 cases), followed by thoracic injury (65 cases) and craniocerebral injury (57 cases). Associated injuries were mostly caused by car accidents (127 sites), followed by fall (32 sites). Logictic regression analysis showed that fall and tumbling were risk factors of mandibular and condylar fracture (OR > 1, P < 0.05), while age was a protective factor (OR > 1, P < 0.05)., Conclusions: Oral and maxillofacial fresh fractures most commonly occurred in young people, and the most common cause of fractures was road traffic accidents. Infraorbital nerve was involved frequently. The most common associated injuries was extremity injuries.

Objective: To characterize maxillofacial fractures due to traffic accidents in patients attending the Hospital Universitario San Vicente Fundación (Medellin-Colombia) from 1998 to 2010., Methods: A descriptive study (n =1609) was carried out with information from the medical records of patients meeting the inclusion criteria established by the general objective of the study. The variables consisted of sex, age, year, type and number of fractures, and type of vehicle. A descriptive analysis of the variables was performed and the frequency of fractures due to traffic accidents was calculated according to year and sex. Crude and adjusted odds ratios (aOR) were estimated to establish associations among age, type of vehicle, and the presence of two or more fractures with stratification by sex., Results: The frequency of maxillofacial fractures due to traffic accidents increased in 2007 (men: n=198, women: n=35) and decreased from 2008 to 2010 in both sexes. Fractures were more frequent in persons aged <35 years (80%) and in men (82%). The highest frequency of fractures was observed in motorists. Male users of motorcycles (aOR=1.41; confidence interval 95% [95%CI]: 1.02- 1.94) and bicycles (aOR=1.61; 95%CI: 1.01- 2.56) were more likely to report two or more fractures compared with pedestrians, after adjustment for other variables., Conclusions: Most maxillofacial fractures occurred in men and in motorists. Future studies should analyze other determinants affecting the epidemiology of maxillofacial fractures. Strategies should be designed to improve the use of protective elements and drivers' knowledge and practices., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background and Objective: The prevalence and etiology of midfacial fractures varies among countries. Until now, knowledge about such type of injuries in the region of the Baltic countries was rather scarce. The purpose of the study was to analyze the prevalence, etiology and localization of midfacial fractures treated at the Vilnius University Hospital Žalgiris Clinic, Vilnius, Lithuania., Materials and Methods: The medical records of patients treated for midfacial fractures during the period January 2005 to December 2010 were analyzed for gender, age distribution, frequency and type of injury, cause of fractures, consciousness status and alcohol abuse during trauma., Results: The records of 799 patients were analyzed. The male-to-female ratio was 4.4:1. The mean age of the patients was 33.16±14.0 years (min 1, max 87). As much as 68.8% of injuries were zygomatic fractures, 27.9% were maxillary, and 3.3% were isolated orbital floor fractures. The most frequent causes for injury were interpersonal violence (64%), followed by falls (16.3%) and traffic accidents (8.3%). Most midfacial fractures (65.3%) occurred between April and October (P<0.05), on weekends (58.2%; P<0.05) and at night (62.0%; P<0.05). In 14%, trauma reports indicated the abuse of alcohol. More often such persons received more than one midfacial bone fracture (P<0.05) concurrently., Conclusions: This study revealed that the main cause of midfacial fractures was assault. Male patients, aged 15-34 years, more often sustain midfacial fractures. Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family, school and community institutions., (Copyright © 2015 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

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.)

Objective: To review the clinical features, treatments, complications, and outcomes of horses with traumatic orbital fractures., Study Design: Retrospective study., Sample Population: Eighteen horses with confirmed orbital fractures., Procedures: Medical records of horses presenting with orbital fractures between 2006 and 2013 were reviewed. Signalment, etiology of fracture, clinical signs, fracture descriptions, diagnostic imaging, treatments, complications, and outcomes were evaluated., Results: Eighteen horses presented with orbital fractures resulting from rearing in a confined space (n = 5), being kicked (4), colliding with a stationary object (3), and unknown trauma (6). Radiography and computed tomography were effective at classifying fractures and evaluating sinus/nasal involvement. Epistaxis/sinusitis were associated with fractures of the zygomatic process of the temporal bone (n = 3) and comminuted fractures of multiple bones (5). Seventeen fractures required treatment, with fifteen receiving a combination of medical and surgical therapy. Surgery included reduction of large bony fragments (n = 8), removal of small fragments (12), stabilization with a wire implant (1), and sinus trephination and lavage (5). Factors contributing to a favorable outcome included: globe retention (n = 16), vision (14), comfort (15), cosmesis (9), and return to previous function (13)., Conclusions: Horses sustaining orbital fractures treated promptly with medical and surgical therapy have a favorable prognosis for return to function and cosmesis. Fractures affecting the zygomatic process of the frontal bone are unlikely to involve the sinus/nasal cavities. Epistaxis and sinusitis warrant more aggressive therapy and decrease functional and cosmetic outcome., (© 2014 American College of Veterinary Ophthalmologists.)

