Characteristics of Associated Injuries in Children and Teenagers With Craniofacial Fractures.

The incidence of pediatric craniofacial fractures and heterogeneity of fractures is known to increase with age. This study aimed to determine the occurrence of associated injuries (AIs) to craniofacial fractures and identify differences in patterns of and predictors for AIs in children and teenagers. A 6-year retrospective cross-sectional cohort study was designed and implemented. The study population included 397 patients aged 19 years or less diagnosed with craniofacial fracture at Helsinki University Hospital from 2013 to 2018. Boys (71.0%) and teenagers (64.7%) were predominated. Associated injuries were more common in teenagers than children. Teenagers had more often AI in 2 or more organ systems. Assault and intoxication by alcohol were observed only in teenagers and predominantly boys. A total of 27.0% of all patients sustained AIs. In 18.1%, brain injury was reported. In children, motor vehicle accident (MVA) was an independent predictor for AI. In teenagers, independent predictors for AI were female sex, isolated cranial fracture, combined cranial fracture, and high-energy trauma mechanism. Injury patterns and AI related to craniofacial fractures in the pediatric population are age-specific, requiring multidisciplinary collaboration in the diagnosis, treatment, and follow-up of such trauma. Predictors for AIs increase in complexity with age, and the role of sex as a predictor is evident in teenagers.

Urban drinking and driving: comparison of electric scooter and bicycle related accidents in facial fracture patients

Background: In recent years, electric scooters (e-scooter) have emerged as an alternative mode of urban transport due to their availability and effortless use. However, e-scooter-related trauma and injuries, especially to the head, have received wide media coverage and raised public concern about their safety. We aim to determine and compare clinically relevant variables, incidence, and severity between bicycle and e-scooter-related facial fractures and potential protective measures for injury prevention. Material and methods: This retrospective study comprised all patients admitted to a tertiary trauma center with bicycle or e-scooter-related facial fractures between January 2019 and October 2020. Patient- and injury-related variables, including demographics, injury mechanisms, helmet use, influence of alcohol, types of facial injuries, types of other injuries, given treatment, and hospital stay, were collected, analysed, and compared between bicycle and e-scooter injuries. Results: Altogether 169 patients with facial fractures, 124 bicycle-related injuries (73.4%) and 45 e-scooter-related injuries (26.6%) were included. Alcohol involvement was significantly higher in e-scooter patients (88.9%) than in bicycle patients (31.5%) (p<0.001). Driving under the influence of alcohol was associated with driving without a helmet in both groups (p<0.001). In multivariate analyses, e-scooter accidents were 18 times more likely to occur under the influence of alcohol (OR 17.85, p<0.001) and were more likely to involve collision with a stationary object (OR 3.81, p=0.028). E-scooter patients were significantly younger (OR 0.95, p<0.001) and had significantly more cranial fractures (OR 10.15, p=0.014) than bicycle patients. (AU)

Otologic injuries are frequent in pediatric patients with temporal bone fractures.

This retrospective study aimed to clarify the occurrence and types of otologic injuries in children and adolescents with skull fractures. Files of all patients under 18 years of age who had been diagnosed with skull fractures at a tertiary trauma centre were included. The primary outcome variable was the presence of any otologic symptom or finding. Secondary outcome variables were clinically detected and radiologically detected otologic injuries. The primary predictor variable was a temporal bone fracture. Other study variables were sex, age, mechanism of injury, traumatic brain injury, and mortality. A total of 97 patients were identified for the study. Otologic symptoms and findings were frequent (33.9%). The most common clinical findings were bleeding from the external auditory canal (18.6%) and hemotympanum (13.4%). The prevailing radiological finding was blood and/or cerebrospinal fluid in the middle ear (30.9%). Patients with fractures of temporal bone had a 29-fold risk for otologic symptoms or findings (RR 28.9, 95% CI 4.1-202.9, p < 0.001) relative to those who did not have a temporal bone fracture. Severe otologic complications, such as permanent hearing loss (6.2%), cerebrospinal fluid leak (5.2%), or facial nerve palsy (1%), were infrequent. Within the limitations of the study it seems that there is the necessity of otoscopy in all pediatric patients with blunt head trauma. In case of positive otologic findings, the patient should undergo imaging and ENT consultation.

Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction.

