A ten-year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: incidence and aetiology.

In the literature it is questioned if the presence of maxillofacial trauma is associated with the presence of brain injury. The aim of this study is to present a 10-year retrospective study of the incidence and aetiology of maxillofacial trauma associated with brain injury that required both oral and maxillofacial and neurosurgical intervention during the same hospital stay. Forty-seven patients from a population of 579 trauma patients undergoing maxillofacial surgery were identified. The main cause of injury was road traffic collision, followed by falls. Interpersonal violence correlated less well with traumatic brain injury. Most of the patients were males, aged 20-39 years. Frontal sinus fractures were the most common maxillofacial fractures (21.9%) associated with neurosurgical input, followed by mandibular fractures and zygomatic complex fractures. In the general maxillofacial trauma population, frontal sinus fractures were only found in 2.2% of the cases. At presentation to the Emergency Department the majority of the patients were diagnosed with severe traumatic brain injury and a Marshall CT class 2. Intracranial pressure monitoring was the most common neurosurgical intervention, followed by reconstruction of a bone defect and haematoma evacuation. Although it is a small population, our data suggest that maxillofacial trauma does have an association with traumatic brain injury that requires neurosurgical intervention (8.1%). In comparison with the overall maxillofacial trauma population, our results demonstrate that frontal sinus fractures are more commonly diagnosed in association with brain injury, most likely owing to the location of the impact of the trauma. In these cases the frontal sinus seems not specifically to act as a barrier to protect the brain. This report provides useful data concerning the joint management of oral and maxillofacial surgeons and neurosurgeons for the treatment of cranio-maxillofacial trauma and brain injury patients in Amsterdam.

Dysocclusion after maxillofacial trauma: a 42 year analysis.

BACKGROUND: The aim of this study was to evaluate the surgical management of posttraumatic dysocclusion in the Department of Oral and Maxillofacial Surgery in the VU Medical Centre in Amsterdam. PATIENTS AND METHODS: All patients who underwent surgical correction of a posttraumatic dysocclusion between 1970 and 2012 were reviewed. Patient charts were reviewed retrospectively. RESULTS: A total of 42 patients were included. Twenty-seven patients had a mandibular condyle fracture (64.3%). The initial fracture-treatment was either conservative, consisting only of intermaxillary fixation (IMF), or open reduction and internal fixation (ORIF). Though different orthognathic treatment options were used to regain normal occlusion, the most frequently used surgical techniques were a uni- or bilateral sagittal split osteotomy of the mandible in 21 patients (50.0%), followed by a Le Fort I osteotomy of the maxilla in 17 patients (40.5%). CONCLUSIONS: Most dysocclusions occur after mandibular condyle fractures, however fractures of other maxillofacial structures also account for a considerable number of cases. Good results are achieved with orthognathic surgery for posttraumatic dysocclusion.

The clinical and radiographical characteristics of zygomatic complex fractures: a comparison between the surgically and non-surgically treated patients.

BACKGROUND: In this retrospective study we evaluated the epidemiological data and the clinical and radiographical differences between surgically and non-surgically treated patients with zygomatic complex fractures at their initial assessment in our clinic over a period of 5 years. More knowledge of the clinical similarities and/or differences between the non-surgical and the surgical group will provide us a more complete view and may help physicians to develop any future methods in clinical decision making or even methods in distinguishing patients benefiting from a surgical treatment. METHODS: Surgically and non-surgically treated patients were included in the study, if clinical and radiographical confirmation of zygomatic complex fractures were present at initial assessment. The patient groups were divided into surgically treated zygomatic complex fractures, and non-surgically treated fractures, with and without displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. RESULTS: In total 283 patients were diagnosed with zygomatic complex fractures, with a mean age of 43 years (±20 years) and a domination of male patients. The mean age was higher in the non-surgically treated group and contained more female patients. Overall type C fractures and the majority of the type B fractures were treated surgically. Only 2.1% of the type A fractures were treated surgically. Overall facial swelling and paraesthesia of the infraorbital nerve were found as most common clinical findings. Additionally, malar depression and extraoral steps were frequently found in the surgically treated group, as in the non-surgically treated group only facial swelling was found frequently, whether there was fracture displacement or not. The clinical characteristics 'extraoral steps', 'intraoral steps', and 'malar depression' were found to be significantly related to surgical treatment. CONCLUSION: Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. The group of non-surgically treated zygomatic complex fractures is a valuable group to investigate as this group also consists of patients with displaced fractures (i.e. surgical indication) and thus, could provide us more insight in future clinical decision methods. Therefore, we highly recommend more research of the non-surgically treated group.

