Tarkan Tuli

Cranio-maxillofacial trauma : a 10 year review of 9543 cases with 21067 injuries

INTRODUCTION Cranio-maxillofacial trauma management requires pertinent documentation. Using a large computerized database, injury surveillance and research data describe the whole spectrum of injuries. The goal of this study was to assess the effect of the five main causes of accidents resulting in facial injury on the severity of cranio-maxillofacial trauma. PATIENTS AND METHODS During a period of 10 years (1991-2000) 9,543 patients were admitted to the Department of Oral and Maxillofacial Surgery, University Hospital of Innsbruck with cranio-maxillofacial trauma. Data of patients were prospectively recorded including cause of injury, age and gender, type of injury, injury mechanisms, location and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures and concomitant injuries. Statistical analyses performed included descriptive analysis, chi square test, Fishers exact test, and Mann-Whitneys U test. This was followed by logistic regression analyses for the three injury types to determine the impact of the five main causes on the type of injury at different ages in facial trauma patients. RESULTS Five major categories/mechanisms of injury existed: in 3,613 (38%) cases it was activity of daily life, in 2991 (31%) sports, 1170 (12%) violence, in 1,116 (12%) traffic accidents, in 504 (5%) work accidents and in 149 (2%) other causes. A total of 3,578 patients (37.5%) had 7,061 facial bone fractures, 4,763 patients (49.9%) suffered from 6,237 dentoalveolar, and 5,968 patients (62.5%) from 7,769 soft tissue injuries. Gender distribution showed an overall male-to-female ratio of 2.1 to 1 and the mean age was 25.8+/-19.9 years; but both varied greatly depending on the injury mechanism (facial bone fractures: 35.4+/-19.5 years, higher risk for males; soft tissue injuries: 28.7+/-20.5, no gender preference; dentoalveolar trauma: 18+/-15.6, elevated risk for females). For patients sustaining facial trauma, logistic regression analyses revealed increased risks for facial bone fractures (225%), soft tissue lesions (58%) in patients involved in traffic accidents, and dental trauma (49%) during activities of daily life and play accidents. When compared with other causes, the probability of suffering soft tissue injuries and dental trauma, but not facial bone fractures, is higher in sports-related accidents, 12 and 16%, respectively. CONCLUSION This study differentiated between injury mechanisms in cranio-maxillofacial trauma. The specially trained surgeons treating cranio-maxillofacial trauma are the primary source of information for the public and legislators on implementing preventive measures for high-risk activities. In facial trauma, older persons are prone to bone fractures (increase of 4.4%/year of age) and soft tissue injuries (increase of 2%/year of age) while younger persons are more susceptible to dentoalveolar trauma (decrease of 4.5%/year of age).

Prevalence of dental trauma in 6000 patients with facial injuries: implications for prevention.

OBJECTIVE In contrast to epidemiologic studies on facial injuries reporting on dental trauma, facial bone fractures with dentoalveolar injuries, or soft tissue injuries individually, the purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation of the impact of sport, work, violence, traffic, household, and play accidents in the relationships among dental trauma, facial trauma, and other concomitant trauma. Finally, preventive considerations are discussed. STUDY DESIGN Six thousand patients registered at the University Hospital of Innsbrucks Department of Oral and Maxillofacial Surgery during a period of 6 years 4 months were admitted for dental trauma, facial trauma, or both. Records were analyzed for cause of injury, age, gender, monthly distribution, frequency, type of injury, and frequency of dental trauma in relation to facial injuries and concomitant injuries. RESULTS The incidence of dental injuries with respect to the total number of facial injuries was as follows: 57.8% in play and household accidents, 50.1% in sports accidents, 38.6% in accidents at work, 35.8% in acts of violence, 34.2% in traffic accidents, and 31% in unspecified accidents. The overall incidence revealed was 48.25%. CONCLUSION Our findings support the fact that in the mosaic of traumatic injuries, the frequencies of tooth trauma and its sequelae are underestimated and that such trauma and sequelae occur without a predictable pattern of intensity and extensiveness. Preventive approaches are the sole way to minimize the number of these injuries. Substantial progress made in treating facial and dental trauma in the last 2 decades only improves functional and esthetic outcomes among the population that has suffered dental injury.

Mountainbiking--a dangerous sport: comparison with bicycling on oral and maxillofacial trauma

The popularity of bicycling is reflected in the number of cycling-related oral and maxillofacial injuries. Five hundred and sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, between 1991 and 1996, accounting for 31% of all sports-related accidents and 48.4% of all traffic accidents. A review of the patient records revealed more severe injury profiles in sixty mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma and 23% soft tissue injuries, compared to 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures and 14% soft tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% LeFort I, II and III fractures. Condyle fractures were more common in bicyclists, with 18.8% compared to 10.8% in mountainbikers. Reduction of facial injuries due to cycling-related accidents needs appropriate design of helmets with faceguards and compulsory helmet use for all cyclists, and particularly mountainbikers.