Lower eyelid malposition (LEM) is a common sequela after orbital fracture reconstruction. This study aimed to analyse the development of LEM, specifically ectropion and entropion, following primary orbital fracture reconstruction, to identify predictive factors for LEM, and to assess the effect of the eyelid complication on patients' daily lives. The retrospective cohort comprised patients who had undergone orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type and site, surgery and implant-related variables, follow-up time and number of visits, type and severity of LEM, subsequent surgical correction, and patient satisfaction, were analysed. The overall occurrence of LEM was 8%, with ectropion in 6% and entropion in 2% of patients. Older age, complex fractures, transcutaneous approaches, preoperative traumatic lower lid wounds, and implant material were associated with the development of LEM. Of all patients, 3% needed surgical correction of LEM. Six of the 13 patients (46%) who developed LEM required surgical correction. The transconjunctival approach and patient-specific implants should be preferred, especially in elderly patients and those with more complex fractures. LEM often requires subsequent surgical correction, and the treatment period is substantially prolonged, with multiple extra visits to the clinic.

Mandibular fractures in aged patients - Challenges in diagnosis.

BACKGROUND/AIMS: Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses. MATERIAL AND METHODS: Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged ≥60 and <80 years), elders (aged >80 years), patient's age as a continuous variable and age sub-group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury. RESULTS: Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p = .02) and site of injury (p = .02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury. CONCLUSIONS: There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder.

Are the Elderly With Maxillofacial Injuries at Increased Risk of Associated Injuries?

PURPOSE: As the geriatric population continues to increase, more elderly patients with maxillofacial injuries are encountered in emergency rooms. It can be hypothesized that advanced age increases the risk of associated injuries (AIs). The purpose of the study was to estimate the frequency of AI and measure the association between age and risk for AI among a sample of patients with facial fractures. METHODS: A retrospective cohort study was designed and implemented. The study sample comprised patients aged 18 years or older who presented to the Töölö Trauma Centre, Helsinki University Hospital, Finland, between 2013 and 2018 for diagnosis and treatment of facial fractures. The primary outcome variable was the presence or absence of AI. AI was defined as any major injury outside the facial region, including injuries to brain, major vessels, internal organs or respiratory organs, and fractures. Secondary outcome variables were affected organ system (classified as brain, cranial bone, neck, upper extremity, lower extremity, chest, spine, and abdomen), number of affected organ systems (classified as 1 and ≥2), need for intensive care, and mortality. The primary predictor variable was age (adults vs elderly). Controlled variables were sex, mechanism of trauma, intoxication by alcohol, and type of facial fracture. Descriptive statistics, univariable, and multivariable logistic regression analysis were executed to measure the association between age groups and AI. P value less than .05 was set as the threshold for statistical significance. RESULTS: Of the total 2,682 patients, 1,931 (72.0%) were adults, and 751 (28.0%) were elderly. Elderly had a 1.6-fold risk (95% confidence interval [CI], 1.5-1.8; P < .001) of AIs as compared with adults. Moreover, after adjusting for mechanism of trauma and type of facial fracture, elderly had 1.8 times greater odds for injuries to 2 or more organ systems (95% CI, 1.3-2.5; P < .001), 2.2 times greater odds for brain injuries (95% CI, 1.6-2.9; P < .001), 2.3 times greater odds for neck injuries (95% CI, 1.5-3.6; P < .001), and 6.8 times greater odds for mortality (95% CI, 2.9-15.6; P < .001). CONCLUSION: Elderly patients have AIs significantly more frequently than younger adults. Age-specific features should be taken into consideration in the multiprofessional evaluation and treatment of facial fracture patients.

Dental injuries in paediatric mandibular fracture patients.

