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Post-traumatic stress disorder (PTSD) is a distressing consequence of a traumatic event associated with an increased suicide risk and reduced quality of life. Surgeons often have low confidence in identifying psychological problems. The prevalence of PTSD following facial trauma ranges from 23% to 41%. This highlights the importance of identifying and managing at-risk patients to optimize both mental and physical recovery. IMPARTS (Integrating Mental and Physical healthcare: Research, Training and Services) provides electronic screening tools to guide the non-mental health clinician in the ‘real-time’ identification, documentation, and management of potential mental health problems. The bespoke IMPARTS facial trauma screening tool was piloted in a UK oral and maxillofacial surgery trauma clinic from July 2015 to November 2017. A total of 199 patients completed screening, with 48 (24%) screening positive for possible PTSD. Further analysis of these 48 patients revealed that four (8%) had PTSD symptoms alone; three (6%) also screened positive for depression, 17 (35%) for co-existing symptoms of anxiety, and 24 (50%) for PTSD, anxiety, and depression. IMPARTS was found to be a highly effective tool aiding the non-mental health clinician to screen for PTSD and initiate prompt management. The data captured informs planning of the psychological support service.

International audience; The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.

The aim of this study was to evaluate the sensitivity, accuracy, and reliability of two-dimensional computed tomography (2D-CT) scans (axial, coronal, sagittal planes) and three-dimensional computed tomography (3D-CT) reconstructions in diagnosing midfacial fractures in relation to actual fractures identified clinically and during surgery (gold standard). The imaging diagnosis was performed by a radiologist and an oral and maxillofacial surgeon. Sixty-two patients with a total of 429 midfacial fractures were included. Frontal sinus and nose fractures were easily diagnosed. For the three CT planes, there was a statistically significant difference between the CT examination and the gold standard for five to seven of the nine bones evaluated, while for 3D-CT, a difference was observed only for fractures of the orbital floor. The inter-observer agreement between the oral and maxillofacial surgeon and the radiologist was 75.5%. In conclusion, in this study 3D-CT reconstructions showed significantly the best sensitivity, accuracy, and reliability for the diagnosis of midfacial fractures. The sagittal reconstructions were the least diagnostic of the 2D-CT images. For areas where the parameters studied showed less agreement and hence a more difficult diagnosis, we recommend a combination of 3D and 2D-CT images to improve diagnostic accuracy.

Maxillofacial trauma costs emergency departments approximately one billion dollars annually. Facial trauma has increased since 2000 and has been attributed to both increased use of computed tomography and interpersonal violence. Alcohol, male sex, and age 18-35 years are significant risk factors for interpersonal violence. This study is novel in using a large database to look at the effect of alcohol on clinical outcomes in facial trauma. A data analysis was performed in Stata/MP 14.2 using variables coded from the National Trauma Data Bank (NTDB); logistic regression was applied. A total 580,313 patient records were analyzed. Operations for facial fractures were performed in 20.19% of cases (n = 117,139). A positive alcohol test reduced the odds of requiring operative fixation in both the unadjusted (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.79-0.82, P 0.001) and adjusted (OR 0.67, 95% CI 0.66-0.68, P 0.001) models. Age and being struck (adjusted OR 1.99, 95% CI 1.91-2.07, P 0.001) or shot (adjusted OR 1.95, 95% CI 1.84-2.06, P 0.001) had a significant effect on operative fixation. Injury mechanisms related to interpersonal violence appeared to have higher operative fixation rates. This study did not find a correlation between acute intoxication and the need for an operative intervention. This further demonstrates the multifactorial nature of facial trauma and stresses the importance of injury and violence prevention on clinical outcomes.