Differential Profile of Facial Injuries among Mountainbikers Compared with Bicyclists

BACKGROUND Bicyclists and mountainbikers are prone to facial trauma. In the current study, we present a large series of cycling-related sports trauma to the face in an effort to identify the injury pattern among mountainbikers compared with bicyclists. METHODS The medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1991, through October 31, 1996. All admissions with injuries caused by cycling-related sports were reviewed, analyzed, and compared according to age and sex distributions, causes of accidents, injury types, frequency, and localization of fractures and associated injuries. The injury types were divided into three categories: fractures, dentoalveolar trauma, and soft-tissue injuries. RESULTS Five hundred sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, during the study period, accounting for 31% of all sports-related or 48.4% of all traffic collisions, respectively. The review of the patient records revealed especially more severe injury profiles in 60 mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma, and 23% soft-tissue injuries, compared with 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures, and 14% soft-tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% Le Fort I, II, and III fractures. Condyle fractures were more common in bicyclists, with 18.8% opposing 10.8% in mountainbikers. CONCLUSION Appropriate design of helmets with faceguards will reduce the incidence of facial injuries caused by cycling-related accidents and incentives are needed for making helmet use compulsory for all cyclists, particularly for mountainbikers.

Incidence of oral and maxillofacial skiing injuries due to different injury mechanisms.

PURPOSE This study emphasizes the significance of maxillofacial injuries in skiing accidents, correlating injury mechanisms and patterns, by evaluating a large population of maxillofacial injuries over a 6-year period. PATIENTS AND METHODS Between 1991 and 1996, of 5,623 patients showing oral and maxillofacial injuries, 1,859 were sports-related. Records of 579 patients with 882 incidents of oral and maxillofacial injury due to skiing were reviewed and analyzed according to age, sex, type of injury, cause of accident, location, and frequency of fractures. Additionally, the five main injury mechanisms were analyzed. RESULTS The oral and maxillofacial injuries in 10.3% of all trauma patients, or 33% of all sports-related trauma patients, were due to skiing. A total of 310 patients (53.5%) had facial bone fractures, 236 patients (40.8%) suffered from dentoalveolar trauma, and 336 patients (58%) showed soft tissue injuries. Five major causes and mechanisms of injury existed, namely, 263 falls (45%); 135 collisions with other skiers (23%); 70 individuals struck by their own ski equipment (12%); 46 collisions against stationary objects (8%); and 34 lift-track accidents (6%). Sex distribution showed an overall male-to-female ratio of 1.9:1.0, but varied depending on the injury mechanism. The age distribution ranged from 2 to 81 years. CONCLUSION The results of this study show the high incidence of oral and maxillofacial injuries due to skiing accidents. Depending on the mechanism of injury, different patterns occur. Facial bone fractures are more likely in collisions with other persons, falls, and collisions with stationary objects, whereas dentoalveolar trauma is more common when persons are struck by their own ski equipment, or when accidents on lift-tracks occur.

