An Update on Maxillary Fractures: A Heterogenous Group

Cohn, Jason E.; Iezzi, Zachary; Licata, Jordan; Othman, Sammy; Zwillenberg, Seth

doi:10.1097/scs.0000000000006675

Cited by 6 publications

(6 citation statements)

References 24 publications

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“… 17 Another retrospective review of maxillary fractures illustrated that 78% of ZMC fractures were managed nonoperatively, with the other 22% undergoing ORIF. 18 In general, the decision to operate is focused on aesthetic and functional improvement. 19 If ZMC trauma is viewed on a spectrum based on severity, the extremes (no displacement and severe displacement/comminution) may be managed nonoperatively and operatively, respectively.…”

Section: Discussionmentioning

confidence: 99%

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

Prabhu

Chung

Rudolph

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: The zygomaticomaxillary complex (ZMC) can experience a multitude of deforming forces. There is limited understanding on which deformities alter patient outcomes. This study utilized an automated, three-dimensional analysis to elucidate which fracture patterns and rotational deformities are most prevalent and associated with postoperative complications. Methods: This study was a 7-year retrospective review of patients with unilateral ZMC fractures who underwent surgical intervention. Patient demographics, injury mechanisms, presenting symptoms, and postoperative outcomes were collected. Segmentation was completed using Mimics software. The lateral-medial, superior-inferior, and anterior-posterior axes were manually identified on the zygoma and then displacement, rotational direction, and rotational degrees were automatically calculated using Geomagic software. Total displacement score was generated by summation of individual displacement scores at each of the five sutures. Results: Eighty-one patients satisfied inclusion criteria. The most prevalent rotational pattern of the zygoma was medially-superiorly-posteriorly ( P < 0.001). When comparing rotation along the three axes, the zygoma had the greatest rotation along the lateral-medial axis compared with the superior-inferior ( P = 0.003) and anterior-posterior ( P < 0.001) axes. Within each axis, the zygoma was more likely to rotate medially than laterally ( P = 0.003) and posteriorly than anteriorly ( P = 0.01). Multivariate analysis identified total displacement scores and degrees rotated along the lateral-medial axis as significant predictors of facial complications and reoperation. Conclusions: This study suggests that patients with unilateral ZMC fractures who undergo surgical intervention are at an increased risk for adverse outcomes with greater rotation along the lateral-medial axis and higher total displacement scores. Additionally, the automated analysis method described can provide objective data to better characterize ZMC fractures.

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Section: Discussionmentioning

confidence: 99%

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

Prabhu

Chung

Rudolph

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…95,122 Sinus fractures are often associated with other fractures but do occur in isolation and are also often managed nonoperatively. 122,123 Maxillary alveolar fractures are frequently accompanied by dental injury. The goals of management are to stabilize the alveolar segment and preserve the involved teeth; however, treatment delays greater than 24 hours do not result in an increased risk of tooth pulp necrosis or infection.…”

Section: Maxillary Sinus Alveolus and Hard Palatementioning

confidence: 99%

“…Maxillary fractures are heterogeneous and may present as part of a complex or in isolation. 73,[122][123][124][125][126][127][128][129][130][131][132] Frontal process fractures are often associated with nasal bone fractures and are generally nonoperative. 95,122 Sinus fractures are often associated with other fractures but do occur in isolation and are also often managed nonoperatively.…”

Section: Maxillary Sinus Alveolus and Hard Palatementioning

confidence: 99%

“…73,[122][123][124][125][126][127][128][129][130][131][132] Frontal process fractures are often associated with nasal bone fractures and are generally nonoperative. 95,122 Sinus fractures are often associated with other fractures but do occur in isolation and are also often managed nonoperatively. 122,123 Maxillary alveolar fractures are frequently accompanied by dental injury.…”

Section: Maxillary Sinus Alveolus and Hard Palatementioning

confidence: 99%

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Interfacility Transfer Guidelines for Isolated Facial Trauma: A Multi-disciplinary Expert Consensus.

