Simon Holmes

European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.

Orbital emphysema – the need for surgical intervention ☆

INTRODUCTION Orbital emphysema is a recognised complication of fractures of the orbit and only rarely poses a threat to vision. PATIENTS AND METHODS We present three patients with threatened vision secondary to orbital emphysema that required an immediate surgical decompression. RESULTS Visual function was preserved in all three patients. CONCLUSION Clinical awareness of pneumo-orbitism is vital as immediate orbital decompression may be necessary to preserve visual function.

European Maxillofacial Trauma (EURMAT) in children: A multicenter and prospective study

OBJECTIVE The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. STUDY DESIGN The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. RESULTS The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. CONCLUSIONS Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

Is there a therapeutic role for cranioplasty

Cranioplasty is often undertaken as a joint neurosurgical and maxillofacial procedure. The principal aims remain to improve cosmesis and to protect the underlying brain. We report two cases of cranioplasty with subsequent improvement in neurological function and discuss the possible therapeutic role of cranioplasty.

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration

OBJECTIVE The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. STUDY DESIGN Demographic and injury data were recorded for each patient who was a victim of an assault. RESULTS Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. CONCLUSIONS Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.

Infraorbital orbitotomy: Modification of the Weber-Ferguson approach

he Weber-Ferguson approach has been well described as the ncision of choice to expose the orbit or maxilla.1,2 Access o the most lateral aspect of the maxilla and infratemporal ossa can be limited by the infraorbital neurovascular bundle, hich is usually transected and reapproximated at the end of he procedure. We describe a technique that keeps the nerve intact without imiting access. A 27-year-old man presented with a one-year istory of absolute trismus secondary to right medial pteryoid myositis ossificans after inferior alveolar nerve block or removal of lower third molars. Previous corrective opertions by right and left preauricular approaches had been nsuccessful. After discussion among the multidisciplinary team a right edial pterygoid myomectomy with access through a stanard Weber-Ferguson approach was planned. During the rocedure the infraorbital neurovascular bundle was idenified. A 5 mm osteotome was placed on the infraorbital rim folowed by two vertical cuts towards the medial and lateral orders of the infraorbital foramen (Fig. 1). The segment of one was raised and the infraorbital neurovascular bundle as released superiorly. Once it was freed we found the lateral modification of the eber-Ferguson incision unnecessary as mobility of the neuovascular bundle gave excellent access to the infratemporal ossa (Fig. 2).

The 100 Most Cited Articles in Facial Trauma: A Bibliometric Analysis

PURPOSE The number of citations an article receives has been used as a marker of its influence within a surgical specialty. Currently, there is limited citation analysis in oral and maxillofacial trauma surgery. The purpose of this study was to determine the 100 most cited articles in facial trauma surgery and their characteristics. MATERIALS AND METHODS Articles were identified from the Science Citation Index of the Institute for Scientific Information using the Thomson Reuters Web of Science search engine. All articles until 2015 were included. Then, the 100 most cited articles were assessed for title, author, journal, country of origin, and number of citations. A citation index (number of citations received per year) also was calculated. RESULTS The 100 most cited articles in facial trauma received 9,933 citations (range, 66 to 297). They were published from 1942 through 2008, with 1990 through 1999 being the commonest decade. Articles were cited on average 4.6 times per year. Articles were published in 28 different journals, with impact factors ranging from 0.94 to 35.3. Most articles were observational research studies. CONCLUSION These findings reflect the attention that articles have received during the past half century in oral and maxillofacial trauma research, shedding light on often-read articles in this field. In addition to current bibliometric indices, it could provide a useful evidence base for facial surgeons, represent key educational material for aspiring trainees, and be used to help guide future research efforts.

How far reaching is our research? An analysis of the journals in which oral and maxillofacial surgery research is cited

In this study we investigate the five most cited articles in the British Journal of Oral and Maxillofacial Surgery (BJOMS). Articles cited were usually published in other OMFS journals (40%) or dentistry journals (32%). The mean (SD) SCImago Journal and Country Rank, (SJR) (an interface to access the bibliometric database of journals) for cited papers was 0.64 (SD=0.56). Nearly one third of citations were of research in OMFS and dentistry, suggesting its relevance to the wider academic community.