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Feasibility of outpatient management of mandibular fractures: a pilot study
21st ICOMS 2013—Abstracts: Oral Papers none of the published studies reported objective means to evaluate accuracy of reconstruction. Methods: Twelve patients with unilateral massively displaced or comminuted orbitozygomatic complex fractures received computer-assisted reconstruction guided by stereolithographic models and zygomatic templates. Titanium meshes and fixation plates were bent onto the models preoperatively, while the templates were used intraoperatively for guidance of zygomatic reduction into the pre-planned position. Linear and angular measurements were used to assess accuracy of reconstruction on the postoperative 3D-CT images. Results: Results are currently being generated and will be presented and disussed during the conference. http://dx.doi.org/10.1016/j.ijom.2013.07.186 T7.OR025 Feasibility of outpatient management of mandibular fractures: a pilot study J. Haq ∗ , J. Olding, K. Fan King’s College Hospital, United Kingdom Background: Over 300 mandibular fractures are managed in this department annually. Currently, all surgery is performed as inpatient care. On occasion, the operation occurs in the day surgery unit (DSU), although the patient remains as an inpatient. There is a shortage of inpatient beds and a proportion of mandibular fractures could theoretically be managed as outpatient care. A rapid access service exists for operations to be carried out by other specialties in this manner. Aims: To determine the feasibility of providing an outpatient service for the management of mandibular fractures To evaluate potential cost and inpatient bed reductions. Methods: A prospective study of patients admitted with mandibular fractures. Patients were excluded if under 16 y or had other indications for admission/surgery. Data collection included: time from injury to surgery, anaesthetic duration, mandibular injury severity score (MISS), operative details and medical/sociodomestic history. Post-operative recovery was assessed at 2, 3 and 5 h as per the DSU criteria for discharge (pain, vital signs, wound site, and other physiological parameters). Results (ongoing): • 30 cases, 22 male, mean age 30 y. • Patients waited from 0 to 8 days from injury to surgery (mean 2.5 d). • Mean anaesthetic duration was 144 min (40–285 min). • 85% of patients met the criteria for DSU admission. • 57% of patients were recovered to being appropriate for discharge at 5 h post op. as per DSU criteria. Conclusion: A significant number of cases would have been appropriate for outpatient management. The study continues to gather more evidence for the selection and prediction of these cases.Key words: mandible fracture; day surgery http://dx.doi.org/10.1016/j.ijom.2013.07.187
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T7.OR026 Maxillofacial firearm injuries: a protocol for management in Asyut University Hospital M. Hassan Osman ∗ , S. shaltout Asyut University, Egypt Purpose: This study discusses the firearm injuries in the maxillofacial region, protocol for primary care and management, the complications encountered and the outcome of the patients in Asyut University Hospital in upper Egypt. Patients and methods: 47 cases were received the primary care and treatment in Assiut University Hospital – were admitted and treated, the results were recorded and analysed. Results: Mandible (area III) was the common site of injury, the CNS and ocular injury have the same frequency of association. The most common complications were deformed commissure and scars. Cases with bone loss of the mandible leads to mal-occlusion and associated with mandibular and cervical branch facial nerve injury. Conclusion: Recommendation of simple approach, post operative safe air way and avoidance of sophisticated technique in the stage of primary care and treatment. http://dx.doi.org/10.1016/j.ijom.2013.07.188 T7.OR027 A review of the aetiology of facial fractures seen at a major trauma centre E. Hayes ∗ , E. Wu, K. Fan King’s College Hospital, United Kingdom Introduction: King’s College Hospital, a major trauma centre in South East London, covers a diverse population. We compare the aetiology of facial fractures we see to that of the rest of the UK. Methods: A retrospective search of the A + E database (Symphony) for three months in 2011 was performed; all patients with facial fractures were included. Data extracted included detailed aetiology and patient demographics. Results: In total 126 patients with facial fractures were identified. 64% of injuries (81 patients) were caused by assault; significantly higher than national data. 64% of these had mandibular fractures; 25% orbital fractures. A quarter had alcohol prior to the assault; 4% had used drugs. Only 4% were documented as being related to mugging. There were various mechanisms of assault. Punched only 63% (51 patients). Punched and kicked 16% (13 patients). Punched and weapon used 6% (5 patients). Kicked only 1% (1 patient). Head-butted only 3% (2 patients). Un-known 11% (9 patients). Fell or pushed to floor 12% (10 patients). Total involving weapons 14% (11 patients). Weapons included traffic cone, bottle, SCART cable falls accounted for 16% of patients, aged between 22 and 97 years; 100% of 22–39 year olds had consumed alcohol ± drugs. 35% sustained fractured orbits; 50% fractured mandibles. RTAs accounted for 7% of patients. 70% of patients sustained orbital fractures, none had mandibular fractures. Conclusion: Assaults account for the majority of patients with facial fractures seen at King’s College Hospital. Alcohol also appears to be a significant factor, particularly in falls and assaults. http://dx.doi.org/10.1016/j.ijom.2013.07.189
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T7.OR026 Maxillofacial firearm injuries: a protocol for management in Asyut University Hospital M. Hassan Osman ∗ , S. shaltout Asyut University, Egypt Purpose: This study discusses the firearm injuries in the maxillofacial region, protocol for primary care and management, the complications encountered and the outcome of the patients in Asyut University Hospital in upper Egypt. Patients and methods: 47 cases were received the primary care and treatment in Assiut University Hospital – were admitted and treated, the results were recorded and analysed. Results: Mandible (area III) was the common site of injury, the CNS and ocular injury have the same frequency of association. The most common complications were deformed commissure and scars. Cases with bone loss of the mandible leads to mal-occlusion and associated with mandibular and cervical branch facial nerve injury. Conclusion: Recommendation of simple approach, post operative safe air way and avoidance of sophisticated technique in the stage of primary care and treatment. http://dx.doi.org/10.1016/j.ijom.2013.07.188 T7.OR027 A review of the aetiology of facial fractures seen at a major trauma centre E. Hayes ∗ , E. Wu, K. Fan King’s College Hospital, United Kingdom Introduction: King’s College Hospital, a major trauma centre in South East London, covers a diverse population. We compare the aetiology of facial fractures we see to that of the rest of the UK. Methods: A retrospective search of the A + E database (Symphony) for three months in 2011 was performed; all patients with facial fractures were included. Data extracted included detailed aetiology and patient demographics. Results: In total 126 patients with facial fractures were identified. 64% of injuries (81 patients) were caused by assault; significantly higher than national data. 64% of these had mandibular fractures; 25% orbital fractures. A quarter had alcohol prior to the assault; 4% had used drugs. Only 4% were documented as being related to mugging. There were various mechanisms of assault. Punched only 63% (51 patients). Punched and kicked 16% (13 patients). Punched and weapon used 6% (5 patients). Kicked only 1% (1 patient). Head-butted only 3% (2 patients). Un-known 11% (9 patients). Fell or pushed to floor 12% (10 patients). Total involving weapons 14% (11 patients). Weapons included traffic cone, bottle, SCART cable falls accounted for 16% of patients, aged between 22 and 97 years; 100% of 22–39 year olds had consumed alcohol ± drugs. 35% sustained fractured orbits; 50% fractured mandibles. RTAs accounted for 7% of patients. 70% of patients sustained orbital fractures, none had mandibular fractures. Conclusion: Assaults account for the majority of patients with facial fractures seen at King’s College Hospital. Alcohol also appears to be a significant factor, particularly in falls and assaults. http://dx.doi.org/10.1016/j.ijom.2013.07.189