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Middle third of face fractures – management in a major trauma centre in London
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21st ICOMS 2013—Abstracts: Oral Papers
T7.OR028 A 10-year prospective analysis of paediatric maxillofacial trauma in Birmingham, UK M. Idle ∗ , M. Hamilton, D. Monaghan, R. Williams
Hammond, K.
McMillan, A.
ried at the earliest. Infection control is extremely important in the success of the treatment. http://dx.doi.org/10.1016/j.ijom.2013.07.191 T7.OR030
Birmingham Children’s Hospital, United Kingdom
Middle third of face fractures – management in a major trauma centre in London
Introduction: The aim of this study is to examine trends in the incidence, nature and management of emergency referrals to the Oral and Maxillofacial Surgery Department at Birmingham Children’s Hospital (BCH). Methods: The maxillofacial unit at BCH receives patients less than 16 years of age from the Paediatric Emergency Department and 6 of the city’s major hospitals with a total catchment area of 5.5 million. The data was collected prospectively between November 2002 and December 2012. Results: A total of 2449 cases (66% male, 34% female) were recorded over the 10-year period. The mean age of patient presenting to the unit was 7 years 2 months (median 6 years, 5 months). 91% of cases were referred directly from BCH emergency department. The commonest presenting complaint was fall (42%) followed by infection (14%) and assault (10%). Injuries were sub classified into soft tissue injury (41%), dentoalveolar injury (26%), facial bone fracture (7%), mandibular fracture (5%) and haemorrhage following dental extraction (2%). Conclusions: The data demonstrated that the incidences of dentoalveolar injuries, facial bone fractures and mandibular fractures have remained relatively constant during the study period. It would suggest, however, that cases presenting with infection have increased over the last two years.
A. Kanzaria ∗ , S. Thomas, S. Holmes, C. Bridle
http://dx.doi.org/10.1016/j.ijom.2013.07.190 T7.OR029 Management guidelines of facial gunshot injuries B. Kambarji United Nations Background: Due to the increase of weapons, fire arms, and violence in several Arabic counties affected by the “Arabic Spring”, a dramatic increase of gunshot injuries was reported. It reached an epidemic proportion in the last three years. These injuries are caused by civil violence, police brutality and armed robberies. Objective: Most of these injuries, including the maxillo-facial ones, are being treated initially in non-hospital conditions and non-sterile environment due to heavy fire, blocked roads and hospitals full to bursting. A pilot study examines the treatment quality, efficiency, and prognosis managed in field medical units. Methods: In this study, treatment plans of 98 patients with facial gunshots who had been treated in field medical units during clashes were compared with other patients who got similar treatment in hospital sterile conditions. Result: Hospital treatment of gunshot injuries to the face and neck have been proven to be safer since patients who have received treatment in the field medical units had worse prognosis, delayed healing process, badly healed scars and 5% mortality. Conclusion/recommendations: The management of facial gunshot injuries should be planned, carried out, and achieved delicately. It takes several stages and procedures to achieve the targeted treatment plan, Bone fixation and wound closure should be car-
The Royal London Hospital, United Kingdom Aims: Zygomatico-orbital–maxillary complex (ZOMC) fractures are the second most common facial fracture following nasal fractures. We present a comprehensive retrospective analysis of the management of 226 patients treated for midface fractures in our unit during January 2012–December 2012 including demographics, timing of surgery, surgical access, reconstructive materials and factors affecting post-operative hospital stay. Methods: All patients were initially assessed following hospital attendance or referral from other centers and their records were obtained retrospectively. Multivariate analysis of standard variables, relating to epidemiological and surgical data, against the length of stay was implemented. Results: Total of 226 patients were operated: male to female ratio (6.5:1); age range14–80. Two-thirds of the operations were carried out in the afternoon. This along with associated other bodily injuries (23%) were the most important factors in determining the length of hospital stay. No plates were removed due to infection. The incisions used were transconjuctival (33.5%), temporal incision (27%), buccal–vestibular (26%), upper blepheroplasty (8%) and coronal (5%). Most of our patients (72%) had internal fixation. A pre-bent titanium plate was the most commonly (76%) used material for orbital floor and medial wall reconstruction. The commonest area of plating was the zygomatic buttress (28%), followed by infra-orbital rim (21%), orbital-floor (20%), fronto-zygomatic suture (17%), zygomatic arch (6.4%) and other areas (7.6%). Length of operation varied from 5 min to 305 min (Mode = 60 min). Excluding the patients with other serious injuries, the length of hospital stay was 0 nights (48.5%), 1 night (44.4%), 2 nights (7.1%). Patients with four or more plates in situ and those with a coronal flap access were more likely to stay for a minimum of two nights. Conclusion: Midface fracture surgery management is essentially guided by surgeon’s experience. Complications in our unit were related to poor positioning rather than infection. Our experience shows that ZOMC fracture surgeries can be performed as day case if operated early in the day. Key words: zygomatic; orbital floor; midface fractures management; hospital stay http://dx.doi.org/10.1016/j.ijom.2013.07.192 T7.OR031 Titanium three dimensional miniplate versus conventional titanium miniplate in fixation of anteriormandibular fractures M. Khalifa ∗ , H. El Hawary Faculty of Dentistry, Egypt Titanium three dimensional miniplate versus conventional titanium miniplate in fixation of anteriormandibular fractures. A total of 20 patients were managed by open reduction and internal fixa-
21st ICOMS 2013—Abstracts: Oral Papers
T7.OR028 A 10-year prospective analysis of paediatric maxillofacial trauma in Birmingham, UK M. Idle ∗ , M. Hamilton, D. Monaghan, R. Williams
Hammond, K.
