The Implementation of COVID-19 Social Distancing Measures Changed the Frequency and the Characteristics of Facial Injury: The Newcastle (Australia) Experience.

STUDY DESIGN: A retrospective study was undertaken of a cohort of facially injured patients using matched 8-week periods: non-COVID (2019) and COVID (2020). OBJECTIVE: To determine whether there were any changes to the frequency and characteristics of facial injury due to the imposition of COVID-19 social distancing measures. METHODS: The primary predictor variable was an 8-week period of COVID-19 social distancing. The primary outcome variable was the sustaining of a facial injury. Demographic (age/gender) and injury characteristics (mechanism, site, and treatment) were also studied. Descriptive statistical analysis was undertaken and comparison made using Pearson χ2 and Fisher's exact tests. RESULTS: The number of facial injuries decreased from 103 (2019) to 73 (2020). There were statistically significant differences in changes over time for the 8-week periods. There were some clinically apparent differences seen in the characteristics of facial injuries. CONCLUSIONS: The imposition of COVID-19 social distancing changed the frequency and characteristics of facial injury.

Role of real-time colour-flow Doppler in perforator free flap head and neck reconstruction.

We discuss the use of real-time colour-flow Doppler ultrasound to optimally evaluate the vascular anatomy of patients receiving free perforator flap head and neck reconstruction. We explore the advantages of the technique and its role as a valuable adjunct for the planning and harvesting of perforator flaps.

Head and neck ablative and microvascular reconstructive surgery in the UK: current operating team composition.

We sought to explore the current landscape of team composition in the provision of major head and neck ablative and reconstructive surgery in the UK. We conducted a survey of maxillofacial surgery units and compiled data on the operating model adopted at each institution. Our survey confirmed 54 active maxillofacial units undertaking microvascular free flap reconstructive surgery, with 44 (82%) hospitals adopting a two-team operative approach. We found no significant association between hospital type and volume of free flaps undertaken and prevailing operating team model. Our study provides an interesting snapshot of the current head and neck microvascular reconstructive practice in the UK.

Specialist titles used in clinical correspondence: a UK survey of oral and maxillofacial surgery consultants.

We explored how oral and maxillofacial (OMF) consultants describe themselves in their correspondence. We did a telephone survey of OMF surgeons' secretaries and compiled data on the specialist titles used. Data were available for 290 consultants and 19 different titles were identified. A total of 190 (66%) consultants used the title OMF surgeon alone and a further 22 (8%) combined it with the name of a subspecialty. The remaining 78 (27%) used 11 alternative titles. Of those surveyed, 212 (73%) continue to use the specialty title of OMF surgeon with or without the name of a subspecialty comprising a readily identifiable group of specialists.

Psychiatric outcomes in operatively compared with non-operatively managed patients with facial trauma: Is there a difference?

Patients who sustain facial injury and who require an operation may be at greater risk for developing psychological distress and maladaptive coping. The purpose of this study was to examine psychological responses in adult victims of facial trauma after operation. A consecutive group of adult patients attending specialist outpatient clinics after facial trauma were evaluated for psychological distress. The subjects were divided into two groups based on whether their facial injuries were managed operatively or conservatively. The primary predictor variable in this study was surgical intervention. The main outcome variable was Hospital Anxiety and Depression Scale (HADS) scores. Chi-squared, Mann Whitney U-test, and multiple regression analysis were used to analyse data. The sample consisted of 102 subjects; 71 patients had been managed operatively and 31 patients treated non-operatively. Psychometric scores suggestive of anxiety were present in 21% (n = 15) of the operatively managed group compared with 13% (n = 4) of the non-operatively managed group of patients. The prevalence of depression was comparable between both groups (14% compared with 13%). The median anxiety subscale scores for the operatively managed group when compared with the conservatively managed group of patients were significantly higher (6.6 compared with 4.4, p = 0.02); however, differences in the depression subscale scores did not reach statistical significance (6.2 compared with 4.6, p = 0.06). This study shows an association between anxiety disorders and operative interventions in patients with facial trauma (HADS-A, ß = 2.2, p = 0.04). Similar rates of depression were found in the surgically and conservatively managed patients.

The prevalence of psychological distress in a sample of facial trauma victims. A comparative cross-sectional study between UK and Australia.

