Le Fort II fractures are associated with death: a comparison of simple and complex midface fractures.

PURPOSE: To investigate whether complex midface fractures have a greater association with death and intracranial injury than simple midface fractures. MATERIALS AND METHODS: A retrospective chart review was performed for patients with blunt-mechanism midface fractures who had presented to an urban trauma center from 1998 to 2010. The survival and intracranial injury status was evaluated for patients with simple and complex midface fractures, including Le Fort, naso-orbitoethmoid, and/or zygomaticomaxillary fractures. Intracranial injury included hemorrhage and brainstem injury. Patients with upper face fractures were excluded to minimize confounding. Adjusted relative risk estimates were obtained using multivariate regression analysis. RESULTS: Of 3,291 patients with midface fractures, 213 (6.3%) died and 693 (21.3%) had an intracranial injury. The cumulative mortality reached 11.6% in patients with complex midface fractures and 5.1% in those with simple midface fractures (P < .001). Patients with complex midface fractures were 57% more likely to die (relative risk = 1.57; P < .005). Specifically, Le Fort II fractures independently conferred a 94% increased risk of death (relative risk = 1.94; P < .01), but Le Fort I and III fractures were not significantly associated with death. Among patients presenting without neurologic impairment, those with Le Fort II and III fractures remained 2.88-fold (P < .01) and 2.54-fold (P < .001) more likely to have an underlying intracranial injury, respectively. CONCLUSIONS: Le Fort II fractures are associated with increased mortality. Furthermore, Le Fort II and III fractures are associated with serious intracranial injury, even in the absence of alterations in consciousness. These patients should be monitored with heightened vigilance and followed up closely during hospitalization, regardless of the presenting clinical findings.

A closer look at orthopedic injuries associated with maxillofacial trauma.

Although orthopedic injury has been reported to be the most frequent injury associated with facial trauma, their relationship has not been sufficiently evaluated in the literature. To evaluate this relationship, we compared 263 patients with concomitant facial and orthopedic injuries with 2006 patients with facial injuries alone. The rate of associated orthopedic injuries was 11.5%. Motor vehicle accidents, falls, mandibular fractures, and Le Fort I fractures increased the chance of sustaining orthopedic injuries nearly 17-, 15-, 10-, 4.4-, and 4.5-fold, respectively. Most fractures occurred in large bones with their inherent potential to cause severe, life-threatening complications. The high rates of mortality and morbidities associated with orthopedic injuries and the frequent occurrence of these injuries in patients with facial trauma emphasize upon the fact that maxillofacial surgeons, residents, and trauma nurses need more training in early diagnosis and appropriate management of associated orthopedic injuries.

[Epidemiology and management in emergency room patients with maxillofacial fractures]. / Epidemiologie und Behandlungsmanagement bei Schockraumpatienten mit Gesichtsschädelverletzungen.

OBJECTIVE: To minimize overall mortality and optimise reconstructive and cosmetic outcome in severely injured patients with maxillofacial injuries the interdisciplinary coordination of several surgical disciplines is required. It is still discussed controversy whether patients with maxillofacial fractures benefit from early fracture repair or if delayed operative management also yields in good results. METHODS: Herein we analysed the data of 1252 severely injured patients between May 1998 through June 2002 in our trauma department regarding fractures of the maxillofacial region, injury severity, length of ICU stay and postoperative complications in patients with either early (within 72 hours) or delayed ( > 3 days) facial fracture repair. RESULTS: 147 patients had severe facial fractures. Average age was 39.8 years (3-87 years), mean ICU was 25 (+/- 16) and the overall mortality 12% (n = 18). The most common cause for the injuries were traffic accidents in 45%. 78 patients (53%) underwent surgical repair of the maxillofacial fractures; 18 patients had early fracture repair and 60 patients had delayed operative repair. We found 4 complications (22%) in the early repair group and 13 local complications (21%) in the group with delayed surgical repair. CONCLUSION: Delayed repair of maxillofacial injuries in severely injured patients is feasible and yields in good results compared to early fracture repair.