McMillan, A.
ried at the earliest. Infection control is extremely important in the success of the treatment. http://dx.doi.org/10.1016/j.ijom.2013.07.191 T7.OR030
Birmingham Children’s Hospital, United Kingdom
Middle third of face fractures – management in a major trauma centre in London
Introduction: The aim of this study is to examine trends in the incidence, nature and management of emergency referrals to the Oral and Maxillofacial Surgery Department at Birmingham Children’s Hospital (BCH). Methods: The maxillofacial unit at BCH receives patients less than 16 years of age from the Paediatric Emergency Department and 6 of the city’s major hospitals with a total catchment area of 5.5 million. The data was collected prospectively between November 2002 and December 2012. Results: A total of 2449 cases (66% male, 34% female) were recorded over the 10-year period. The mean age of patient presenting to the unit was 7 years 2 months (median 6 years, 5 months). 91% of cases were referred directly from BCH emergency department. The commonest presenting complaint was fall (42%) followed by infection (14%) and assault (10%). Injuries were sub classified into soft tissue injury (41%), dentoalveolar injury (26%), facial bone fracture (7%), mandibular fracture (5%) and haemorrhage following dental extraction (2%). Conclusions: The data demonstrated that the incidences of dentoalveolar injuries, facial bone fractures and mandibular fractures have remained relatively constant during the study period. It would suggest, however, that cases presenting with infection have increased over the last two years.
A. Kanzaria ∗ , S. Thomas, S. Holmes, C. Bridle
http://dx.doi.org/10.1016/j.ijom.2013.07.190 T7.OR029 Management guidelines of facial gunshot injuries B. Kambarji United Nations Background: Due to the increase of weapons, fire arms, and violence in several Arabic counties affected by the “Arabic Spring”, a dramatic increase of gunshot injuries was reported. It reached an epidemic proportion in the last three years. These injuries are caused by civil violence, police brutality and armed robberies. Objective: Most of these injuries, including the maxillo-facial ones, are being treated initially in non-hospital conditions and non-sterile environment due to heavy fire, blocked roads and hospitals full to bursting. A pilot study examines the treatment quality, efficiency, and prognosis managed in field medical units. Methods: In this study, treatment plans of 98 patients with facial gunshots who had been treated in field medical units during clashes were compared with other patients who got similar treatment in hospital sterile conditions. Result: Hospital treatment of gunshot injuries to the face and neck have been proven to be safer since patients who have received treatment in the field medical units had worse prognosis, delayed healing process, badly healed scars and 5% mortality. Conclusion/recommendations: The management of facial gunshot injuries should be planned, carried out, and achieved delicately. It takes several stages and procedures to achieve the targeted treatment plan, Bone fixation and wound closure should be car-
The Royal London Hospital, United Kingdom Aims: Zygomatico-orbital–maxillary complex (ZOMC) fractures are the second most common facial fracture following nasal fractures. We present a comprehensive retrospective analysis of the management of 226 patients treated for midface fractures in our unit during January 2012–December 2012 including demographics, timing of surgery, surgical access, reconstructive materials and factors affecting post-operative hospital stay. Methods: All patients were initially assessed following hospital attendance or referral from other centers and their records were obtained retrospectively. Multivariate analysis of standard variables, relating to epidemiological and surgical data, against the length of stay was implemented. Results: Total of 226 patients were operated: male to female ratio (6.5:1); age range14–80. Two-thirds of the operations were carried out in the afternoon. This along with associated other bodily injuries (23%) were the most important factors in determining the length of hospital stay. No plates were removed due to infection. The incisions used were transconjuctival (33.5%), temporal incision (27%), buccal–vestibular (26%), upper blepheroplasty (8%) and coronal (5%). Most of our patients (72%) had internal fixation. A pre-bent titanium plate was the most commonly (76%) used material for orbital floor and medial wall reconstruction. The commonest area of plating was the zygomatic buttress (28%), followed by infra-orbital rim (21%), orbital-floor (20%), fronto-zygomatic suture (17%), zygomatic arch (6.4%) and other areas (7.6%). Length of operation varied from 5 min to 305 min (Mode = 60 min). Excluding the patients with other serious injuries, the length of hospital stay was 0 nights (48.5%), 1 night (44.4%), 2 nights (7.1%). Patients with four or more plates in situ and those with a coronal flap access were more likely to stay for a minimum of two nights. Conclusion: Midface fracture surgery management is essentially guided by surgeon’s experience. Complications in our unit were related to poor positioning rather than infection. Our experience shows that ZOMC fracture surgeries can be performed as day case if operated early in the day. Key words: zygomatic; orbital floor; midface fractures management; hospital stay http://dx.doi.org/10.1016/j.ijom.2013.07.192 T7.OR031 Titanium three dimensional miniplate versus conventional titanium miniplate in fixation of anteriormandibular fractures M. Khalifa ∗ , H. El Hawary Faculty of Dentistry, Egypt Titanium three dimensional miniplate versus conventional titanium miniplate in fixation of anteriormandibular fractures. A total of 20 patients were managed by open reduction and internal fixa-