Journal Reading

drg. Gilang Wahyu Pratama (2006540716)

___________________

Dr. drg. Mohammad Adhitya Latief, Sp.B.M.M., Subsp. I.D.M. (K)

J Oral Maxillofac Surg Volume 78, number 1, 2020
 Table of contents

01 02 03
Abstract Introduction Patients & Methods

04 05
Results Discussion
 01
Abstract
Abstract
 02
Introduction
 Introduction
● The mortality and morbidity rates after facial trauma in civilians and
military personnel are substantial

● There is a high incidence of survival after injuries in military personnel,

including injuries from improvised explosive devices, with advanced
survivability after severe injuries owing to quicker search, rescue, and
triage; enhanced medical evacuation; improved body armor; improved first-
responder training; and more sophisticated combat- zone hemostatic
products.

● Many studies on the causes, prevalence, and treatment of maxillofacial (MF)

injuries in war-wounded patients have been re- ported.
 Introduction

● Studies have shown that the mandibular zone has a comparatively greater
risk of fractures than the midface; the results of such evaluations can be used
to improve the quality of health care for military personnel with MF injuries.

● This study was conducted to investigate the prevalence, pattern, causes, and
outcomes of MF trauma, including soft and hard tissue injuries, among
military casualties referred to our hospital from 2012 to 2018.
 03
Patients & Methods
 Patients & Methods

Patients
591 patients was assessed to investigate the prevalence, causes, and
outcomes of MF trauma, including soft and hard tissue injuries, among military
casualties from war- stricken countries referred to our hospital from from 2012 to 2018.

Methods
Cross-sectional, retrospective, descriptive study
All eligible samples were included in the study, and sampling was performed by census
sampling and a standard questionnaire
 Patients & Methods

Methods
Cross-sectional, retrospective, descriptive study
All eligible samples were included in the study, and sam-pling was performed by census
sampling and a stan- dard questionnaire

Mean and frequency of data were evaluated and analyzed via t test and c2 test using
SPSS 20. A P value of less than .05 was considered statistically significant
 Patients & Methods

Methods
Goals:
- Evaluate the prevalence and site of fracture in the mandible
- Evaluate sensory and motor nerve damage associated with the trigeminal nerve
and facial nerve branches was assessed, and globe-related injuries (actual vision
loss injuries)
 Patients & Methods

Soft tissue injuries of facial structures caused by penetrating or

blunt trauma, as well as vascular or neurologic injuries, were evaluated.

Mid- face hard tissue injuries including dentoalveolar fractures,

maxillary fractures, zygomaticomaxillary complex (ZMC) fractures, naso-orbito-
ethmoid (NOE) fractures, and isolated zygomatic arch and nasal bone fractures also
were evaluated.
 04
Results
 Results

DEMOGRAPHIC RESULTS
90% of patients were men (n = 530) and 10% were women (n = 61)

Ages ranged between 20 and 70 years

90% of patients were men (n = 530) and 10% were women (n = 61)

31% of the patients with MF fractures (183 of 591 patients)

were aged between 21 and 30 years
Results
DEMOGRAPHIC RESULTS
 Results

CAUSES OF FRACTURES
The most common cause of injury was explosive devices (58%)

The most common cause of midface injuries was explosive devices (52%)

The most frequent cause of lower face (mandible) injuries was gunshot
wounds (40%)

the most common cause of upper face injuries was

explosive devices (57%)
Results
CAUSES OF FRACTURES
 Results

FRACTURE SITES AND DISTRIBUTION

Hard tissue injuries were categorized into 3 groups:
1. Upper face injuries were defined as fractures of the orbital rim, orbital roof, and
frontal sinus
2. Midface fractures were defined as injuries located below the aforementioned
structures and involving the superior zygomaticofrontal suture and the area from
the supe- rior orbital rim to the maxillary occlusal plane
3. Lower face injuries related to mandibular fractures.
Results

FRACTURE SITES AND DISTRIBUTION

• Facial laceration (86%)

• Fractures was 503 (85%)
142 upper face fractures (24%)
289 Midface fractures (49%)
254 lower face fractures (43%)
Results

FRACTURE SITES AND DISTRIBUTION

• Facial laceration (86%)

• Fractures was 503 (85%)
142 upper face fractures (24%)
289 Midface fractures (49%)
254 lower face fractures (43%)
Results

DISTRIBUTION OF MIDFACE FRACTURES

Results

DISTRIBUTION OF MAXILLA FRACTURES

Results

DISTRIBUTION OF MANDIBULAR FRACTURES

 Results

TREATMENT AND COMPLICATION

The hard tissue traumatic fractures were treated by open reduction–internal
fixation (ORIF) (89%) or closed reduction (11%)