Acquired injuries of the nasolacrimal apparatus may be the result of craniomaxillofacial surgical procedures, facial trauma, or inflammation. Injury to the nasolacrimal duct system following maxillary orthognathic surgery is rarely reported. This study evaluated the importance of early diagnosis and treatment of epiphora developing after Le Fort I surgery. The records of 83 patients who underwent maxillary orthognathic surgery over a 2-year period were reviewed. The prevalence of postoperative epiphora was 3.6% and it persisted for a mean of 32.7 days. No patient required further surgical treatment of the nasolacrimal duct obstruction. Clinicians should evaluate the lacrimal canal position and schedule close postoperative follow-up of injuries to the nasolacrimal apparatus. These may become permanent, necessitating additional surgery.

The management of upper facial trauma is a common responsibility of surgeons taking care of maxillofacial injuries. Historically, the most commonly used surgical approach has been the bi-temporal (coronal) incision. As is well known, the coronal incision carries some inherent complications such as hair loss, long scars, and increased length of hospital stay. The purpose of this article is to describe an aesthetic approach, similar to an endoscopic brow lift, for the repair of anterior wall fractures of the frontal sinus without the need for long incisions or fixation devices.

This retrospective study evaluated the epidemiology, treatment and complications of mandibular fracture associated, or not associated, with other facial fractures, when the influence of the surgeon's skill and preference for any rigid internal fixation (RIF) system devices was minimized. The files of 700 patients with facial trauma were available, and 126 files were chosen for review. Data were collected regarding gender, age, race, date of trauma, date of surgery, addictions, etiology, signs and symptoms, fracture area, complications, treatment performed, date of hospital discharge, and medication. 126 patients suffered mandibular fractures associated, or not, with other maxillofacial fractures, and a total of 201 mandibular fractures were found. The incidence of mandibular fractures was more prevalent in males, in Caucasians and during the third decade of life. The most common site was the condyle, followed by the mandibular body. The therapy applied was effective in handling this type of fracture and the success rates were comparable with other published data.

Assessment of the eyes and visual pathways in the multiply injured patient with co-existing craniofacial injuries can be very difficult. Although ocular injury is common in facial trauma, vision-threatening injuries and severe visual impairment are less frequently seen and may be associated with specific injury patterns. Some vision-threatening injuries require early diagnosis and treatment if useful sight is to be preserved, but at the same time this must not interfere with any ongoing investigations and resuscitation. Progressive swelling, blood loss and some therapeutic interventions may all potentially contribute to loss of vision later on, highlighting the need for repeated assessment. In many cases initial assessment is limited, especially in the confused, agitated or unresponsive patient, but early recognition of significant ocular injuries is important for a number of reasons. Arguably, initial assessment should be to confidently exclude a sight-threatening injury, requiring emergent or urgent intervention. More detailed ophthalmic examination can be performed later, when the patient is in a better condition. The management of the severely proptosed eye in the multiply injured unconscious patient is also a very difficult area, particularly if the precise cause is unknown. A number of causes exist and these may require different therapeutic strategies, which are discussed.

Maxillofacial trauma is without doubt still a very challenging area, especially in the early stages of care when other injuries may be present. Craniofacial trauma, with or without life and/or sight-threatening complications, may be associated with significant injuries elsewhere. Both general trauma and facial trauma management have evolved considerably over the last 20 years and on occasion clinical priorities may seemingly conflict, suddenly change or be hidden. In these circumstances a number of clinical dilemmas may arise, which this and three further reviews will discuss. These are based on review of the current literature, supplemented where appropriate by the collective experiences of the co-authors. Facial injuries can be broadly placed into one of four groups, which can aid determination of the urgency for treatment. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems.

The cases of 107 paediatric patients aged 0-12 years were retrospectively reviewed. The patients presented with facial trauma and both plain radiographs and computed tomography (CT) scans had been ordered. Sixty-five per cent of facial fractures were missed in radiography, but revealed on CT; fractures of the maxilla, the zygoma and the orbit were most frequently missed in radiography. Pedestrian motor vehicle accidents were the most frequent cause of facial fractures (37%), followed by passenger motor vehicle accidents (22%). In contrast with other studies reporting the mandible as the most frequent facial fracture site, the most common fracture sites in this study, in descending order of frequency, were the orbit, the frontal bone and the maxilla.

