Delayed contralateral traumatic carotid cavernous fistula after craniomaxillofacial fractures

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

Reduction of Isolated Zygomatic Arch Fractures with Gillies Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of facial bone fracture is increasing. The zygomatic bone, due to its anatomical prominence, is the second most common site of all facial bone fractures. In this study, we present the clinical experiences of zygomatic arch fracture in a tertiary hospital and introduce the Gillies approach for reduction and its outcome results. SUBJECTS AND METHOD: We collected data from retrospective chart reviews of patients who underwent surgeries from 2010 to 2017 for zygomatic arch fractures at Chungbuk National University Hospital. Data were analyzed according to age, gender, cause of trauma, location of trauma, and clinical symptoms including trismus. All surgery was performed under general anesthesia and via the use of Gillies approach. The result of surgery was evaluated by postoperative facial computed tomography. RESULTS: Sixteen patients underwent surgery for zygomatic arch fracture. The patients had the average age of 41.3 years, a male predominance of 15:1 and physical assault as the most common cause of trauma. The time lag between injury and surgical reduction was 5.5 days. The surgical outcomes were assessed “good” in 14 cases and “moderate” in one case. Patients who had trismus preoperatively were resolved of it in all cases after operation. Postoperative complications were absent. CONCLUSION: The Gillies approach proved to be a relatively easy, safe, and reliable method, and its surgical outcomes was satisfactory in our experiences.

A Retrospective Analysis of 303 Cases of Facial Bone Fracture: Socioeconomic Status and Injury Characteristics

BACKGROUND: The incidence and etiology of facial bone fracture differ widely according to time and geographic setting. Because of this, prevention and management of facial bone fracture requires ongoing research. This study examines the relationship between socioeconomic status and the incidence of facial bone fractures in patients who had been admitted for facial bone fractures. METHODS: A retrospective study was performed for all patients admitted for facial bone fracture at the National Medical Center (Seoul, Korea) from 2010 to 2014. We sought correlations amongst age, gender, fracture type, injury mechanism, alcohol consumption, and type of medical insurance. RESULTS: Out of the 303 patients meeting inclusion criteria, 214 (70.6%) patients were enrolled in National Health Insurance (NHI), 46 (15.2%) patients had Medical Aid, and 43 (14.2%) patients were homeless. The main causes of facial bone fractures were accidental trauma (51.4%), physical altercation (23.1%), and traffic accident (14.2%). On Pearson's chi-square test, alcohol consumption was correlated significantly with accidental trauma (p<0.05). And, the ratio of alcohol consumption leading to facial bone fractures differed significantly in the homeless group compared to the NHI group and the Medical Aid group (p<0.05). CONCLUSION: We found a significant inverse correlation between economic status and the incidence of facial bone fractures caused by alcohol consumption. Our findings indicate that more elaborate guidelines and prevention programs are needed for socioeconomically marginalized populations.

Significant Intraocular Sequelae in Orbital Blunt Trauma and Their Association with Blowout Fracture

PURPOSE: To investigate the frequency of significant intraocular sequelae (SIOS) in orbital blunt trauma and their association with blowout and facial bone fractures. METHODS: A retrospective survey consisting of 726 patients with orbital blunt trauma who visited Korea University Medical Center was performed. Patients were divided into three groups: blowout fracture only group (group 1), facial bone fracture group (nasal bone fracture, maxillary fracture, zygoma fracture without blowout fracture, group 2), and non-fracture group (group 3). SIOS (traumatic iridocyclitis, commotio retina, hyphema, retinal hemorrhage, eyeball rupture, vitreous hemorrhage, retinal detachment, lens dislocation, traumatic cataract) were surveyed in each group, and the association between the frequency of SIOS and the presence of blowout fracture or facial bone fracture was analyzed. RESULTS: The frequency of SIOS in the fracture groups was 83.8% in group 1 and 73.3% in group 2, which were both higher than the 67.9% in group 3, the non-fracture group (p = 0.000 by chi-square linear by linear association). Traumatic iridocyclitis and hyphema were also significantly higher in groups 1 and 2 than group 3 (p = 0.003, p = 0.008 by chi-square linear by linear association). CONCLUSIONS: SIOS was found significantly more often in the fracture group than the group without fracture, although the frequency of severe SIOS was lower in the fracture group than the non-fracture group. The results from the present study could help in the treatment and management of patients with orbital blunt trauma.