Background: Few reports have described the ophthalmic complications that occur after maxillary orthognathic surgery. Since cases of decreased reflex tearing after maxillary orthognathic surgery are extremely rare, we describe 2 cases of loss of reflex tearing after maxillary orthognathic surgery., Case Presentation: Two Asian women, an 18-year-old and a 32-year-old, suffered from unilateral dryness and irritation caused by maxillary orthognathic surgery. In both patients, Schirmer test (II) showed reduced reflex tearing in 1 eye. Computed tomography showed that the pterygoid plate had been fractured in both patients., Conclusions: The pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa may be injured during Le Fort osteotomy.

Typical associated signs and symptoms of displaced zygomatic fractures include lack of zygoma projection, diplopia, and sensory disturbances of the infraorbital nerve (ION). The aim of this article was to assess eventual associations between ION sensory disturbances and zygomatic fractures patterns. This study is based on 2 databases that have continuously recorded patients hospitalized with maxillofacial fractures in 2 Departments of Maxillofacial Surgery in Amsterdam, The Netherlands, and Turin, Italy between 2001 and 2010. The following data for patients surgically treated for displaced zygomatic fractures were considered: gender, age, site and severity of facial fractures, etiology, and presenting symptoms. Statistically significant associations were found between ION sensory disturbances and assaults (P = 0.007) and sport accidents (P = 0.00003), as well as between ION sensory disturbances and isolated zygomatic fractures (P = 0.000002) and between ION sensory disturbances and diplopia (P = 0.00009).The severity of injury and the absorption of middle-energy and high-energy forces by the zygomatic complex only were associated with ION sensory disturbances. The etiology and severity of the injury as well as the presence of associated symptoms should be thoroughly investigated when a zygomatic fracture is suspected.

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 and Objectives: The aim of this paper is to investigate epidemiological data (age, gender), sites, etiology and surgical approach of zygomatic fracture., Materials and Methods: A 9 years retrospective clinical and epidemiologic study evaluated 642 patients treated for zygomatic fracture. There were 569 men and 77 women. The age range was 2 to 86 years with 205 (31.9%) in the 21 to 30 years age group. A number of parameters, including age, gender, cause of injury, site of injury, treatment modalities were evaluated., Results: There were 552 (86%) zygoma fractures and 90 (14%) zygomatic arch fractures. The left zygoma was involved in 309 cases (56%); the right zygoma was involved in 243 cases (44%). Concerning the zygomatic arch, the left side was involved in 43 cases (48%) and the right side in 47 cases (52%). 7% of the patients were younger than 9 years old, about 70% between 10 and 39 years, and 18% between 40 and 59 years, while 4% were older than 60 years. Causes of zygoma fracture were traffic accidents in 151 (26%), assault in 117 (20%), accidental falls in 105 (19%), sports injuries in 56 (10%), home injuries in 45 (8%), work accidents in 34 (6%). Causes of zygomatic arch fractures 28 (29.1%) were assaults in 28 (29.1%), traffic accidents in 20 (21.5%), sports injuries in 14 (15.8%), accidental falls in 11 (14%), domestic accidents in 8 (8.8%) and work accidents in 4 (5%). The access to the fronto-zygomatic suture (74.6%) and the maxillary vestibular approaches (66.8%) were the commonest method of reduction of zygomatic fracture. About arch fractures, the Gillies temporal approach was the most used method of reduction (94.4%)., Conclusions: The findings, compared with similar studies reported in the literature, support the view that the highest prevalence is in young male patients and, concerning cause, traffic accidents and assault are the most frequent.

