Background Presence of head injuries in patients with maxillofacial trauma is a lifethreatening condition. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery. Hence, the need to know about the incidence of head injuries associated with maxillofacial trauma becomes an important aspect. Materials and Methods A total of 100 patients were included in the study. Patient with head injuries associated with maxillofacial fractures was accounted to determine the incidence and pattern of head injuries accompanying maxillofacial trauma. They were evaluated for epidemiological demographic and clinical characteristics.Results The present study had 91% predominance of male patients with age ranging from 1 to 75 years. 91% cases were as a result of RTA. The most frequent maxillofacial injury represented was the fractured mandible. The incidence of head injuries associated with maxillofacial trauma was 67 %. Among all the patterns of head injuries, concussion was the most common head injury associated with maxillofacial trauma. Conclusion In our study, the risk of head injury increased significantly as the Glasgow Coma Scale score decreased and with increase in the number of facial fractures. There was association between head injury and maxillofacial trauma.

Background and purpose Midfacial fractures may often be associated with injuries to the orbit which may lead to notable dysfunction of the visual apparatus, if not detected early after injury. The purpose of this study is to evaluate the associated ophthalmic injuries in mid-face trauma and to emphasize the need for understanding the ophthalmic signs and symptoms by an attending maxillofacial surgeon. Patients and methods A total number of 60 clinically and radiographically proven subjects with midfacial fractures were considered in the study that underwent complete ophthalmological evaluation at initial presentation. Referral to ophthalmologist was considered to determine the exact nature of injury and its implications. Results by a maxillofacial surgeon and ophthalmologist were evaluated. Results In our study, a male predominance with a mean age of 32 years was observed, with the most common etiology being Road Traffic Accidents. Forty-two of the 60 patients exhibited sub-conjunctival hemorrhage accounting for 70 % of ocular injuries recorded. While 28 of the 60 patients displayed peri-orbital edema (53.3 %), 8 patients experienced diplopia (13.32 %) and 8 patients showed relative afferent pupillary defect (13.32 %). Conclusion From our study, it becomes imperative that the maxillofacial surgeon should have a thorough knowledge of the various ophthalmic injuries that could occur in association with midfacial trauma in order to prevent visual complications to the patient. Understanding of the subtle injuries to the ocular apparatus which may be undiagnosed by a maxillofacial surgeon but have significant grave outcomes is essential.

Background Trigemino-cardiac reflex is a physiologic response of the body to pressure effects in the region of distribution of the trigeminal nerve. Oral and maxillofacial surgical procedures can induce the development of this reflex, which leads to significant changes in the heart rate and sinus rhythms. This study intends to evaluate the effects of this reflex in patients with facial fractures and its subsequent management. Patients and Methods A total of thirty-seven patients with facial fractures who reported to the Department of Oral and Maxillofacial Surgery at Basaveswar Teaching and General Hospital, Gulbarga during a period from July 2015-March 2016 were considered for the study. Results A male preponderance is observed with the most susceptible age group being 21-30 years. Twenty-three patients sustained mid-facial fractures alone, nine patients had isolated mandible fractures and five patients had fractures of both the mid-face and mandible. A relative bradycardia was observed in the patients with mid-facial trauma, both at the time of presentation and also during the surgical reduction of midfacial fractures which improved after completion of procedure in most of the patients. However, in two patients, the bradycardia progressed to a cardiac asystole during midface manipulation which required immediate halt of the procedure and intravenous administration of atropine. Conclusion Trigeminocardiac reflex though physiologic, which usually tends to subside without complications is not to be neglected in the surgeries of the maxillofacial skeleton. A propensity for unforeseen complications due to this reflex has to be avoided by meticulous monitoring of the ECG.