AIM: The potential psycho-social sequelae of traumatic facial injury have received increasing attention in recent years, however there remains paucity of cross-national comparative data on the prevalence of psychological distress following such trauma. The aim of the present study was to investigate and compare the prevalence of anxiety and depression in an adult patient group who have been treated for maxillofacial trauma, and who attend a follow-up clinic in either the West Midlands, UK or New South Wales (NSW), Australia. By using an identical methodological and statistical approach, we hoped to add to the available information on the incidence of early psychological distress in patients following facial trauma. METHOD: This was a comparative cross-sectional study. A sample of fifty consecutive adult victims of facial trauma in the West Midlands UK, was compared to a group of fifty-two facially injured patients in NSW, Australia. Demographic data was collected, following which the Hospital Depression and Anxiety Scale (HADS) were applied to both groups of patients. RESULTS: Psychometric scores suggestive of anxiety and depressive state were common in both groups of patients. The mean HADS depression subscale score for UK patients compared to Australian patients was not significantly different (5.94 versus 5.54 p=0.62). This was also the case for the HADS anxiety subscale (5.96 versus 5.94 p=0.98). Although the number of patients achieving scores suggestive of a 'caseness' for co-morbid psychological state was higher within the UK sample when compared to the Australian group (20% versus 11.5% for HADS depression subscale, and 20% versus 15% for HADS anxiety subscales respectively); these differences did not reach statistical significance. CONCLUSION: This cross-national comparative study has shown that anxiety and depression in facial trauma victims were comparable in both settings.

Does attribution of blame influence psychological outcomes in facial trauma victims?

PURPOSE: The relative importance of different variables and specific post-traumatic psychological reactions after facial injuries is poorly understood. The aim of the present study was to assess the association between the subjective attribution of blame and anxiety and depression in facial trauma victims. MATERIALS AND METHODS: We undertook a comparative cross-sectional study of psychological outcomes in a cohort of adult patients who have sustained a facial injury. The primary predictor variable was the attribution of blame (self-blame vs blame-others). The main outcome variable was the Hospital Anxiety and Depression Scale (HADS) scores. We also considered several demographic and other clinical variables to assess their relationship with the nature of blame attribution. Cochran-Mantel-Haenszel statistics were used to assess the relationship between the primary predictor and outcome variables, adjusted for age, gender, and confounding factors. RESULTS: The sample consisted of 102 facial trauma victims (77 men and 25 women). Of the 77 patients, 63 attributed blame for their injuries to someone else and 39 patients attributed blame to themselves. Psychometric scores suggestive of anxiety and the depressive state were significantly greater in the "blame-others" group than in the "self-blame" group (HADS-Anxiety 22% vs 13%, HADS-Depression 17% vs 8%). The prevalence of psychomorbidity in the blame-others group was approximately twice that found in the self-blame group (odds ratio 2.2). Facial trauma patients who blamed others for their injury were predominantly younger men (P = .01) and typically victims of intentional trauma (P < .001). CONCLUSIONS: The results of the present study suggest that external attribution of blame for facial injury is associated with poor postinjury psychiatric outcomes.

The association between depression and anxiety disorders following facial trauma--a comparative study.

AIM: Although the surgical care provided for patients who have sustained a maxillofacial injury has advanced in recent years, psychological disorders may develop. Anxiety and depression may be a cause of significant morbidity in these patients. Such problems are often unrecognised and untreated. PATIENTS & METHODS: We undertook a comparative cross-sectional study in a cohort of adult patients to assess the association between traumatic facial injury and the presence of anxiety and depressive disorders. Study subjects were recruited during the period of June 2008 through August 2008. Fifty consecutive adult patients attending the maxillofacial outpatient clinic following facial trauma were asked to complete the Hospital Anxiety and Depression Scale (HADS). Data gathered from this group of patients were compared to 50 adult control subjects who were under follow-up following elective oral and maxillofacial surgery. We also looked at several demographic and other variables to assess its association with poor mental health outcomes. RESULTS: Ten patients (20%) in the facial trauma group achieved high scores in both subscales suggesting a probable anxiety and depression state. The mean score for the depression subscale was significantly higher in the facial trauma group compared to the control group (p=0.006). The mean score for anxiety was also higher but did not reach statistical significance (p=0.07). Stratified analysis (Mantel-Haenszel) was used to control for possible confounding variables. The odds ratio for probable depression, for facial trauma patients compared with "control" patients, was 9.02, 95% CI=2.45, 33.1, p<0.001. Variables with significant associations (p<0.05) with high depression scores in the facial trauma group were female sex, presence of a permanent facial scar, and a past psychiatric history. There was also significant correlation between patients' self-perception of facial disfigurement scores and scores obtained in both anxiety subscale (r=0.41, p=0.003) and depression subscale (r=0.46, p=0.001). CONCLUSION: Our results support the findings of previous studies and provide further evidence to clinicians for the critical identification and treatment of anxiety and depression in facial trauma victims.

Multidisciplinary management of a complicated orbital injury inflicted by a horse.

This case report describes an unusual and complicated orbital injury inflicted by a horse. Definitive management required multidisciplinary surgical collaboration to prevent significant ocular sequelae. The diagnostic role of good imaging and the potential use of bio-models are highlighted.