C-spine injury and mandibular fractures: lifesaver broken in two spots

Chu, Michael; Soleimani, Tahereh; Evans, Tyler A.; Fernandez, Sarah I.; Spera, Leigh J; Klene, Carrie; Zarzaur, Ben L.; Tholpady, Sunil S.

doi:10.1016/j.jss.2016.08.019

Cited by 17 publications

(14 citation statements)

References 14 publications

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“…The incidence of MFI–CSI ranges from 0.8 to 12% according to the recent literature 1 – 6 . However, the largest registry studies, report an incidence of 1.1–11.3% 7 – 10 , single-center studies estimate the occurrence of 0.8–9.7% 1 – 3 , 11 . In lethally injured patients this incidence is reported as high as 46.4% 12 .…”

Section: Introductionmentioning

confidence: 99%

Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

Bicsák

Sarge

Müller

et al. 2021

Sci Rep

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Concomitant maxillofacial and cervical spine injuries occur in 0.8–12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture. A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization. 7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1 and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.

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Section: Introductionmentioning

confidence: 99%

Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

Bicsák

Sarge

Müller

et al. 2021

Sci Rep

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“…The severity of maxillofacial injuries is complicated by the association with other systemic injuries, which can be a serious life-threatening concern ( Abosadegh et al, 2017 ). Concomitant serious injuries have been reviewed in the literature, and the most common injury associated with traumatic facial injury was traumatic brain injury ( Chu et al, 2016 ). Furthermore, patency of airways can be affected by fractures, broken teeth, cervical edema, subconsciousness, and foreign bodies aspiration.…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional study of the prevalence and severity of maxillofacial fractures resulting from motor vehicle accidents in Riyadh, Saudi Arabia

AlHammad

Nusair

Alotaibi

et al. 2020

The Saudi Dental Journal

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Objectives To investigate the prevalence and severity of maxillofacial fractures resulting from motor vehicle accidents (MVAs) at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Materials and methods A cross-sectional study of 325 males (89%) and 47 females (9%) was conducted that retrospectively reviewed records of patients referred to oral and maxillofacial surgery department from emergency department from 1st January 2016 to 31st December 2017 at KAMC, Riyadh. Results A total of 372 subjects were included in the study. MVAs (80%) were the most prevalent cause of trauma. The age range most susceptible to MVAs was between 20 and 24 years old (28%). The most common site of fracture was the midface (64%), specifically orbit (32%). For mandibular fractures, the subcondylar was the most common site of fractures (19%). The most common treatment approach was conservative (65%). In terms of severity, approximately half of patients needed admission to the intensive care unit (ICU) (50%); the mean score on the Glasgow Coma Scale (GCS) was 11.34, but most scores fell in the mild range; and (68%) of subjects presented with other associated systemic injuries, especially orthopedic injuries (36%). Conclusions MVAs were the main cause of trauma and affected mainly young males. The most common site of fracture was midface, specifically orbit. Subcondylar was the most prevalent fracture site for mandibular fractures. The severity of MVAs injuries was significantly higher compared to non-MVAs injuries. We suggest enforcing legislation and regulations on road safety such as the use of compulsory seat belts.

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“…This will allow for identification of fractures with a step-deformity, but prove harder in diagnosing nondisplaced fractures. This is primarily due to a minimum of 0.2 mm displacement required to be detected by U/S (37). If high resolution echography is used however, detection can be improved to as little as 0.1 mm of displacement (41).…”

Section: Ultrasoundmentioning

confidence: 99%

“…Interestingly, where multiple mandibular fractures were sustained, this has demonstrated to be inversely correlated with CSI. This was hypothesised to be due to more energy being dissipated in multiple mandibular fractures therefore leading to less force transmitted to the cervical spine (37). Overall, due to the high incidence of concomitant injuries, commonly a combined CT Brain, Facial Bones & C-Spine should be performed, which will also reduce radiation through avoidance of subjecting the patient to separate scans.…”

mentioning

confidence: 99%

Imaging in traumatic mandibular fractures

Naeem¹,

Gemal²,

Reed³

2017

Quant. Imaging Med. Surg.

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A fracture of the mandible is a common trauma presentation amongst young males and represents one of the most frequently encountered fractured bones within the viscerocranium. Historically, assault was the dominant contributing factor but now due to the increased number of vehicles used per capita, motor vehicle accidents are the primary cause. Mandibular fractures can be classified anatomically, by dentition, by muscle group and by severity. The fracture may also be closed, open, comminuted, displaced or pathological. It is important that the imaging modality used identifies the classification as this will decide definitive treatment. X-ray projections have typically been used to detect a mandibular fracture, but are limited to an anteroposterior (AP), lateral and oblique view in an unstable trauma patient. These views are inadequate to detail the level of fracture displacement and show poor detail of the condylar region. Computer tomography (CT) is the imaging modality of choice when assessing a traumatic mandibular injury and can demonstrate a 100% sensitivity in detecting a fracture. This is through use of a multidetector-row CT, which reduces motion blur and therefore produces accurate coronal and sagittal reconstructions. Furthermore, reconstructive three-dimensional CT images gained from planar views, allows a better understanding of the spatial relationship of the fracture with other anatomical landmarks. This ensures a better appreciation of the severity and classification of a mandibular fracture, which therefore influences operative planning. Ultrasound is another useful modality in detecting a mandibular fracture when the patient is too unstable to be transferred to a CT scanner. The sensitivity however is less in comparison to a CT series of images and provides limited detail on the fracture pattern. Magnetic resonance imaging demonstrates use in assessing soft tissue injury of the temporomandibular joint but this is unlikely to be of priority when initially assessing a trauma patient.

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C-spine injury and mandibular fractures: lifesaver broken in two spots

Cited by 17 publications

References 14 publications

Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

A cross-sectional study of the prevalence and severity of maxillofacial fractures resulting from motor vehicle accidents in Riyadh, Saudi Arabia

Imaging in traumatic mandibular fractures

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