Aim To compare the displacement gap of mandible fracture segments treated with different designs of miniplates under various loading conditions. Materials and Methods Fracture in the body of mandible was bridged with 15 different designs and configuration of titanium mini-plates. Bite forces were applied at 3 locations, ipsilateral fractured side, contra lateral side and incisor site. 3D finite element methods (FEM) model of mandible was generated using 10 nodal tetrahedral elements. A commercial FE solver was used to solve bone inter fragmentary displacement during loading. Results Superior position of mini-plates produced better stability than inferior position. Positive bending moments can be reduced by larger plate in lower border in 2 plate system. Results of X mini-plate are comparable to 2 plate configuration. If length of middle portion of plate increased, stability decreased. Number of screws did not affect fracture stability. Conclusion Finite element methods analysis is used to determine the gap between mandible fragments which is otherwise impossible to measure clinically. The results obtained from this study offered us a choice of mini-plate design and configuration for clinical application.

Aim Maxillofacial trauma when associated with concomitant injuries has a significant potential for increased morbidity. This study aims to identify the causes of trauma, evaluate the types of associated injuries and to highlight the significance of multi professional collaboration in sequencing of treatment. Patients and Methods A total of 300 patients who reported to the casualty of a tertiary Hospital in Karnataka with facial fractures were enrolled. Results Associated injuries were sustained by 162 patients. The predominant aetiology was the Road Traffic Accident with maximum number of patients in the age group of 20-29 and a male to female ratio of 10.1:1. The mandible was the most frequently fractured bone. Head injury was the most common associated injury. The mortality rate was 0.66%. The mean ISS and GCS values among the patients who sustained associated injuries along with maxillofacial trauma were higher and lower respectively, as compared to those without associated injuries with a statistically significant difference (p \ 0.001). Conclusion Implementation of strict road safety measures in the rural and interior regions of South India, to prevent morbidity and mortality due to road traffic accidents is essential. Injuries to the facial skeleton must be approached with the knowledge of probable associated injuries that could have been incurred.

Aim of the study The present study compares lingual stability of monocortical miniplate fixation with that of bicortical miniplate fixation in parasymphysis fracture using FEM analysis. Materials and methods Using multislice CT scanner, 3D FEM of patient's mandible was created. Fracture was simulated at parasymphysis region and fixed with 2-mm titanium miniplates and screws of length 8, 10, 12 mm, respectively. Loading force of 120 N applied at molar region and 62.8 N at incisor region. These three models were imported into ANSYS Workbench FEM software. Result There is no significant difference in results between bicortical fixation and monocortical fixation. Conclusion It was concluded that use of monocortical fixation provides sufficient lingual stability. This suggests monocortical fixation system is as reliable as bicortical fixation. Keywords Open reduction and internal fixation (ORIF) Á Finite element model (FEM) analysis Á Monocortical Á Bicortical

This article intends to provide information regarding the possible biomechanics and management of bilateral superolateral dislocation of mandibular condyles associated with symphysis fracture.

Background:With the development of urban setting worldwide, the major issue of concern is the increase in the mortality rate in the population due to road traffic accidents. The face, being the most exposed region is susceptible to injuries and maybe associated with injuries to the adjacent neuro-cranium. The literature has conflicting views on the relationship between facial fractures and head injuries with some authors opining that the facial skeleton cushions the brain while some other authors claim that the facial fractures act as indicators for head injuries.Objectives:To analyze the correlation between the facial fractures and head injuries and to assess if the facial skeleton acts to protect the brain from injury.Patients and Methods:A prospective study that included patients who reported to the emergency department of Basaveswar Teaching and General Hospital, Gulbarga, during 2 years, between August 2013 and July 2015 was conducted. A total of 100 patients with facial fractures were enrolled in the study.Results:Head injuries were sustained by 51 patients in the study. Maximum number of patients was in the age group of 20–29 with a male to female ratio of 10.1:1. The mandible was the most frequently fractured bone in the facial skeleton followed by the zygomatico-maxillary complex. A majority (96%) of patients with head injuries had fractures of either the upper third or the middle third of the face. Contusions and pneumocephalus were the most common head injury encountered. The Glasgow Coma Scale score was significantly lower in patients with associated head injuries as compared to those patients with facial trauma alone. The mortality rate in the study was 2% with both the victims having sustained middle third and upper third fractures respectively with associated head injuries.Conclusion:The facial skeleton does not act to cushion the brain from injury but, in fact, the facial trauma victims should be considered potential head injury patients.