Maxillofacial injuries in severely injured patients

Abstract

Background: A significant proportion of patients admitted to hospital with multiple traumas exhibit facial injuries. The aim of this study is to evaluate the incidence and cause of facial injuries in severely injured patients and to examine the role of plastic and maxillofacial surgeons in treatment of this patient collective.

Methods: A total of 67 patients, who were assigned to our trauma room with maxillofacial injuries between January 2009 and December 2010, were enrolled in the present study and evaluated.

Results: The majority of the patients were male (82 %) with a mean age of 44 years. The predominant mechanism of injury was fall from lower levels (<5 m) and occurred in 25 (37 %) cases. The median ISS was 25, with intracranial bleeding found as the most common concomitant injury in 48 cases (72 %). Thirty-one patients (46 %) required interdisciplinary management in the trauma room; maxillofacial surgeons were involved in 27 cases. A total of 35 (52 %) patients were treated surgically, 7 in emergency surgery, thereof.

Conclusion: Maxillofacial injuries are often associated with a risk of other serious concomitant injuries, in particular traumatic brain injuries. Even though emergency operations are only necessary in rare cases, diagnosis and treatment of such concomitant injuries have the potential to be overlooked or delayed in severely injured patients.

Keywords: Head injury; Maxillofacial injury; Trauma.

Fig. 1

A 37-years-old patient who was hit by a pipe through the car windscreen. As a result, the patient suffered, beside a fracture of the mandibular, severe cervical (destruction of the larynx, cervical spine fractures, thyroid gland and esophagus lesion), and chest trauma (serial rib fracture, lung contusion, clavicles fracture, soft tissue emphysema). The initial treatment of the mandibular fracture within the trauma room included provisional bony stabilization. Definitive treatment was carried out after stabilization of the patient three days after trauma (Fig. 2)

Fig. 2

Definitive treatment of the abovementioned mandibular fracture of a 37-years-old patient three days later

Fig. 3

A 24-years-old patient with epidural hematoma and fracture of the orbital floor, lateral orbital wall, fracture of the sinus maxillaris, and zygoma fracture. A haematoma compression of the optical nerve resulted that was decompressed by a maxillofacial surgeon in collaboration with an ophthalmologists in the trauma room

Fig. 4

Distribution of age and sex at the time of injury

Fig. 5

Associated Injuries in relation to the AIS Face

Fig. 6

Correlation between Glasgow Coma Scale at the Emergency Room and AIS Face and Head for 63 patients (4 missing). There was no correlation between GCS and AIS Face (Spearman’s rho, p = 0.43) but there was a correlation between GCS and AIS Head (Spearman’s rho, p = 0.02)

Fig 7

ATLS based algorithm of a diagnostic and therapeutic work-up in severely injured patients. Immediate involvement of a maxillofacial surgeon is necessary in accordance with the ATLS algorithm: A: midface fracture with obstructed airway; C: Severe nasal and/or oral bleeding. Instable midface fracture with severe bleeding; D: Partial or complete visual loss due to direct or indirect optic nerve trauma, retrobulbar hematoma or emphysema. (*Special Requirements of the Whole Body CT: Need for standard protocol, which should include the midface and mandible, if injuries of the midface are obvious. In case of no other life threatening injuries, if the standard protocol does not include vascular sequences of the head and neck, this should be done in hemodynamic stable patients direct after the primary scan is completed)