Tymour Forouzanfar

Aetiology and incidence of maxillofacial trauma in Amsterdam: a retrospective analysis of 579 patients

INTRODUCTION The incidence of maxillofacial fractures varies widely between different countries. The large variability in reported incidence and aetiology is due to a variety of contributing factors, including environmental, cultural and socioeconomic factors. This retrospective report presents a study investigating the aetiology and incidence of patients with maxillofacial fractures in Amsterdam over a period of 10 years. RESULTS The study population consisted of 408 males and 171 females with a mean age of 35.9 (SD: ±16.3) years. The age group 20-29 years accounted for the largest subgroup in both sexes. The most common cause of the fractures was traffic related, followed by violence. There were mainly mandibular and zygomatic bone fractures in both males and females, accounting for approximately 80% of all fractures. The main fracture site of the mandible was the combination of mandibular body with mandibular condyle (66 patients; 26.8%), followed by the combination of bilateral condylar fracture and fracture of the symphysis (43 patients; 17.5%). In fractures of the upper 2/3 of the face, zygomatic bone fractures were most common. In patients with alcohol consumption the injury was mostly the result of violence. In conclusion, this report provides important data for the design of plans for injury prevention, as compared with previous studies. Violence related injuries are increasing whereas fractures caused by traffic accidents are decreasing.

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.

Treatment and complications of mandibular fractures: A 10-year analysis

The surgical treatment and complications of patients with mandibular fractures in Amsterdam over a period of 10 years are analysed. Between January 2000 and January 2009 225 patients were surgically treated for a mandibular fracture (mean age of 32.6 (SD±14.6) years). A total of 426 fracture lines were identified. Of 213 dentate patients 29 patients were treated primarily with intermaxillary fixation (IMF). IMF combined with osteosynthesis was performed on 99 patients. Seventy-nine patients received IMF only per-operatively to make open reduction and internal fixation (ORIF) possible. Of 12 edentulous patients three patients were treated with Gunning splints. Nine patients were treated by manual reduction and internal fixation. A total of 1965 screws and 442 plates were used. Sixty (26.7%) patients presented with complications, including (transient) hyposensibility of the lip and chin (34 patients), dysocclusion (15 patients), infected osteosynthesis material (six patients) and temporomandibular dysfunction (five patients). Four patients needed surgical retreatment for correction of a dysocclusion. The results of this report are partly in line with other studies and provide important data for improving the treatment of the fractured mandible.

A ten-year analysis of midfacial fractures.

INTRODUCTION With respect to maxillofacial trauma a substantial part consists of midfacial fractures. The distribution of fracture sites seems to be influenced by the cause of the injury, geographic location, local behaviour and socioeconomic trends. This retrospective study presents an investigation of the aetiology and incidence of midfacial fractures in Amsterdam over a period of 10 years. RESULTS The study population consisted of 278 patients, 200 males and 78 females, with a mean age of 39.3 (SD: ±16.0) years and a male-female ratio of 2.6:1. Most fractures were found in the age group of 20-29 years for males and the age group of 50 years and older for females. The most common cause of the fractures was traffic related accidents. The main fracture site was the zygomatic complex, followed by the zygomatic arch and the orbital floor. In patients with alcohol consumption, violence was the main cause of injury. Complications consisted mainly of suboptimal fracture reduction, followed by temporary paraesthesia of the infraorbital nerve and wound infection. Complications were treated by retreatment, removal of the osteosynthesis material and antibiotic therapy. CONCLUSION This study presents the aetiology and incidence of midfacial fractures in a Dutch population over a period of 10 years. Furthermore our treatment protocols for these fractures are discussed.

Aetiology of maxillofacial fractures: a review of published studies during the last 30 years

The epidemiology of facial trauma may vary widely across countries (and even within the same country), and is dependent on several cultural and socioeconomic factors. We know of few reviews of published reports that have considered the sex distribution and aetiology of maxillofacial trauma throughout the world. The aim of this review was to discuss these aspects as they have been presented in papers published during the last 30 years. We made a systematic review of papers about the epidemiology of maxillofacial trauma that were published between January 1980 and December 2013 and identified 69 studies from Africa (n=9), North America and Brazil (n=6), Asia (n=36), Europe (n=16), and Oceania (n=2). In all the studies men outnumbered women, the ratio usually being more than 2:1. In American, African, and Asian studies road traffic crashes were the predominant cause. In European studies the aetiology varied, with assaults and road traffic crashes being the most important factors. In Oceania assaults were the most important. A comparison of the incidence of maxillofacial trauma of different countries together with a knowledge of different laws (seat belts for drivers, helmets for motocyclists, speed limits, and protection worn during sports and at work) is crucial to allow for improvement in several countries. To our knowledge this paper is the first attempt to study and compare the aetiologies of maxillofacial trauma.