Pontell

Steinberg

Mackay

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: The objective of this study was to develop guidelines for the transfer of patients with isolated craniomaxillofacial trauma. Methods: A national, multidisciplinary expert panel was assembled from leadership in national organizations and contributors to published literature on facial reconstruction. The final panel consisted of five plastic surgeons, four otolaryngologist–head and neck surgeons, and four oral and maxillofacial surgeons. The expert panelists’ opinions on transfer guidelines were collected using the modified Delphi process. Consensus was predefined as 90 percent or greater agreement per statement. Results: After four Delphi consensus building rounds, 13 transfer guidelines were established, including statements on fractures of the frontal sinus, orbit, midface, and mandible, as well as soft-tissue injuries. Twelve guidelines reached consensus. Conclusions: The decision to transfer a patient with craniomaxillofacial trauma to another facility is complex and multifactorial. While a percentage of overtriage is acceptable to promote safe disposition of trauma patients, unnecessarily high rates of secondary overtriage divert emergency medical services, increase costs, delay care, overload tertiary trauma centers, and result in tertiary hospital staff providing primary emergency coverage for referring hospitals. These craniomaxillofacial transfer guidelines were designed to serve as a tool to improve and streamline the care of facial trauma patients. Such efforts may decrease the additional health care expenditures associated with secondary overtriage while decompressing emergency medical systems and tertiary emergency departments.

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“…The involvement of the maxillary sinus walls is frequent. Sinusitis is the most common disorder of the maxillary sinus after trauma [ 7 , 8 , 9 , 10 ]. The symptoms of maxillary sinusitis include nasal congestion, nasal discharge, facial pain, rhinocnesmus, etc., [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Maxillary Sinus Pathology after Surgery for Midfacial Fracture: A Multivariate Analysis

Jiang

et al. 2022

JCM

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This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall who were treated with open reduction and internal fixation (ORIF) between January 2015 and December 2020. Fracture reduction, the number of screws implanted in the maxillary sinus, and the number of screws penetrating the maxillary sinus, etc., were examined as potential risk factors. Maxillary sinus pathology on postoperative CT was considered the primary outcome for case-control analysis. Binary logistic regression was used to identify variables associated with postoperative maxillary sinus pathology. Thereafter, propensity score matching (PSM) was used to extract confounding factors. A total of 262 patients (totaling 372 maxillary sinuses) were included for analysis. PSM yielded 178, 246, and 70 matched sinuses, respectively, depending on the potential risk factors. Postoperative maxillary sinus pathology was visualized in 218 of the 372 maxillary sinuses (58.60%). The risk factors for postoperative maxillary sinus pathology included the number of screws penetrating the maxillary sinus (odds ratio (OR), 1.124; p = 0.007), an imperfect maxillary sinus wall fracture reduction (OR, 2.901; p = 0.021), and the number of sinus walls involved (OR, 1.383; p = 0.011). After PSM, postoperative maxillary sinus pathology was still more prevalent in sinuses with multiple maxillary sinus wall fractures (64.04% vs. 48.31%, p = 0.034), sinuses with more screws penetrating the maxillary sinus (64.23% vs. 50.41%, p = 0.028), and sinuses with an imperfect reduction (80% vs. 51.43%, p = 0.012). In conclusion, maxillary sinus pathology is common after the ORIF of midfacial fractures. Patients with a fracture of multiple maxillary sinus walls require a close follow-up. Screw penetration of the maxillary sinus should be avoided to prevent maxillary sinus pathology after a midfacial fracture ORIF.

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An Update on Maxillary Fractures: A Heterogenous Group

Cited by 6 publications

References 24 publications

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

Interfacility Transfer Guidelines for Isolated Facial Trauma: A Multi-disciplinary Expert Consensus.

Risk Factors for Maxillary Sinus Pathology after Surgery for Midfacial Fracture: A Multivariate Analysis

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