Objective: The purpose of this study was to compare the outcome of wire osteosynthesis with bone plating in the management of zygomatic complex (ZMC) fractures. The rationale was to enable the oral and maxillofacial surgeon to select either of the treatment procedure with confidence., Methods: In this quasi experimental study, Sixty five patients of ZMC fractures were randomly allocated in groups of bone plating and wire osteosynthesis. This was done through envelope draw method. Three points fixation with either of the treatment modality was undertaken. Titanium bone plating or stain less steel wire osteosynthesis was carried out at frontozygomatic suture, infra orbital rim and at zygomaticomaxillary buttress., Results: In this quasi experimental study, three patients failed to follow up. There were 31 patients in each group. Infra orbital step defect was observed in one patient of wire osteosynthesis and two patients of bone plating. Mild facial deformity was observed in two patients of wire osteosynthesis while none in that of bone plating., Conclusion: There is insignificant difference of proportion of infra orbital step defect and facial deformity between wire osteosynthesis and bone plating.

Background: Fractures of the zygomatic complex occur worldwide and are a component part of injuries that can be sustained in the maxillofacial region. The objective was to analyze the clinical presentation and management ofzygomatic complex fractures., Methods: This was a prospective study carried out over a period of five years at the University of Calabar Teaching Hospital, Nigeria. Data documented were patients' age, gender, time of presentation, cause and type of fracture, associated head and maxillofacial injuries, clinical features, types of plain radiographs, treatment methods, duration of follow-up and complications., Results: Majority of the patients (n = 81, 63.3%) were in their third and fourth decades of life while the male to female ratio was 20.3:1. Road traffic accident (n = 111, 86.7%) was the most common cause of fracture. Fractures of the zygomatic complex alone (n = 105, 82.0%) were more common than isolated fractures of the arch (n = 13, 10.2%) and combined fractures of the zygomatic complex and arch (n = 10, 7.8%)., Conclusion: While multi-disciplinary approach to treatment is important, majority of the fractures were treated by simple elevation and transosseous wire osteosynthesis. Delay in presentation, associated injuries and non-availability of mini-plating technique contributed to the development of complications.

Midfacial fractures rank first concerning maxillofacial traumatology. Collisions of two heads or head to object are the main causes for these fractures. An investigation based on a transient simulation using the finite element method was performed. A biomechanical head model was created and tested. A transient collision of two heads was simulated. The results were compared to a typical real patient case. This comparison revealed an identical fracture pattern, which can be interpreted as a clinical match of the simulation. The results of this study show the validity of biomechanical investigations, which may serve as a method to better understand maxillofacial fracture patterns. These results will be used for the optimization of fracture therapy or trauma prevention in the future., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

A rare case of fracture of the coronoid process, sphenoid bone, zygoma, and zygomatic arch caused by a firearm is described. A 25-year-old man was hit in the face with a bullet, resulting in restricted mouth opening, difficulty chewing, and pain when opening the mouth. The clinical examination revealed a perforating wound in the right parotid region. A computed tomographic scan revealed a comminuted fracture of the left coronoid process with the bullet stopping in the intact left coronoid process. Treatment was bilateral coronoidectomy associated with speech therapy and was successful. Details of the clinical signs, computed tomography, treatment, and follow-up are presented.

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.)

Purpose: Pattern and aetiology of maxillofacial injuries varies from one country to another and even within the same country depending on prevailing socio-economic, cultural and environmental factors. Various studies have been carried out in various countries to study the epidemiology and demographics of the maxillofacial injuries but the studies from India are few., Material and Methods: Retrospective study was undertaken at Christian Medical College Ludhiana (India) from January 2006 to December 2009. Treatment records of the patients was checked and age, gender, aetiology of injury, associated injuries, maxillofacial fractures and treatment offered were recorded., Results: A total of 1075 fractures were recorded in 718 patients, ranging from 11 months to 85 years of age. Male:female ratio was 6.6:1. Maxillofacial injuries were most common in third decade of life. A total of 517 patients suffered injuries because of road traffic accident, 115 because of accidental fall and 67 because of interpersonal violence. A total of 184 patients had 221 associated injuries of which 56.1% head injuries, 29.0% orthopaedic injuries and 14.9% other injuries were present. Of 596 middle third fractures, 29.8% were managed conservatively; for 21.7% and 48.7% of fractures, closed reduction and open reduction were performed respectively. Of 479 mandibular fractures, 1.8% was managed conservatively; for 16.7% and 81.5% fractures, closed reduction and open reduction were performed respectively., Conclusion: Better socio-economic status of people, increased vehicular movements and non-implementation of road safety norms have increased road traffic accidents. Proper education of the people who are most commonly involved in the RTA can be one of the possible ways to reduce the maxillofacial injuries., (© 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.