Statistical Analysis of Factors Associated with Facial Bone Fractures

PURPOSE: Statistical analysis of facial bone fractures has been performed in various papers. However, reports on risk factors for facial bone fractures are rare. In order to prevent facial bone fractures, it is important to determine the risk factors for their occurrence. This study seeks to perform a statistical analysis on and identify the risk factors associated with facial bone fractures. METHODS: A retrospective study was performed to assess facial bone fractures in patients presenting from October 2009 to January 2011 through a chart review. The data collected included age, gender, etiology, and alcohol consumption. Data was analyzed using multinomial logistic regression analysis. The significance level was set at p<0.05 and SAS ver. 9.2 was used. RESULTS: A total of 489 patients were analyzed. The patients' age ranged from 2 to 85 years (mean age, 31.8+/-15.4 years). The ratio of men to women was 5.0:1. The predominant group was age below 19 years old (30.9%). The main causes of facial bone fractures were assaults (37.8%), falls (27.2%), and sport accidents (19.5%). On multinomial logistic regression analysis, age, especially in the teen group was associated with assaults (p<0.05) resulting in facial bone fractures. Alcohol consumption was significantly associated with assaults and falls (p<0.05) leading to facial bone fractures. CONCLUSION: Facial bone fracture is a challenging problem, because of its high incidence and financial cost. The findings of this study indicate that more effective policies aimed at reducing alcohol intake and teenage violence are needed.

Statistical Analysis of Factors Associated with Facial Bone Fractures

PURPOSE: Statistical analysis of facial bone fractures has been performed in various papers. However, reports on risk factors for facial bone fractures are rare. In order to prevent facial bone fractures, it is important to determine the risk factors for their occurrence. This study seeks to perform a statistical analysis on and identify the risk factors associated with facial bone fractures. METHODS: A retrospective study was performed to assess facial bone fractures in patients presenting from October 2009 to January 2011 through a chart review. The data collected included age, gender, etiology, and alcohol consumption. Data was analyzed using multinomial logistic regression analysis. The significance level was set at p<0.05 and SAS ver. 9.2 was used. RESULTS: A total of 489 patients were analyzed. The patients' age ranged from 2 to 85 years (mean age, 31.8+/-15.4 years). The ratio of men to women was 5.0:1. The predominant group was age below 19 years old (30.9%). The main causes of facial bone fractures were assaults (37.8%), falls (27.2%), and sport accidents (19.5%). On multinomial logistic regression analysis, age, especially in the teen group was associated with assaults (p<0.05) resulting in facial bone fractures. Alcohol consumption was significantly associated with assaults and falls (p<0.05) leading to facial bone fractures. CONCLUSION: Facial bone fracture is a challenging problem, because of its high incidence and financial cost. The findings of this study indicate that more effective policies aimed at reducing alcohol intake and teenage violence are needed.

The Relationship between Socioeconomical Status and Incidence of Facial Bone Fracture

PURPOSE: The human face is the most exposed part of the body, and in patients with simple or complex trauma from traffic accidents, industrial calamities, sports injuries, human assaults, and daily accidents, facial trauma occupies an important portion. The etiology of facial trauma vary on a society's economic, cultural, and environmental status. METHODS: Regarding patients who were admitted from between the years 2000 to 2009 at the Hanyang University hospital, the authors studied how the changes in the economic status in the past 10 years of our country influences the incidence of facial bone fractures. RESULTS: In this study, 1) The unemployment rate showed a strong negative relationship with the total number of inpatients with facial bone fractures, the number of male patients, the number of female patients, the number of patients with facial bone fractures caused by fall down, the number of patients who were admitted for shorter than 7 days, and the number of the facial bone fracture patients with their age in the twenties. 2) The consumer price index showed a strong positive relationship with the number of female patients, the number of patients who were admitted for shorter than 7 days, and the number of the facial bone fracture patients with their age in the teens and fifties. CONCLUSION: Looking at the results of correlation analysis and multiple regression analysis with economic indicators, the unemployment rate showed negative influence to the total number of inpatients with facial bone fractures, and the number of inpatients with facial bone fractures caused by fall down, with statistical significance.

The Useful Method on Temporary Fixation with Screw-wire Technique

PURPOSE: Until now, many kinds of treatment modalities for facial bone fractures have been proposed. Among them, the semi-rigid fixation using miniplates has become the most popular procedure due to its simplicity and good clinical results. However, achieving anatomic reduction of bone fragments with miniplates may be difficult because of inadequate instrumentation for fracture fragment stabilization. We examined the use of inter-maxillary fixation screws or titanium screws tied with stainless steel wire to assist in positioning of fractured segment. METHODS: We used this method for reduction in 50 cases of facial bone fractures. Inter-maxillary fixation screws or titanium screws tied with stainless steel wire were used to assist in aligning bony segment. Postoperative radiologic and clinical follow-ups were performed. RESULTS: Radiologic follow-up showed correct reduction and fixation in all cases. Nonnunion and malunion were not shown. Clinical follow-up showed an satisfactory results. CONCLUSION: By using Inter-maxillary fixation screws tied with stainless steel wire, it was shown that reducing the bony segment to their preinjury position is easy to perform and it enables us to make more accurate reduction, ensure wider visual field.

