Presence of accompanying head injury in patients with maxillofacial trauma.

BACKGROUND: Patients with maxillofacial fractures are at high risk of accompanying traumatic cranial injuries. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery. METHODS: The records of 246 patients with maxillofacial fractures referred to the emergency department of our hospital between January 2006 and September 2009 were reviewed in this retrospective study. The patients' age and gender, cause, type and location of the maxillofacial fracture, and the cranial injuries were analyzed. RESULTS: The mean age of the patients was 23.61±16.75 years (83.3% males and 16.7% females). Cranial injury was observed in 38 patients with maxillofacial trauma. While the risk of head injury was found to be 3.44-fold lower among patients with single facial bone fracture (p<0.001), the risk of experiencing head injury significantly increased in patients with multiple facial bone fractures (p<0.001). The risk of head trauma significantly increased in patients with fractures of the nasal bone, maxillary bone, mandibular bone, and with frontal region fractures (p<0.05 in each group). CONCLUSION: The patients with multiple facial bone fractures should be investigated with regard to head injury even if they do not have clinical findings.

A rare case of fistula: nasocutaneous fistula.

A three-year-old male patient was brought to our clinic by his family with the complaint of a non-healing wound with discharge on his forehead and the nasal region. He had a history of a fall one-year ago. The patient had recurrent complaints of swelling and hyperemia following this trauma. He had undergone an operation with the pre-diagnosis of foreign body in soft tissue six months ago. However, no foreign body had been detected and the inflamed tissue had been excised and closed again. The swelling and purulent discharge in the region between nose and eye continued after this surgery. The patient underwent an operation and a circular defect 0.5 cm in diameter was detected on the dorsum of the nasal bone and a fistula tract was found to have developed between this defect and the skin between the nose and the eye. A subcutaneous forehead flap without skin tissue was removed including the periosteum from the left part of forehead after excision of the fistula tract. The flap was transferred to the nasal dorsum and the component of the forehead flap including the periosteum was used for reconstruction of the nasal mucosa. The wound healed without any problems and no fistula or infection developed again during the six-month follow-up.