The psychological sequelae of maxillofacial trauma: a scoping review of the literature.

Managing the physical sequelae of facial trauma is routine for the maxillofacial surgeon. However, managing the psychological consequences is more challenging. The often violent mechanism of injury, changes in appearance, altered self-perception, and self-confidence can significantly impact daily life. This review summarises the literature regarding post-traumatic stress disorder (PTSD) and facial trauma, highlighting evidence to guide clinical practice. PubMed and MEDLINE were searched for relevant keywords and MeSH headings. Articles between 2000-2022 were independently reviewed by two authors. Articles were excluded if the full text was not available in English, did not relate to facial trauma, or was not related to PTSD/psychological sequelae. A total of 211 articles were retrieved. The most common reasons for exclusion were papers not reporting psychological outcomes (n = 68) or not relating to facial trauma (n = 35). Articles were sub-categorised to enable evaluation of key themes. Categories included children and adolescents, cross sectional, longitudinal studies, and interventional studies. Whilst there were potential confounders such as socioeconomic factors, overall, patients who had experienced facial trauma (regardless of the mechanism of injury) had an increased risk of PTSD and anxiety/depression. PTSD following facial injury is increasingly recognised as an important issue. A robust evidence base is desirable to inform clinical practice and provide holistic care to often vulnerable patients. Identifying those at increased risk of negative psychological sequelae is essential. We have appraised the literature relevant to OMFS trauma clinicians.

Quantitative assessment of bony orbital volume symmetry: CT analysis in the uninjured caucasian population.

There is a surprising lack of evidence documenting the volumetric symmetry of the bony orbit. This paper establishes reference values for orbital volume (OV) and symmetry in the 25 - 40 year old caucasian population. Secondarily, this paper sets a landmark for the tolerances in OV that can be expected when reconstructing the bony defects which may occur from trauma. A standardised method of quantitative OV measurement was developed using CT sinus examinations acquired for indications unrelated to orbital trauma. Sex, ethnicity, age, right and left OV were recorded. Data for 100 patients was obtained (50 male, 50 female). Mean left OV was 23.1cm3 and mean right OV was 23.3cm3. Left and right OV were strongly positively correlated (correlation coefficient: 0.96). Mean female OV was 21.6cm3 and mean male OV was 24.8cm3. On average, male OV is 3.2cm3 larger than female OV. The mean difference between left and right OV was 0.5cm3 in females and 0.6cm3 in males. The intra-class coefficient score between the two assessors was 0.973 (excellent). There is strong positive correlation between left and right OV in this study population. Previous work suggests that orbital volume loss less than 1cm3 would not lead to significant clinical symptoms of orbital fracture. When orbital reconstruction is undertaken, this study suggests that a volume symmetry difference of <0.5cm3 in females and <0.6cm3 in males would be consistent with the variation seen in the study population of uninjured caucasian 25-40 year olds and is therefore a reasonable goal of surgical management.