Clinical outcomes of surgical management of anterior bilateral mandibular fractures.

PURPOSE: The aims of this study were to assess the clinical outcomes of patients with anterior bifocal mandibular fractures and to discuss the management of this peculiar type of trauma. METHODS: From the systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients admitted with anterior bifocal bilateral mandibular fractures between 2001 and 2011 were considered. Patients were contacted, and they were invited to volunteer for a clinical follow-up examination. Statistical analysis was performed using the Fisher exact test, and P < 0.05 was considered statistically significant. RESULTS: Forty dentate patients with anterior bifocal bilateral mandibular fractures (without the presence of further mandibular fractures) were included in the study. Nineteen patients with dislocated anterior segment underwent surgical intervention within 12 hours from hospital admission in the emergency department, whereas 21 patients with nondisplaced mandibular fractures were surgically treated in the elective operating room within 72 hours. Only 3 patients underwent tracheostomy. All patients underwent open reduction and internal fixation with 2.0- and 2.4-mm plates via intraoral approach, except for patients with submental or submandibular facial lacerations. CONCLUSIONS: Anterior bifocal bilateral mandibular fractures may involve a challenging management because they can compromise the upper airway. Accurate reduction and internal fixation of these fractures have been critical to restoring form and function of the mandible. The upper airway management and securing always take first, but a prompt surgical intervention of dislocated fractures avoids upper airways impairment.

Quality of life after open versus closed treatment for mandibular condyle fractures: a review of literature.

INTRODUCTION: Many studies have compared treatment outcomes after open reduction and internal fixation (ORIF) and closed reduction (CR) of mandibular condylar fractures. Despite this the optimal treatment for these fractures remains a controversy. The purpose of this review is to compare the influence of objective and subjective treatment outcomes after open versus closed treatment of mandibular condyle fractures on quality of life, based on the current literature. METHODS: A MedLine and Embase search was performed to find relevant titles on treatment outcomes after open versus closed reduction of mandibular condylar fractures. RESULTS: Thirty-six studies were found. Twenty-eight retrospective studies, in addition to eight prospective studies were assessed. Nine treatment outcome variables were evaluated from the studies. Three studies reported on subjective discomfort. Although many studies investigated (objective) measurements (e.g. range of motion, masticatory function), no studies evaluated quality of life outcomes. In conclusion, prospective, patient-centred research is needed, in order to provide a guideline in decision making in the treatment of mandibular condylar fractures, based on subjective patient satisfaction.

Long-term results and complications after treatment of bilateral fractures of the mandibular condyle.

The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n=42, 59%) and falls (n=20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3-193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p=0.02). Increasing age was significantly related to reduction in the intensity of pain (p=0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular condylar fractures.

A 10-year analysis of the "Amsterdam" protocol in the treatment of zygomatic complex fractures.

Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4-87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures.

A ten-year analysis of midfacial fractures.

INTRODUCTION: With respect to maxillofacial trauma a substantial part consists of midfacial fractures. The distribution of fracture sites seems to be influenced by the cause of the injury, geographic location, local behaviour and socioeconomic trends. This retrospective study presents an investigation of the aetiology and incidence of midfacial fractures in Amsterdam over a period of 10 years. RESULTS: The study population consisted of 278 patients, 200 males and 78 females, with a mean age of 39.3 (SD: ±16.0) years and a male-female ratio of 2.6:1. Most fractures were found in the age group of 20-29 years for males and the age group of 50 years and older for females. The most common cause of the fractures was traffic related accidents. The main fracture site was the zygomatic complex, followed by the zygomatic arch and the orbital floor. In patients with alcohol consumption, violence was the main cause of injury. Complications consisted mainly of suboptimal fracture reduction, followed by temporary paraesthesia of the infraorbital nerve and wound infection. Complications were treated by retreatment, removal of the osteosynthesis material and antibiotic therapy. CONCLUSION: This study presents the aetiology and incidence of midfacial fractures in a Dutch population over a period of 10 years. Furthermore our treatment protocols for these fractures are discussed.

The epidemiological characteristics of zygomatic complex fractures: A comparison between the surgically and non-surgically treated patients.