Facial injuries can impair a patient's ability to eat, speak and interact with others. Severe injuries occur as a result of interpersonal or domestic violence, or in motor vehicle collisions, including those involving motorcycles and all-terrain vehicles. The authors present a case of LeFort II fracture caused by a collision of opponents while heading the ball in a football match.

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.

Objectives: To assess the causes and management of Zygomatic bone fractures at Abbasi Shaheed Hospital, Karachi., Methods: This study was carried out at Department of Oral & Maxillofacial surgery Abbasi Shaheed Hospital, Karachi. A total of 82 cases were studied. A detailed history was taken, clinical examination was performed and fractures were confirmed by radiography. Management of fractures was done by using different proposed modalities, suitable for every case. A number of factors, like age of patients, causes of trauma and gender were assessed., Results: The commonest cause of Zygomatic bone fracture was found to be road traffic accident (RTA) 50% (n = 41), followed by assault 23.17% (n = 19), fall 20.73% (n = 17), sports injuries 3.65% (n = 3), and others 2.43% (n = 2) respectively. Right side (55%) was involved a little more than the left side (45%). Zygomatic bone fracture was more prevalent in age group between 21-30 years, while male to female ratio was 5.30:1. Remote reduction using Gillie's Temporal Approach with and without fixation using bone plates were the commonest management modalities used in this center., Conclusion: The commonest cause of Zygomatic bone fracture was found to be road traffic accident, with the right side fractures being more common. It reveals poor road traffic sense in road users, lack of road safety measures and legislation in our population.

The aim of this research was to analyze the surgical approaches and methods of rigid fixation used to treat zygomatic complex (ZC) fractures over a 10-year period. One hundred fifty-three patients who underwent surgery to treat ZC fractures between 1999 and 2008 were retrospectively evaluated. Demographic information, signs, and symptoms of the fractures, classification, surgical approaches, and methods of internal fixation were obtained from the medical records. The data were analyzed using statistical descriptive analysis and chi test (P < 0.05). The mean age of the sample was 31 years, and males were predominant (82.3%). In 60.1% of the patients, one surgical approach was used to treat the ZC fractures, whereas 2 surgical approaches were used in 24.8% of the patients. The zygomaticomaxillary buttress was fixed in 86.9% of the patients, followed by infraorbital rim fixation and zygomaticofrontal. There was a statistical significance between fracture displacement and surgical approach for the infraorbital rim (P < 0.0001) and zygomaticofrontal suture (P < 0.0001). Considering that adequate reduction and fixation should be performed and that we try to minimize the amount of scarring, the intraoral zygomaticomaxillary buttress approach is the first choice to treat ZC fractures. In cases of displacement bigger than 5 mm, approaches to 3 of 4 points of the ZC are mandatory to reduce the fractures. The infraorbital rim and zygomaticofrontal suture approaches are indicated to treat displaced fractures.

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.

Zygomatic complex fractures are one of the most common facial fractures treated by maxillofacial surgeons. Because of the importance of the zygomatic complex in midfacial skeletal orientation, comminuted zygomatic arch fractures can lead to significant morbidity and deformity. Common repair modalities include closed reduction via a Gilles approach, open reduction and internal fixation with screws and/or plating systems, primary bone grafting, and/or biosynthetics. In patients with significant comminution and arch defects, who are poor candidates for bone grafting, reconstruction can be difficult. In this clinical report, we present 2 patients with comminuted zygomatic arch fractures and significant bony defects, who were reconstructed with mandibular adaption plates alone without primary bone grafting. Over a mean follow-up period of 12.5 months, both patients healed well without any complications and had acceptable cosmetic outcomes.