The aim of this study was to define if the alterations in sensory modalities could be a predictive factor in the prognostic recovery of the ION. Ten patients that had suffered facial trauma, associated with sensitivity alterations of the ION were evaluated prospectively. Touch detection thresholds (TD) were measured using Von Frey's filaments aesthesiometer. A warm/cold discrimination (W/C) was also done to the patients, on the same areas. The patients were examined in both sides of the face, using the non-traumatized side as control. The tests were done before surgery and several times postoperatively. For statistical analysis of the results, the two-sample t test was used. A significant difference (P < 0.0001) in the mean tactile recovery time between the areas without thermal sensitivity before surgery and those with normal thermal sensitivity before surgery was observed. Therefore, we propose that during the preoperative examination, the surgeon examines the thermal discrimination in order to establish prognosis and approximate recovery times.

Congenital Frey's syndrome and bilateral trifid mandibular condyle are two different entities. The occurrence of both together is rare and has not been reported in the literature. This article describes the case of a 17-year-old male patient who complained of bilateral warmness, flushing and sweating in the preauricular area after eating spicy and sour foods since childhood. He had no complaint related to the functions of the temporomandibular joint and had no history of facial trauma. The patient was treated with injections of botulinum toxin A and the signs and symptoms of Frey's syndrome improved significantly.

Computed tomography is currently the standard in preoperative evaluation of facial fractures, but cone beam computed tomography (CBCT) or digital volume tomography (DVT) offers potential advantages. Intraoperative imaging may facilitate adequate fracture reduction, optimising fracture repair. The aim of this article is to demonstrate the potential benefits of a new mobile CBCT system in a series of patients with complex facial fractures. Intraoperative imaging was performed with the xCAT ENT portable CBCT system. Images were provided in three planes and in a three-dimensional reconstruction. This system was used for intraoperative imaging of 46 consecutive facial trauma patients. The impact of intraoperative CBCT on the management of these cases is described and two select cases are presented to illustrate the potential benefits of this technique. Intraoperative CBCT was successfully performed in all patients and has led to immediate consequences in 12 (26%) cases. In 5 cases, fracture reduction turned out to be insufficient and was further optimized and in 5 other cases the titanium implan (orbital mesh) was not placed in the optimal position and the position was corrected. Bony fragments were detected and removed in 2 cases. Intraoperative imaging provides a number of advantages over post-therapeutic imaging in the management of facial fractures.

Repair of an isolated anterior table frontal sinus fracture traditionally requires a coronal incision, which results in a large scar, alopecia and paresthesias, because of these problems, endoscopic approaches have been attempted. These approaches still involve small incisions at the forehead or behind the hairline so might be better described as endoscopy-assisted surgery. This report describes the reduction of an isolated anterior table frontal sinus fracture in a 14-year-old boy using an endoscopic procedure that involves a transnasal approach with no external incisions. Endoscopic instruments were used under 25 and 70 degrees endoscope guidance. A custom-made latex glove balloon was inserted into the frontal sinus, and then expanded and maintained for 20 days to support the reduced bony fragments. Postoperatively, the reduction was successful. The cosmetic deformity was repaired and there was no postoperative morbidity. This case indicates that endoscopic reduction may be a valuable treatment option for certain types of frontal sinus fractures.

Hypovolaemic shock is a common cause of morbidity and mortality following trauma, accounting for approximately 30% to 40% of trauma deaths. Life-threatening blood loss from the maxillofacial region is uncommon, but represents one of a number of possible sites which must be rapidly identified and controlled. Bleeding from the face may not be obvious especially in awake, supine patients and it poses an obvious threat to the unprotected airway. Identification requires careful assessment. Control of bleeding in the maxillofacial region requires a number of correctly sequenced techniques. Computerized tomographic imaging is now playing an increasingly important role in identifying blood loss, especially in the chest, abdomen and pelvis. This need may potentially result in the transfer of patients, with unrecognised facial injuries, outside the relative safety of the emergency department. The concepts of the 'lethal triad' and 'biologic first hit' have resulted in new strategies in managing the profoundly shocked patient, although some of these remain controversial. Debate continues over the optimal blood pressure, fluid administration and role of surgical intervention in the actively bleeding patient. These may have an impact on the timing and extent of any proposed maxillofacial repairs, and are discussed.