INTRODUCTION: This retrospective study is aimed at the documentation of a more complete view of epidemiological data with particular focus on the characteristics of the surgically and non-surgically treated patients with zygomatic complex fractures. MATERIALS AND METHODS: A total of 133 surgically and 150 non-surgically patients were treated with zygomatic complex fractures in VU University medical center Amsterdam from January 2007 to January 2012 were analyzed. These patient groups were further subdivided into displaced or non-displaced fractures and compared with each other according to age, gender and trauma etiology. RESULTS: The mean age of all 286 patients was 42.8 years (standard deviation [SD: ±19.8]). Surgically and non-surgically treated patients differed in presentation with a significantly overall higher age of females, especially within the non-surgically treated patient group with displaced fractures (mean age of 59.5 years, SD: ±27.4). The mean ages of males from the different subgroups were more consistent with the overall mean age. The main causes were traffic accidents, whereas the contribution of falls and assaults depended on age group, gender, treatment management and even fracture displacement. CONCLUSIONS: This report provides us important epidemiological data of all patients with zygomatic complex fractures. The non-surgically treated patient group contained patients of higher age, more females and a fall-related cause, compared to the surgically treated patient group. The surgically treated patient group showed the same epidemiological characteristics as were demonstrated in previous studies.

Treatment and complications of mandibular fractures: a 10-year analysis.

The surgical treatment and complications of patients with mandibular fractures in Amsterdam over a period of 10 years are analysed. Between January 2000 and January 2009 225 patients were surgically treated for a mandibular fracture (mean age of 32.6 (SD±14.6) years). A total of 426 fracture lines were identified. Of 213 dentate patients 29 patients were treated primarily with intermaxillary fixation (IMF). IMF combined with osteosynthesis was performed on 99 patients. Seventy-nine patients received IMF only per-operatively to make open reduction and internal fixation (ORIF) possible. Of 12 edentulous patients three patients were treated with Gunning splints. Nine patients were treated by manual reduction and internal fixation. A total of 1965 screws and 442 plates were used. Sixty (26.7%) patients presented with complications, including (transient) hyposensibility of the lip and chin (34 patients), dysocclusion (15 patients), infected osteosynthesis material (six patients) and temporomandibular dysfunction (five patients). Four patients needed surgical retreatment for correction of a dysocclusion. The results of this report are partly in line with other studies and provide important data for improving the treatment of the fractured mandible.

Aetiology and incidence of maxillofacial trauma in Amsterdam: a retrospective analysis of 579 patients.

INTRODUCTION: The incidence of maxillofacial fractures varies widely between different countries. The large variability in reported incidence and aetiology is due to a variety of contributing factors, including environmental, cultural and socioeconomic factors. This retrospective report presents a study investigating the aetiology and incidence of patients with maxillofacial fractures in Amsterdam over a period of 10 years. RESULTS: The study population consisted of 408 males and 171 females with a mean age of 35.9 (SD: ±16.3) years. The age group 20-29 years accounted for the largest subgroup in both sexes. The most common cause of the fractures was traffic related, followed by violence. There were mainly mandibular and zygomatic bone fractures in both males and females, accounting for approximately 80% of all fractures. The main fracture site of the mandible was the combination of mandibular body with mandibular condyle (66 patients; 26.8%), followed by the combination of bilateral condylar fracture and fracture of the symphysis (43 patients; 17.5%). In fractures of the upper 2/3 of the face, zygomatic bone fractures were most common. In patients with alcohol consumption the injury was mostly the result of violence. In conclusion, this report provides important data for the design of plans for injury prevention, as compared with previous studies. Violence related injuries are increasing whereas fractures caused by traffic accidents are decreasing.

Analysis of mandibular fractures.

We investigated the etiology, incidence, and complications of patients with mandibular fracture in Amsterdam for a period of 10 years. Between January 2000 and January 2009, 213 patients with surgically treated mandibular fracture were identified. Two hundred thirteen patients were included with a mean age of 32.5 (SD, 15.2) years. Male-female ratio was 2.2:1. A total of 410 fracture lines were identified. In violence-related injuries, angle fractures were proved to be the main fracture site. For male patients, violence (33.6%) was the main cause of injury. The most common cause for female patients was traffic related. In 169 patients, open reduction with internal fixation was performed in 17 patients without intermaxillary fixation. Twenty-seven patients were treated only with intermaxillary fixation. A total of 1738 screws and 393 plates were used. Sixty patients presented with complications. The results of this report are partly in line with other studies and provides important data for the design of plans for injury prevention.