The complication rate after hard tissue injuries was 7%; the complications after hard
tissue traumatic fractures included nonunion or malunion, bone malposition,
osteomyelitis, and infection.
 Results

TREATMENT AND COMPLICATION

The soft tissue traumatic injuries and facial tears were treated by primary closure
(83%) (P < .0001), delayed primary closure (13%), or flap closure (4%)

The complications after soft tissue injuries were recorded and included infection, scar,
wound dehiscence, facial nerve dysfunction, ectropion, and globe injury including
non–vision loss injury and globe rupture in 1 or both eyes.
 05
Discussion
 Discussion

The demographic results in our study showed that the MF fractures in military
personnel were more prevalent in men and the mean age was 31.4 years. The
prevalence of fractures was in accord with our previous study. Several studies
reported similar results to these demographic results in various regions of the world;
because the vast population of military personnel are men and they are in the third
decade of life; socioeconomic characteristics and culture limit the employment of
women in the military.
 Discussion

Midface fractures were the most common category of regional fracture, although
mandibular angle fracture was the single most common facial fracture encountered. In
our study, the most common fracture sites in the mandibular region were the angle
region followed by the body and condyle region. The predominant mandibular
fracture varied in different studies, but several studies showed a correlation with our
results. Body and angle fractures were common in studies with high rates of
interpersonal violence.
 Discussion

In our study, the most common type of injury to the face was a facial laceration
(86%); the number of patients with fractures was 503 (85%). In addition, the most
frequent type of hard tissue injury was midface fractures (49%), followed by lower
face fractures (43%) and upper face fractures (24%). Several studies reported similar
results; for example, Keller et al reported the most common MF fractures to be
midface fractures, rather than fractures of the upper and lower third of the face.
However, other studies have shown that the lower third of the face is the main region
susceptible to injury.
 Discussion
In this study, the distribution of maxilla fractures was as follows: nasal fractures in 44% of
patients, zygomatic arch fractures in 42%, fractures in the ZMC region in 39%, dentoalveolar
fractures in 39%, fractures in the Le Fort region in 35% (of which 40% were Le Fort I, 37% were
Le Fort II, and 23% were Le Fort III fractures), fractures in the orbital region in 29%, and NOE
fractures in 18%. Several studies reported similar results; for example, Gandhi et al (2011)
reported the highest rate for nasal fractures. However, the pre-dominant maxillary fracture is the
Le Fort fracture in civilian studies.

MF trauma management is highly related to technol- ogy, innovations, and materials. In our study,
ORIF was used for treatment in 89% of patients. Generally, open reduction and plate
osteosynthesis are used as a replacement for closed reduction by most surgeons because this
method has several advantages incuding early recovery, more rapid return of function, segment
stability, and patient comfort.However, the treatment of MF fractures differs from surgeon to
surgeon; it also depends on the accessible instruments.
 Discussion
On the basis of this study, the complication rate after hard tissue fractures was 7%; this included
nonunion, malunion, or infection. The complications recorded after soft tissue traumatic injuries
included infection, scar, wound dehiscence, facial nerve dysfunction, and ectropion. However,
the most common complication was previously reported to be remaining neuro- sensory
disturbance of the inferior alveolar nerve. Several previous studies showed a relation- ship with
our results; Kittle et al evaluated the characteristics of midface injuries among US military
forces occurring from 2001 to 2011 during the wars in Iraq and Afghanistan. They reported that
infections and malunions were the most common complications; in addition, infections and
malunions were considered the major cause of morbidity. Akhlaghi and Aframian- Farnad
evaluated the incidence and treatment of MF injuries in the war between Iran and Iraq. In their
study, 210 patients underwent surgery from 1981 to 1986 in their clinic. Ophthalmic damage
was seen in about 20% of midface injuries, and osteomyelitis was described as the most
common and most serious post- operative complication.
 Discussion
We identified the patterns of MF injuries and the treatment modalities used to treat these
patients. On the basis of the results of this study, MF fractures were more prevalent in men and
the mean age was 31.4 years. The most frequent type of MF injury was midface fractures
(49%), followed by lower face frac tures (43%) and upper face fractures (24%). The most
common cause of injury was explosive devices (58%). The most frequent fracture site in the
mandible was the angle region, followed by the body and condyle region. Nasal fractures were
seen in 44% of MF fractures. Regarding soft tissue trauma, the rate of globe injuries has
decreased substantially, in contrast to previous studies. This is probably because of the use of
eye-protecting glasses among military personnel. In our study, ORIF showed a greater pro-
portion among the treatment modalities, which may be related to the lower complication rate
after facial bone fractures. ORIF was used for treatment in 89% of patients. These results can
help improve the quality of treatment and decrease the rate of complications in military
casualties.
Thank you