Oral and Maxillofacial Surgery (OMFS), a dentistry specialty recognized by the Federal Dentistry Board in the mid-1960s, is responsible for the diagnosis, and clinical and surgical treatment of traumatic, congenital, developmental and iatrogenic lesions in the maxillofacial complex. Even today, difficulties are experienced owing to the lack of knowledge of the general public and health professionals concerning the scope of OMFS. To investigate recognition of the scope of OMFS, 400 questionnaires were sent to dentistry students, medical students, dentists and doctors, in 4 equal groups. The questionnaire covered 26 clinical situations in four different specialties (OMFS, Plastic Surgery, Ear Nose and Throat Surgery, Head and Neck Surgery) and an option with no specialty specified. Each interviewee had to correlate the clinical situation with the respective specialist. For facial trauma, dento-facial deformities, mandibular reconstruction and temporomandibular joint surgery, most respondents would consult the OMF surgeon for treatment (mean, 90%). In cases of oral biopsy and treatment of benign mandibular tumours the mean referral rate to OMFS was low (48%). On the basis of the questionnaire responses, a good level of knowledge of the scope of OMFS was found. In order to ensure the correct referral of all patients, the specialty needs to broaden its horizons.

Background: Paediatric facial injury can lead to significant morbidity. Sociodemographic determinants in Scotland have not previously been reported. Aim: To analyse the pattern, time trends, and key sociodemographic determinants in children and adolescents who have suffered facial trauma. Method: Scottish Morbidity records (SMR01) for the period 2001–2009 were retrieved from the Information Services Division in Scotland (ISD): annual incidences were calculated by age, gender, health board, SIMD (Scottish Index of Multiple Deprivation) and mechanism of injury. A Poisson regression analysis model was used to incorporate the variables. Results: 45,388 (0.05%) of 9,568,185 persons aged 0–17 years had suffered injury (4.7 per 1000 population). 60% of injuries were due to accidents, with an additional 15% due to traffic accidents, 9% due to assault. 4.5% were alcohol related. The incidence decreased over time from 5.5/1000 in 2001 to 4.0/1000 in 2009. The relative ratio (RR) for maleswas 1.98 times greater than females (p < 0.001). RR varied significantly between Heath Boards (areas) from 0.68 (Dumfries) −1.76 (Grampian) (p < 0.001). There was a significant association between facial injury and deprivation (p < 0.001); SIMD 1 (most deprived) has the highest incidence rate of 6.3/1000 population (RR = 1.89), while in SIMD 5 (least deprived) the incidence rate was 3.7/1000 population (RR = 1.08). Conclusion: Among the Scottish paediatric population the incidence and RR of facial injury is higher in males living in areas of social deprivation. Many injuries are due to accidents and more needs to be done to direct education and resources towards prevention.

Aims: Subcutaneous emphysema in he maxillofacial area may have differnt causes. In this study we present cases ccurring from traumatic injuries and iatroenic surgical or dental treatment. Our bjective is to describe the etiology, evoution and management of patients with ervicofacial subcutaneous emphysema. Methods: 12 patients with subcutaeous emphysema of the maxillofacial area ere included in this study. The data was egistered in tables an graphs describing tiology, clinical and imaging characterisics, treatment and complications. Results: In 8 patients the cause was lowing after facial trauma, 4 cases were ssociated to the utilization of turbine in surgical or dental procedure in the oral egion. 3 cases had pneumomediastinum nd one had orbital cellulites as compliations, all patients treated with the same rotocol without other complications. Conclusion: Subcutaneous emphyema is rare. Usually, it resolves sponaneously and does not cause a lifehreatening complication. Prevention and arly diagnosis is crucial, to start treatment voiding the development of secondary nfectious and cardiopulmonary complicaions. Conflict of interest: None declared.