PURPOSE: Dental injuries (DIs) are associated with facial fractures, particularly mandibular fractures. As paediatric mandibular fractures have special features, we sought to clarify the occurrence and types of DIs among this patient group. We assessed how age, injury type, and fracture location affects the occurrence of DIs and thereby defined which patients are most susceptible. METHODS: This retrospective study included patients < 18 years with a recent mandibular fracture. Predictor variables were gender, age group, mechanism of injury, type of mandibular fracture, and other associated facial fracture(s). Types and locations of DIs and tooth loss due to injury were also reported. RESULTS: DIs were detected in 34.7% (n = 41) out of 118 patients. Patients with tooth injury had on average 3.5 injured teeth. A total of 16.2% of injured teeth were lost, typically at the time of the injury. Loss of at least one tooth was seen in approximately 10% of patients. Avulsion was the most common cause of tooth loss (52.2%). Non-complicated crown fracture (50.7%) was the most common DI type. Statistically significant associations between studied variables and DIs were not detected. CONCLUSION: DIs are common and often multiple in paediatric mandibular fracture patients regardless of background factors. DIs often lead to tooth loss. Prompt replantation of an avulsed tooth, early detection of DIs, and prevention of tooth loss whenever possible are important to avoid permanent tooth defects.

Sports-based distribution of facial fractures - findings from a four-season country.

OBJECTIVE: The aim of this study was to elucidate the relationship between injury mechanisms and sports-related facial fractures, and to evaluate the changes in incidence rates of facial fractures sustained in sports-related events in a 30-year period. MATERIAL AND METHODS: This retrospective cohort study included all patients sports-related facial fractures admitted to a tertiary trauma centre during 2013-2018. Specific fracture types, sports, injury mechanisms as well as patient- and injury related variables are presented. The results underwent evaluated statistically with logistic regression analysis. RESULTS: Facial fractures occurred most frequently while playing ice hockey and football. Unilateral zygomatic-maxillary-orbital and isolated mandibular fractures accounted for 74.2% of all fracture types. In total, 99 patients (46.5%) required surgical intervention for their facial injuries. About 12.7% of patients sustained associated injuries in addition to facial fractures. Overall, the number of sports-related facial fractures has increased during the last three decades mostly due to the surging rates of ice hockey- and football-related facial fractures. CONCLUSIONS: Sport-related facial fractures have markedly increased in different sports disciplines during the past decades. The use of safety gear to protect the facial area should be enforced particularly in ice hockey.

Effect of Perioperative Systemic Dexamethasone on Pain, Edema, and Trismus in Mandibular Fracture Surgery: A Randomized Trial.

ABSTRACT: The authors' aim was to evaluate the effect of perioperative systemic dexamethasone (DXM) administration on postoperative pain, edema, and trismus in mandibular fracture patients. The authors conducted a prospective randomized study of 45 patients with one or 2 noncomminuted fractures of the dentate part of the mandible. All patients underwent surgery for intraoral miniplate fixation. Patients in the study group were given a total of 30 mg DXM, while patients in the control group received neither DXM nor placebo. Only paracetamol and opioids were served as analgesics. Pain severity was assessed using the visual analog scale. The effect in facial swelling was measured in centimeters and analyzed as percentage change. Trismus was evaluated as the difference in maximal mouth opening by measuring interincisal distance in millimeters. The Mann-Whitney U test was applied to determine the statistical significance of differences between the groups. Thirty-four patients were included in the statistical analysis. The visual analog scale score was significantly lower in the study group than in the control group at 18 hours postoperatively (P = 0.033). Significant differences in edema or trismus were not found postoperatively between the DXM and control groups. In conclusion, perioperative DXM decreases postoperative pain in mandibular fracture patients when nonsteroidal anti-inflammatory drugs are not used, but it does not seem to be effective in reducing edema or trismus.

Craniofacial Fractures in Equine-Related Injuries: What Should a Maxillofacial Surgeon Expect?

ABSTRACT: Patients with equine-related injuries (ERI) have high rates of hospitalization and often require surgical treatment. This study aimed to clarify the injury profiles of patients sustaining ERI-related craniofacial fractures and their relationship with other severe head and neck injuries.This retrospective study included all patients with craniofacial fractures admitted to a tertiary trauma center during 2013 to 2018. Out of 3256 patients, a total of 39 patients were included in the study (1.2%). Demographic and clinically relevant variables were reported and statistically evaluated.Males represented only 7.7% of the study population. Isolated facial fractures were over-represented in this study population at 84.6% whereas only 7.7% of patients sustained isolated cranial fractures and 7.7% of patients sustained combined craniofacial fractures, respectively. Surgical intervention for craniofacial fractures was required in 48.7% of patients. In total, 17.9% of patients sustained severe head and neck injuries. Periods of unconsciousness and/or post-traumatic amnesia were seen in 41% of patients. Helmet use could only be confirmed in 17.9% of patients.As trauma mechanisms behind ERI are often multifactorial and patients are at a high risk of sustaining associated injuries, attentive examination, and exclusion of serious life-threatening injuries through a multi-disciplinary approach is imperative for this specific patient population.