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6%) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6%). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7% of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Objective: The purpose of this study was to perform a clinical retrospective analysis of the etiology, incidence and treatment of selected oral and maxillofacial injuries in Brazilian children and adolescents., Material and Methods: This study was conducted during a 14-year period between 1986 and 2000. All patients were admitted to Hospital XV in the city of Curitiba, State of Paraná. Age, gender, monthly distribution, etiology, soft injuries, associated injuries, site of fractures and methods of treatment were reviewed., Results: Of the total of 350 patients of all ages treated for facial injuries, 29.42% were within the age range of the study (0 to 18 years). Mean age was 10.61. Of the patients, 63.1% were male. The most common cause of injury was accidental falls (37.87%), followed by bicycle and motorcycle accidents (21.36%). Of the 103 patients, 88.34% had single injuries. Mandibular fractures were the most common and the condylar region was particularly affected., Conclusions: Facial trauma is a relatively common occurrence in children. The study indicates that fractures in children and adolescents differ quite considerably from an adult population.

Introduction: Fractures of the zygomatic complex with its accompanying functional and esthetic deficits are a fairly common phenomenon in the practice of maxillofacial and plastic surgery. The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world., Methods: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of maxillo facial and plastic surgery in Charles Nicolle Hospital (Tunisia), who had sustained a fractured zygoma from 1995 to 2004., Results: A total of 356 fractures were sustained. Patients in the third decade of life (34%) recorded the highest incidence. The sex distribution is markedly higher for males than for females (9/1). Road traffic accidents (31%) were the predominant etiology. Tetrapod fractures (43.7%) were the most frequent type of fractures followed by zygomatic arch fractures (34.53%). Cases were managed by either closed or open reduction. Percutaneous reduction was the commonest technique employed. However, in unstable fractures necessitated open reduction, transosseous wiring was the most frequently employed fixation. Patients were followed-up routinely, for an average of nine months. Inferior orbital nerve dysfunctions were seen in 8.7% of cases., Discussion: Epidemiological findings are similar to those reported in the literature. Males sustained more fractures than females and road traffic accidents were the commonest cause of zygomatic fractures. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures.

The authors report the case of a patient who sustained a complex craniofacial trauma secondary to a recreational fireworks blast. Initial assessment and management were performed with a multidisciplinary approach to achieve control of cerebral hemorrhage, debridement of wounds and brain, isolation of the brain from the external environment, reconstruction of the cranial base floor, and orbital and facial reconstruction. Modification of multiple conventional approaches, along with a multispecialty surgical team, were used to deal effectively with this unusual patient who was treated by single-stage immediate management. Reconstruction of both the intracranial and extracranial compartments was considered successful with a satisfactory cosmetic result.

Purpose: To investigate the prevalence, anatomic sites, and management of sports-related maxillofacial fractures in New Zealand., Patients and Methods: A retrospective analysis of 561 patients presenting with sports-related maxillofacial fractures between 1996 and 2006 was conducted. Variables analyzed included sociodemographic data, cause of injury, site of fracture, and method of treatment., Results: The mean patient age was 26.2 years, with a male:female ratio of 9:1. Sports-related facial fractures accounted for 21.7% of all fractures, with most of these secondary to rugby (52.0%), cycling (15.3%), cricket (7.1%), and soccer (4.8%). Mandibular fractures were the most frequent presentation (41.4), followed by zygomatic (29.4%) and orbital floor fractures (16.9%). Almost 50% of the patients from each sport required active treatment, with the majority requiring open reduction and internal fixation of the fracture (60.3%). The prevalence of sports-related facial fractures increased between the first 6 years (17.6%) and the next 5 years (25.8%) of the 11-year study period. The March-to-August period had a considerably higher number of fractures compared with the rest of the year., Conclusions: Nearly 20% of all maxillofacial fractures were sports-related, with most occurring in males. The prevalence of sports-related facial fractures increased over the study period. Most of the fractures involved the mandible and zygoma. Active intervention was required for almost 50% of the injuries.