ntroduction: Maxillofacial trauma contitutes a series of injuries involving bone nd soft tissues, causing functional and esthetic alterations. Aim: To determine the profile of atients with facial trauma submitted to urgical treatment in the Regional Hospital f Temuco, Chile. Material and method: The cenral database of Regional Hospital was btained for the admission of maxillofaial trauma patient between 2008 and 2009. as determined variables how maxilloacial compromise, sociodemographical ariables, surgical treatment variables and ocalization of fractures. Was used a escriptive analysis and fisher exact test hen was necessary with p< 0.05. Results: In 145 patients, with ratio ale (11.1) female (1), the age was not resent relation with diagnosis of fracture p= 0.3661) and sex was related positively ith diagnosis of fracture (p= 0.006); were ound 28 cases without record of diagnoses 19.3%) and more prevalent fracture was ygomatic complex (24.1%), mandible ractures (14.5%) and orbital floor fracures (11.7%). Conclusion: The age was not related o fracture and sex was associated to the iagnosis; the zygomatic fractures is more revalent and the registration data base is eficient in multiples clinical and office sitation. Conflict of interest: None declared.

We present a retrospective review of a new technique for the transportation of alveolar bone using a Hyrax device modified by the principal author (O.A.V.). There were seven patients (five males and two females), including five patients with cleft palate and lip diagnosis, one patient with a high-speed gunshot wound, and one patient with facial trauma sequel due to mandibular fracture. They were all treated with an alveolar bone transportation technique (ABT) through the use of the modified Hyrax device (VEGAX). Before surgery, distraction osteogenesis of the bifocal type was performed on four patients, and the trifocal type was performed on the other three patients. However, in one case, direct dental anchorage was not used, only orthodontic appliances. In all the cases, new bone formation and gingival tissue around the defect were obtained, posterior to the alveolar distraction process; no complications were observed in any patient. In one case, two teeth involved in the disk of the ABT were extracted, due to a previous condition of periodontal disease. The alveolar bone transport with the VEGAX device is an accessible technique for almost every patient with alveolar defects due to diverse causes. In all the presented cases, predictability and success were demonstrated.

A case is reported of traumatic external carotid artery aneurysm causing facial paralysis. The aneurysm was successfully treated surgically.

In 1980 a survey was conducted of the methods employed by OMF surgeons in the United Kingdom on the treatment of facial injuries. In 1986 a similar questionnaire was circulated in the UK with the addition of questions about clinical management. Towards the end of 1986 at a meeting in Amsterdam, arrangements were made for similar questionnaires to be circulated in The Netherlands, the USA and later in India and Hong Kong. The results recorded were as follows: UK: 164; The Netherlands: 94; USA: 1999; India: 20; Hong Kong: 5. This survey has revealed differences in the treatment of maxillofacial injuries in the countries concerned. There were differences in the means of fixation of fractured mandibles and in the types of anaesthesia used. The Americans were more likely to use extra oral surgical approaches for their lower border wirings or platings and were liable to operate on fractured mandibular condyles. The acceptability of patients being sent from the operating room with jaws wired together is confirmed by the fact that 95% of British and American OMF surgeons do this. The British OMF surgeons are much more likely to use fixation other than IMF in middle third injuries and are likely to use extra oral cranial fixation. Both the Dutch and the Americans are not so concerned about maxillary mobility and when they do employ fixation almost always use internal skeletal fixation. The approach to the reduction of a fractured malar is markedly different. The British are mainly using the Gillies approach, whereas the Dutch use the facial hook and the Americans a lower lid or brow approach.(ABSTRACT TRUNCATED AT 250 WORDS)