Dentoalveolar trauma. Analysis of 4763 patients with 6237 injuries in 10 years

Ziel dieser Studie war es, das Ausmaß der dentoalveolären Verletzungen bei Patienten mit Gesichtstraumen zu erfassen. In einer retrospektiven Untersuchung wurden über einen Zeitraum von zehn Jahren hohe Unfallzahlen auf diese Verletzungsart hin analysiert. Im Zeitraum 1991 bis 2000 wurden insgesamt 9543 Unfallpatienten registriert. Darunter waren 4763 Patienten mit 6237 dentoalveolären Verletzungen. Diese wurden auf Unfallursache, Unfallhergang, Verletzungsart, Häufigkeit, Alter und Geschlecht der Patienten sowie Auftreten von Begleitverletzungen untersucht und statistisch mit der Häufigkeitsverteilung, dem Chi-Quadrat-, t-, Mann-Whitney-U-, und Kolmogorov-Smirnov-Test sowie der logistischen Regressionsanalyse ausgewertet. 2117 Haushalts- und Spielunfälle standen 1533 Sportunfällen, 438 Verkehrsunfällen, 426 Rohheitsdelikten und 201 Arbeitsunfällen gegenüber. Im gesamten Krankengut traten 2988 Luxationen, 2356 Kronenfrakturen, 444 Avulsionen, 176 Wurzelfrakturen, 154 Intrusionen und 119 Zahnkontusionen auf. Insgesamt betrug die Prävalenz für dentoalveoläre Verletzungen 49,9% unter den erfassten Gesichtsverletzungen. Erst die Analyse hoher Unfallzahlen offenbart und relativiert das Unfallrisiko für dentoalveoläre Verletzungen. Daraus ableitend können risikoorientiert vorbeugende Maßnahmen effektiver empfohlen und gefordert werden. The purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation based on the analysis of a large amount of dentoalveolar injuries over a 10-year period. Between 1991 and 2000, 4763 of 9543 patients suffering from oral and maxillofacial injuries, sustained dentoalveolar trauma. Records of 6237 different dental injury patterns were reviewed according to the five main injury mechanisms: age, sex, type of injury, cause of accident, and frequency of dentoalveolar trauma. They were statistically analyzed using frequency distribution, chi-square test, t-test, Mann-Whitney U test, Kolmogorov-Smirnov test, and logistic regression analysis. Household and play (2117), sports (1533), traffic accidents (438), acts of violence (426), and work-related accidents (201) were noted. A total of 4763 patients had 2988 subluxations, 2356 showed crown fractures, 444 had avulsions, 176 root fractures, 154 intrusions, and 119 patients suffered from concussions. This number of patients accounts for the prevalence of 49.9% for dentoalveolar trauma among all facial injuries. Only the analysis of a large number of injuries reveals the risk of suffering from dentoalveolar trauma. Due to this fact, preventive methods can be recommended and demanded more effectively.

Facial Trauma: How Dangerous Are Skiing and Snowboarding?

PURPOSE The aim of this study was to investigate maxillofacial injuries sustained in both skiing and snowboarding accidents and correlate injury mechanisms and patterns evaluating a large population. MATERIALS AND METHODS Between 1991 and 2003, all patients with maxillofacial injuries due to skiing and snowboarding accidents (1,393 cases) were reviewed and statistically analyzed according to age, gender, type of injury, cause of accident, location of trauma, and associated injuries. RESULTS Skiing accidents resulted in a total of 1,250 injuries, and snowboarding resulted in 143. In this study 686 skiers presented with 1,452 facial bone fractures and 80 snowboarders sustained 160 fractures of the face. Skiers had dentoalveolar trauma in 810 cases and 1,295 soft tissue injuries, whereas snowboarders had 88 dental injuries and 187 soft tissue lesions. Mechanisms of injury included 542 cases due to skiing and 85 falls due to snowboarding (a 1.79-fold higher risk for snowboarders). The gender distribution showed a male-female ratio of 3:1 in skiers and 5.5:1 in snowboarders. In both groups male patients were more prone to have a facial bone fracture than female patients. Snowboarders aged between 10 and 29 years had a 2.14-fold higher risk of sustaining a maxillofacial injury than skiers. CONCLUSIONS In both groups facial bone fractures occurred more often in male patients, and they were more likely to result from falls and collisions with other persons. Young snowboarders had a higher risk of maxillofacial injuries (especially soft tissue lesions) than skiers, whereas for children and old persons, skiing posed a much higher risk. Wearing a helmet while skiing and snowboarding should be mandatory to prevent serious trauma to the head.

Facial Injuries in Skiing A Retrospective Study of 549 Cases

In the last 2 decades, reports of skiing injuries have shown an increasing number of skiers with severe trauma. This article provides an account of a retrospective study of 549 patients with 1155 facial injuries sustained while skiing who received treatment at the Department of Oral and Maxillofacial Surgery at the University Hospital in Innsbruck, Austria between 1991 and 1996. The study was based on a questionnaire answered by the patients and on case report forms.Most of the patients were male (65.2%) and were aged between 3 and 81 years (average 28.4 years). A simple fall while skiing was the main type of accident (45.9%), followed by collisions with other people (23.5%). Injuries were classified into 1 of 3 groups: (i) lesions of the soft tissue (32.2% of all injuries); (ii) dentoalveolar traumas (24.3%); and (iii) fractures of facial bones (43.5%). Lacerations and haematomas were the most frequent lesions in patients with injuries to the soft tissues. The group of patients with dentoalveolar trauma mainly presented with fractures of tooth crowns. Fractures involving the mandible and the zygomatic bone were predominant in patients in the third group. Concomitant injuries mainly included injuries to the brain and skull fractures. Treatment was ambulatory, or by admission and surgery.We did not observe an increase in the number of skiing accidents causing facial injury in the last 5 years. Facial injuries represented 4% of all skiing injuries, a lower proportion than in other sports.