Clinical Study of 123 Facial Bone Fractures in Elderly

PURPOSE: Aging society was realized after persons over 65 was rated above 7% in 2000. It is inevitable fact that society gets older. Few study about facial bone fracture in elderly was reported until now. This study provides a retrospective statistical analysis of facial bone fracture and reports of some demographical information from medical records. METHODS: From January 2000 to December 2005, 123 cases of facial bone fracture in above 55 year-old persons were reviewed and analysed. Statistic data was related to distribution, age, sex, causes, occupations, occurrence, time, incidence of facial bone fracture, treatment and it's complications. RESULTS: Facial bone fractures in elderly tend to increase and rated to 4.7%. Facial bone fractures in elderly were most frequently occurred in farmers, cultivator accidents and zygoma fractures. A few minor complications were checked, but easily improved. CONCLUSION: Facial bone fractures in elderly have small proportion of the whole facial bone fractures, but gradually have been increased. This study was observed trends in changes of facial bone fracture in elderly for 5 years and expected to provide statistical index to prevent facial bone fracture in elderly.

Re-treatment of malocclusion resulting from improper reduction of facial bone fracture

Clinical Analysis of Pediatric Facial Bone Fracture; 10-years Experiences in 201 Cases

The proper management of the pediatric facial bone fracture is critical in the facial bone development. This study characterizes the surgically treated patient population suffering from facial bone fractures by the use of current data from a large series consisting of 201 cases. The data was gathered through a retrospective chart review of patients surgically treated for facial bone fractures at the department of plastic and reconstructive surgery, Sanggye Paik hospital, Inje university medical center, collected over 10-years period from January, 1993 to December, 2002. Data regarding patient demographics(age, sex), seasonal distribution, location of fractures, and the causes of injury with admission periods, were collected. In total, there were 201cases of pediatric facial bone fractures. Male patients outnumbered female patients by a 5.48: 1 ratio and were found to engage in a wider range of behaviors that resulted in facial bone fractures. Physical violence was the leading cause of pediatric facial bone fractures(27.9%), followed by sports-related mechanisms (22.9%) and falling down(17.9%). The most prevalent age group was 11-15 years-old(71.1%) and there was a 14.3% prevalence in March. Among the location of fractures, the nasal bone was the most prevalent, accounting for 82.3% of injuries, followed by the orbit(9.95%), and the mandible fractures(7.5%). Most patients(59.7%) were treated within 6-9 days after trauma and the mean hospitalization period was 8-11 days. We should follow up the surgically treated patients, and they will be further evaluated about postoperative sequele and effect on the facial bone development. These studies demonstrate differences in the demographics and clinical presentation that, if applied to patients, will enable a more accurate diagnosis and proper management.

A clinical consideration of submental intubation at oral and maxillofacial surgery

Usefulness of Absorbable Plate for Facial Bone Fracture Accompanying Malocclusion

At the present day, the metallic rigid fixation is used universally in facial bone fracture surgery. However, these metallic plating system have problems associated with growth restriction in pediatric patients, intracranial migration, increase risk of infection, palpability, and exposure. To overcome these problems, absorbable devices have been developed and used in the reconstruction of pediatric craniofacial deformities before early stages and in the facial bone fracture of adult recently. However, the usefulness of fixation for the force vector affecting region was not verified. From October 2000 to August 2001, absorbable fixation system(BiosorbFX(R) Bionix Implants inc.) was used in 10 open reduction of facial bone fracture with malocclusion; 5 patients with Le Fort I or Le Fort II fracture, 1 patient with maxillary-sagittal fracture, 4 patients with mandible fracture. All the patients, the malocclusion was corrected with no complications, and stabilized fixation was achieved after average 8 months follow up period. These results show usefulness of absorbable devices for fixation of force vector affecting region.

A Clinical Analysis and Appropriate Management of Pediatric Facial Bone Fractures: 6 Years Survey