Associated Injuries Are Common Among Patients With Bicycle-Related Craniofacial Fractures.

PURPOSE: Ample evidence exists on the relationship between bicycle injuries and craniofacial fractures. However, as the mechanism behind these injuries is often multifactorial, the presence of associated injuries (AIs) in this study population requires further examination. We hypothesized that patients with craniofacial fracture injured in bicycle accidents are at high risk of sustaining severe AIs, especially those of the head and neck region. PATIENTS AND METHODS: The investigators performed a retrospective study on all patients with bicycle-related craniofacial fracture admitted to a tertiary trauma centre during 2013 to 2018. The predictor variable was defined as any type of craniofacial fracture. The outcome variable was defined as any kind of AI. Other study variables included demographic and injury-related parameters. Variables were analyzed using bivariate and Firth's logistic regression analyses. RESULTS: A total of 407 patients were included in the analysis. Our results revealed that AIs were present in 150 (36.9%) patients; there were multiple AIs in 47 cases. Traumatic brain injuries followed by upper limb injuries were the most frequent AIs. Severe head and neck injuries were present in 20.1% of all patients with craniofacial fracture. AIs were observed in 57.4% of patients with combined midfacial fractures (P < .001). Helmet use had a protective effect against traumatic brain injuries (P < .001). CONCLUSIONS: Our results suggest that AIs are relatively common in this specific patient population. Close co-operation in multidisciplinary trauma centers allowing comprehensive evaluation and treatment can be recommended for patients with bicycle-related craniofacial fracture.

Cervical spine injuries in facial fracture patients - injury mechanism and fracture type matter.

Evidence supports the notion that craniofacial fractures are significant predictors of cervical spine injuries (CSIs), but some debate remains on the injury mechanism of co-existing CSIs in craniofacial fractures and the relationship between CSI and specific facial fractures. In this retrospective study, we aim to assess the incidence rates of specific facial fracture types as well as other important variables and their relationship with CSIs. The primary outcome variable, CSI, and several predictor variables, including facial fracture type, were evaluated with logistic regression analyses. Of 2919 patients, the total CSI incidence rate was 3.0%. Rates of CSI in patients with isolated mandibular fractures (OR 0.26 CI 0.10, 0.63; p = 0.006) were lower than those previously reported, whereas isolated nasal fractures were strongly associated with CSI (OR 2.67 CI 1.36, 5.22; p = 0.004). Patients with concomitant cranial injuries were twice as likely to have CSI (OR 2.00, CI 1.22, 3.27; p = 0.006). Even though there is a strong occurrence rate of CSIs in patients with cranial injuries, clinicians should be aware that patients presenting with isolated facial fractures are at significant risk for sustaining CSIs also.

MMP-7, -8, -9, E-cadherin, and beta-catenin expression in 34 ameloblastoma cases.

OBJECTIVES: Ameloblastoma is a benign, locally aggressive odontogenic tumor with high recurrence rates. Matrix metalloproteinases (MMPs) mediate extracellular integrity in normal and pathological conditions, and exert multiple functions coordinating inflammation and tumor progression. E-cadherin and beta-catenin are adherence junction molecules in cell-to-cell connections. We investigated the involvement of MMP-7, -8, -9, E-cadherin, and beta-catenin in ameloblastoma and the surrounding extracellular matrix. MATERIAL AND METHODS: Our material consisted of 30-34 tissue samples from ameloblastoma patients of Helsinki University Hospital. We used immunohistochemistry to detect the expression of the biomarkers. Two oral pathologists independently scored the immunoexpression intensities and statistical calculations were made based on the results. RESULTS: E-cadherin expression was weaker in the maxillary than in mandibular ameloblastomas. Beta-catenin was expressed in the ameloblastoma cell membranes. We detected MMP-8 and -9 expression in polymorphonuclear neutrophils in the extracellular area and these MMPs correlated positively with each other. Osteoclasts lining bone margins and multinuclear giant cells expressed MMP-9. Neither MMP-8 nor MMP-9 immunoexpression could be detected in ameloblastoma cells. MMP-7 expression was seen in some apoptotic cells. CONCLUSION: The fact that E-cadherin immunoexpression was weaker in maxillary compared to mandibular ameloblastomas might associate to earlier recurrences. It promotes the idea of mandibular and maxillary ameloblastoma exerting differences in their biologies. We detected MMP-8 and -9 in polymorphonuclear neutrophils which relates to these MMPs participating in extracellular remodeling through a mild inflammatory process. Bone degradation around ameloblastoma may be due to MMP-9 in osteoclasts but this phenomenon might be an independent process and needs further investigations.