Purpose: To evaluate the long-term functional and esthetic outcomes of using the subtarsal approach for orbital trauma patients in a group of Jordonian patients., Patients and Methods: Twelve patients treated using the subtarsal approach for orbital floor fractures in the Oral and Maxillofacial Surgery unit at the Jordan University Hospital were involved. Aspects evaluated included: the distance between scar and lower lid lash margin, scar length, esthetic appearances of the scar, lid edema, scleral show, ectropion, lagophthalmous, epiphora, subconjunctival injections, and keratoconjunctivitis., Results: Half the cases were the result of road traffic accidents. Follow-up time ranged from 10 to 73 months (mean +/- SD, 37.25 +/- 23.7 months). The postoperative outcome was favorable; 1 scar was noticeable, but was not hypertrophic. One patient suffered from scleral show that was associated with subconjunctival injections. One patient suffered from mild lid edema and 1 had keratoconjunctivitis. No other complications were recorded and patients were satisfied with the outcome., Conclusions: The subtarsal approach is a safe and simple to perform procedure for treating orbital floor fractures. It results in a good surgical outcome functionally and esthetically.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the common signs, symptoms, and treatment options for zygomatic fractures. 2. Answer basic questions on therapy for zygomatic fractures., Summary: This maintenance of certification article on zygomatic fractures attempts to review the current approaches to the treatment of these fractures. Although the article does not deal with extended approaches to treatment, it does in a general sense present the preoperative, intraoperative, and postoperative thinking for the plastic surgeon approaching these patients in general practice. A further in-depth review can be obtained through the references at the end of the article.

Objective: The purpose of this study was to establish the constructive of craniofacial suture in the three-dimensional finite element model of craniofacial complex in child, to analyse the response procedure of the zygomatic impact, to explore the biomechanics characteristic of the children craniofacial trauma., Methods: A 7-year-old female was adopted for study The complex cranial geometry was measured from a series of two-dimensional CT images. The multi-lay spiral CT scans were transformed with a self-developed preprocessor into a finite element mesh. The craniofacial sutures were constructed through the MSC Patran program. Identical impact and boundary conditions were used for the zygomatic impact simulations., Results: It has been shown that the finite element model (FEM) exhibited fine morphological and mechanical comparability. The higher stress was showed in the zygomatic regions and atlas occipital articular in 3d FEM. The maximum von Mises stress was found at the zygomatic regions and atlas occipital articular., Conclusion: The concentrations of shear stress and tension stress in the suture and articular would increase the risk of injury in this area. But the conduction of the stress might be weakening in the suture of child skull.

A 5-year review of 101 cases of zygomatico-orbital fractures is presented. The epidemiology, fracture patterns, treatment modalities, and complications were evaluated in this retrospective study. A majority of fractures were sustained by males and resulted from trauma inflicted during altercations and traffic accidents. The most common fracture pattern was tripod fracture and the most common associated facial fractures were mandibular fractures. Open reduction and rigid fixation was the most frequently employed treatment modality. Depending on the stability of reduced zygoma, one, two and three-point fixations were applied. Orbital floor exploration was performed in 41 cases. Ten out of 16 orbital floor bone defects required reconstruction. In these cases orbital floor was reconstructed with 1.5-mm porous polyethylene implant. Although we encountered a few complications related to the incisions for open reduction, the rate of complication in which correction was difficult (e.g. facial asymmetry) was lower with this approach when compared with the literature.

The purpose of this study is to develop injury risk functions that predict zygoma fracture based on baseball type and impact velocity. Zygoma fracture strength data from published experiments were mapped with the force exerted by a baseball on the orbit as a function of ball velocity. Using a normal distribution, zygoma fracture risk functions were developed. Experimental evaluation of these risk functions was performed using six human cadaver tests and two baseballs of different stiffness values. High speed video measured the baseball impact velocity. Post test analysis of the cadaver skulls was performed using CT imaging including three-dimensional reconstruction as well as autopsy. The developed injury risk functions accurately identify the risk of zygoma fracture as a result of baseball impact. The experimental results validated the zygoma risk functions at the lower and upper levels. The injuries observed in the post test analysis included fractures of the zygomatic arch, frontal process and the maxilla, zygoma suture, with combinations of these creating comminuted, tripod fractures of the zygoma. Tests with a softer baseball did result in injury but these had fewer resulting zygoma bone fragments and occurred at velocities 50% higher than the major league ball.

This study emphasizes the importance of scrupulous diagnostic first aid procedures to avoid the consequences of trauma due to a foreign body. Two patients were examined, both with facial trauma showing nonspecific symptoms. Through objective internal and external oral examination complete with clinical and radiographic examinations Three dimensional computed tomography (TC3D), foreign bodies unknown at the time of the trauma were identified. When the foreign bodies had been removed, the ache symptoms disappeared, restoring functionality and the patient's facial appearance. This study shows the need for detailed early diagnosis to achieve correct monitoring and therefore proper treatment for these patients.