As significant increase in the pediatric accidents becomes socially and morally concerned, reviewing over the statistical analysis of the pediatric accidents was needed especially in their facial bone traumas, in order to deduce a preventive and so to speak, protocols of treatments. This retrospective study comprise 73 pediatric patients who sustained facial bone fractures through various accidents and treated in the department of Plastic and Reconstructive Surgery, Seoul Hospital, Hanyang Medical Center during past 6 years from January 1993 to December 1998. The medical records of these 73 patients (91 fractures) were reviewed and analyzed retrospectively in order to obtain the clinical pattern and understand the therapeutic modalities. The statistical items were the prevalent time, age, sex and cause distribution, fracture sites, accompanying injuries, intervals among accident, arrival and operation, treatment methods with fixation materials, and complications were reviewed as following results. An increment of 5.1% per year of pediatric facial bone fractures was noted where 5.4% reduction of the population during the same periods. The mean age of patients was 10.5 years and the range of age was 3 to 15 years with males predominating over females in 3.1:1 ratio as in 3.5:1 in adults. Traffic accidents(43.9%) were responsible for the majority of facial bone fractures followed by violence(26.4%), fall(18.7%) and 91 facial fractures in 73 patients were classified where most common sites were nasal bone (56.1%) followed by blow-out fracture excluding other orbital fractures(17.6%), mandible(15.4%), zygoma(5.5%), orbital rim(2.2%), maxilla (2.2%) and frontal sinus(1.1%). Associated soft tissue injuries were combined in 52 patients(71.2%) and fractures other than facial bone were developed in 12 patients (16.4%) and treatment for facial bone fracture consisted of open reduction(40.6%), closed reduction(54.9%) and conservative treatment(5.5%). The complication rate was 9.4% and the most common complication was local infection followed by ophthalmologic problems and facial asymmetry. All data were analyzed based on the charts, medical records, and X-ray findings and presentation of the goals and optimal course of the entire management was made.

THE CLINICOSTATISTICAL STUDY OF FACIAL BONE FRACTURE IN RECENT FIVE YEARS

This study was aimed to furnish the data of facial bone fracture which was related regional and social environment and to aid diagnosis and treatment of the fracture. This is the retrospective and clinicostatical study on 625 patients with facial bone fracture. The patients were treated in the Dept. of Oral and Maxillofacial Surgery of Wonkwang University Hospital from Jan. 1, 1993 to Dec. 31, 1997. The result were as follows : The facial bone fractures occured most frequently in the twenties(32.3%) and male were predominent(77.4%) than female. The most frequent etiologic factor of facial bone fracture was fall down(42.8%) and midface fracture was traffic accident(63.4%). The most common site of fracture was symphysis(51.1%) and angle(29.7%), condyle(27.5%), ZMC(13.4%) were next in order of frequency. Of the 626 patients, 590 patients(89.5%) were treated with open reduction and only 36 patients(10.5%) were treated with closed reduction. In the blow, the ratio of angle fracture(50%) is especially high(the overall ratio 29.7%) and in the Out car TA, the ratio of ZMC fracture(34.6%) is especially high(the overall ratio 13.4%). In the fall-down, the ratio of symphysis(58.4%) and condyle fracture(33.6%) is especially high(the overall ratio 51.1%, 27.5%). Postoperatives complication were found in 35(5.6%) of 626 patients, in which mouth opening limitation(3%) was the most common. Above results suggest that early diagnosis and treatment of fracture site, systemic condition and associated injuries are nessary, and cooperative treatment with medical department should be performed.

A Clinical Analysis of Facial Bone Fractures Excluding Nasal Bone Fractures / 대한이비인후과학회지

BACKGROUND: The number of facial bone fractures are steadily increasing because of increment of traffic volume and expansion of social activity. Also the forms of the fractures show to be more complicated due to increase of traffic vehicles. Facial region has an important role in human aesthetic and functional aspects. Therefore, it it very important to diagnose accurately and treat promptly and appropriately the fracture, to minimize deformity and functional disturbance in the face and enable the patient to socialize normally. OBJECTIVE: Our objective of this study is to elucidate general characteristics of clinical aspect in the facial bone fractures by analyzing the cases with facial bone fractures who diagnosed and treated at Nam Kwang Hospital for recent 2 years. MATERIALS AND METHODS: The authors reviewed retrospectively the medical records of 115 patients among 200 patients with facial bone fractures, excluding 85 patients who had only nasal bone fractures, diagnosed and treated at Nam Kwang Hospital from Jan. 1995 to Dec. 1996. The records of the cases were examined and analyzed according to sex and age distribution, cause of injury, symptoms and signs, associated injuries, frequency and treatment modality in each region, and complications. Results and CONCLUSIONS: The results were as follows; 1) Ninty cases(78.3%) were male and the peak age group was third decade(33.0%). 2) The most common cause of injury was motor vehicle accident(53.0%). 3) The most common symptoms and signs were pain, tenderness and edema(100%). 4) The most common associated injury was soft tissue injury(58.3%). 5) Single facial bone fracture was more common(68.7%) and among them, mandibular fracture was the most common. 6) The incidences of anatomical locations of facial bone fracture were mandible(45.2%), zygoma(39.1%), maxilla(17.4%) and frontal bone(14.8%), in order of frequency. 7) In zygomatic fractures, arch fracture was the most common(46.7%). 8) In maxillary fractures, complete Le Fort fracture type I was the most common(20.0%). 9) In orbital fractures, pure blow-out fracture was the most common(52.9%). 10) In mandibular fractures, symphysis and parasymphysis were the most common anatomical site(48.1%). 11) The cases treated with surgical approach were 70.4%. 12) The most common complication was infraorbital nerve dysfunction(6.1%).