Health-related quality of life in patients surgically treated for orbital blow-out fracture: a prospective study.

PURPOSE: The purpose of this study was to evaluate patients' health-related quality of life (HRQoL) before and after surgical treatment of orbital blow-out fracture. METHODS: This prospective study comprises of all adult patients undergoing a surgical reconstruction of an orbital blow-out fracture in 2006-2010. Their HRQoL was evaluated for 6 months postoperatively with the aid of the standardized 15D instrument and was compared with that of an age- and gender-standardized sample of the general Finnish population. A complementary questionnaire for more detailed information was also administered. RESULTS: Twenty-six patients completed the study. Mean 15D score among the patients preoperatively (0.898) was statistically significantly and clinically importantly worse than the score of the control population (0.936). Six months postoperatively, the mean 15D score was 0.920, with no significant difference compared with the control population and the significant differences on the different dimensions had disappeared. The most common complaint at 6 months postoperatively was diplopia in daily life (19%). Disturbances in facial sensation (27%) and defects in facial appearance (15%) were the most unpleasant subjective outcomes. CONCLUSION: The HRQoL is significantly decreased after orbital blow-out fracture compared with the general population but will recover completely in 6 months. Thus, the negative impact of orbital blow-out fracture on HRQoL is only transient. Disturbances in facial sensation, defects in facial appearance, and diplopia are the most common subjective complaints after the injury and its surgical treatment. However, these do not appear to affect the overall quality of life in the long term.

Assessment of Craniomaxillofacial Injuries After Electric Scooter Accidents in Turku, Finland, in 2019.

PURPOSE: Since the introduction of rental electric scooters (ESs), clinicians have increasingly encountered facial trauma patients whose injuries were caused by ES use. Despite this fact, few studies have analyzed these patients, particularly in Nordic countries, where the climate may cause additional challenges. We hypothesized that ESs have caused several facial trauma cases in Turku, Finland, that might be related to the timing of ES use, that is, month, day, and hour. PATIENTS AND METHODS: The medical records of all patients in whom craniofacial fractures or dental injuries caused by ES use were diagnosed at Turku University Hospital, Turku, Finland, in 2019 were reviewed. The occurrence and characteristics of injuries, with special reference to time of the accident, intoxication, hospital stay, and additional injuries sustained were analyzed. RESULTS: A total of 23 patients were identified for this analysis. The mean age was 30 years, and most patients (n = 16) were men. Four patients had not used helmets, whereas for 19, there was no mention whatsoever about helmet use. Of the patients, 21 were intoxicated and 18 had a blood alcohol content greater than 0.1%. A great majority of the accidents occurred in the nighttime (n = 17) and during weekends (n = 19). Most injuries (n = 15) occurred between September and November. We observed craniofacial fractures in 15 patients and dental injuries in 14; brain injuries occurred in 5 patients, and multiple chest injuries occurred in 1. All patients with dental injuries and 9 of the 15 patients with craniofacial fractures required interventions. An average of 3 days of hospitalization was required for 14 patients. CONCLUSIONS: Injuries associated with ESs result from driving under the heavy influence of alcohol and occur mostly during weekend nights without helmet use.

Survival of Autotransplanted Teeth With Open Apices: A Retrospective Cohort Study.