Effect of ice compression on pain after mandibular third molar surgery: a single-blind, randomized controlled trial

This study was designed to investigate the effect of compression with ice and compression alone on pain and quality of life after surgical removal of mandibular third molars. A prospective, single-blind, randomized controlled study design was chosen. Participants in group A applied 45 min of repeated compression with ice; those in group B applied 45 min of repeated compression without ice (control); and those in group C did not apply any compression. Pain intensity was measured on a visual analogue scale (VAS) three times a day for seven days. At day seven, overall pain reduction was scored on a global perceived effect (GPE) scale and a quality-of-life questionnaire was completed. Ninety-five patients completed the trial. The VAS scores demonstrated a significant pain decrease in groups A and B three days postoperatively. No significant differences were observed between groups A and B. Based on the GPE ratings, in groups A and B more patients indicated that pain was reduced successfully, but this was not statistically significant. Quality of life was significantly better for patients in groups A and B. These results demonstrate that compression after surgical removal of mandibular third molars is a valuable method for preventing pain.

Treatment of cervicofacial actinomycosis: a report of 19 cases and review of literature

Objectives: Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis. Study design: A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature. Results: The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 – 4 weeks, being shorter than the 3 – 52 weeks reported in the literature. Conclusion: When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 – 4 weeks is generally efficient. Key words:Actinomycosis, actinomyces, actinomycosis treatment, cervicofacial infection, actinomycosis diagnosis, head and neck infection.

Advances in Bioprinting Technologies for Craniofacial Reconstruction

Recent developments in craniofacial reconstruction have shown important advances in both the materials and methods used. While autogenous tissue is still considered to be the gold standard for these reconstructions, the harvesting procedure remains tedious and in many cases causes significant donor site morbidity. These limitations have subsequently led to the development of less invasive techniques such as 3D bioprinting that could offer possibilities to manufacture patient-tailored bioactive tissue constructs for craniofacial reconstruction. Here, we discuss the current technological and (pre)clinical advances of 3D bioprinting for use in craniofacial reconstruction and highlight the challenges that need to be addressed in the coming years.

Bicycle-related maxillofacial injuries: a double-center study

OBJECTIVE Bicycle-related injuries account for an important proportion of road injuries all over the world. As only few reports have focused on the characteristics of maxillofacial fractures sustained in bicycle accidents, the purpose of this study was to present and compare epidemiological data about bicycle-related maxillofacial injuries in two European centers between 2001 and 2010. METHODS Bicycle-related facial fractures occurred in 105 patients (79 males, 26 females) in Turin, with a percentage of 5.77 among all facial fractures, and in 103 patients (55 males, 50 females) in Amsterdam, with a percentage of 19.69. RESULTS The major risk groups include young people between their first to third decades. The mandible is the most frequently involved facial bone. Among mandibular injuries the most commonly involved site was the condyle. CONCLUSIONS Bicycle-related injuries must be considered an important etiological factor in maxillofacial fractures with typical patterns, such as a peculiar seasonal incidence.

Quality of life after open versus closed treatment for mandibular condyle fractures: A review of literature

INTRODUCTION Many studies have compared treatment outcomes after open reduction and internal fixation (ORIF) and closed reduction (CR) of mandibular condylar fractures. Despite this the optimal treatment for these fractures remains a controversy. The purpose of this review is to compare the influence of objective and subjective treatment outcomes after open versus closed treatment of mandibular condyle fractures on quality of life, based on the current literature. METHODS A MedLine and Embase search was performed to find relevant titles on treatment outcomes after open versus closed reduction of mandibular condylar fractures. RESULTS Thirty-six studies were found. Twenty-eight retrospective studies, in addition to eight prospective studies were assessed. Nine treatment outcome variables were evaluated from the studies. Three studies reported on subjective discomfort. Although many studies investigated (objective) measurements (e.g. range of motion, masticatory function), no studies evaluated quality of life outcomes. In conclusion, prospective, patient-centred research is needed, in order to provide a guideline in decision making in the treatment of mandibular condylar fractures, based on subjective patient satisfaction.