PURPOSE: Autotransplantation of teeth is an alternative treatment method in growing patients with hypodontia or impacted teeth. The purpose of the present study was to investigate the occurrence of, and predictors for, the loss of transplanted teeth in children and young adults. PATIENTS AND METHODS: All patients who had undergone tooth transplantation at the Department of Oral and Maxillofacial Surgery, Turku University Hospital, from October 1, 2009 to January 5, 2017, were identified from the hospital's database. The outcome variable was survival of the transplanted tooth. The predictor variables were the transplantation type, donor tooth, maturity of the donor tooth, number of roots of the donor tooth, recipient's jaw, the need for extraoral storage of the donor tooth during surgery, continuation of root development during follow-up, and institution experience. One tooth was randomly selected from each subject. The Kaplan-Meier method for survival analysis, and the Cox proportional hazards regression analysis results were used to assess the association between survival and the risk factors. RESULTS: The sample included 36 subjects with a mean age of 14.3 years; 33.3% were male, 45 teeth were transplanted, and the median follow-up time was 1.3 years. The 1-year survival rate was 87% (95% confidence interval [CI], 75 to 99%). A significant predictor for tooth survival was the continuation of root development (hazard ratio, 21.3; 95% CI, 2.1 to 215.0; P = .009). Although not statistically significantly, more favorable prognoses were found for distant than for transalveolar transplantations, 1-rooted than multirooted teeth, premolars than molars, teeth not stored in an extraoral media, and teeth that had been transplanted later during the study period. CONCLUSIONS: The experience of the professional team, use of open apex premolars, and postoperative continuation of root development of the transplant were the factors associated with favorable outcomes. Transplants could benefit from the use of 3-dimensional models during surgery.

Management of maxillofacial trauma in the elderly: A European multicenter study.

BACKGROUND/AIMS: Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery. MATERIALS AND METHODS: This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017. RESULTS: A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P < .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P < .000005). CONCLUSIONS: Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.

Temporomandibular Dysfunction After Surgery of Mandibular Fractures Not Involving the Mandibular Condyle: A Prospective Follow-Up Study.

PURPOSE: Facial trauma can lead to temporomandibular dysfunction (TMD). The aim of this study was to clarify the occurrence and characteristics of TMD in patients surgically treated for mandibular fractures not involving the mandibular condyle. MATERIALS AND METHODS: This prospective single-center follow-up study was composed of patients who underwent surgery for non-condylar mandibular fracture. Patients were evaluated at presentation and 6 months after surgery to assess the function of the masticatory system using the Helkimo index. Specifically, this index incorporates 2 complementary subindices: the subjective symptomatic (anamnestic) index (Ai) and the objective clinical dysfunction index (Di). The Ai score was recorded at presentation and 6-month follow-up. The Di score was recorded at 6-month follow-up. RESULTS: Thirty-one patients completed the study. All patients were men (mean age, 26.2 yr; range, 18 to 47 yr). Four (12.9%) developed severe symptoms of dysfunction during the study period according to the Ai. Clinical findings (Di) were observed in 25 patients (80.6%), but these were not associated with symptoms of dysfunction. CONCLUSIONS: TMD is common 6 months after surgery in patients with non-condylar mandibular fractures. Patients with such fractures should be evaluated for dysfunction during follow-ups and referred for further treatment if necessary.

The Effect of Dexamethasone on Pain Severity After Zygomatic Complex Fractures.

The authors sought to assess the effect of systemic perioperative dexamethasone (DXM) on pain severity after zygomatic complex (ZC) fracture surgery. To achieve this, the authors conducted a prospective randomized observer-blinded trial on 63 patients with isolated ZC fracture requiring surgical intervention. Patients randomly received either perioperative systemic DXM (10 or 30 mg), or served as controls receiving no DXM, and postoperative pain severity was assessed. Pain was measured with a 10 cm visual analogue scale (VAS) each time that analgesics (1 g paracetamol 4 times daily or oxycodone upon request) were administered, and analyzed as the area under the VAS curve for the immediate postoperative 24 hours. This further divided experienced pain into 2 categories (mild, or moderate to severe) using VAS = 4 as the cutoff. For statistics the authors used χ test, Mann-Whitney U test, and logistic regression analysis, setting significance at P < 0.05. Zygomatic complex fracture patients receiving perioperative systemic DXM experienced milder pain compared with controls (P = 0.04). Subgroups receiving DXM (10 or 30 mg) reported no statistical difference regarding pain (P = 0.43). Overall, patients receiving DXM experienced less pain, thus DXM may be recommended as pre-emptive analgesic. Nonetheless, considering the possible adverse effects, a 10 mg single dose may be sufficient.