Mandibular fractures in British military personnel secondary to blast trauma sustained in Iraq and Afghanistan

Breeze, John; Gibbons, Ann; Hunt, Nicholas; Monaghan, A.; Gibb, Iain; Hepper, A.; Midwinter, Mark J.

doi:10.1016/j.bjoms.2010.10.006

Cited by 30 publications

(25 citation statements)

References 14 publications

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“…[1516171819] Our finding, is however, not in concordance with most studies from Nigeria, western Europe, and Japan that showed much narrower gender ratio. [567891011122021] Fasola et al ., and Tanaka et al ., found a 3:1 male-to-female ratio. [721] There had been several postulations in the literature regarding the high male bias.…”

Section: Discussionmentioning

confidence: 99%

“…[910] However, recent report on the war in Afghanistan by Breeze and associates have identified increasing facial fractures among British troops despite to protective armor worn and advances in on-field resuscitation and critical care that have increased survival in the battle field. [11] Falls are common in the very young and elderly. [12] Pattern of facial fracture is predicated on etiology, population density, socioeconomic, cultural, race, and time.…”

Section: Introductionmentioning

confidence: 99%

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Facial fracture management in Northwest Nigeria

Taiwo

Soyele

Godwin

et al. 2013

J Surg Tech Case Report

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Background:Facial fracture is gradually become a public health problem in our community due to the attendant morbidity and mortality. Hence, the aim of this study was to determine the pattern of facial fracture in Dental and Maxillofacial Surgery Department of Usmanu Danfodiyo University Teaching Hospital. This cross-sectional study was undertaken to provide information regarding gender, age, etiology, and diagnosis of patients with maxillofacial fractures.Materials and Methods:A 1-year review of patients diagnosed and treated for facial fractures in Usmanu Danfodiyo University Teaching Hospital between January 2011 and December 2011. The diagnosis was based on radiographic data and clinical examination. The main analysis outcome measures were etiology, age, gender, site, and treatment. Data were organized and presented by means of descriptive statistics and Pearson's Chi-square test. The level of significance adopted was 5%.Results:A total of 40 patients were treated in this period. Over 95% were male, 81% were caused by road traffic crash (RTC) and 86.4% were in the 21-30 years group. Most patients (52%) had mandibular fractures, and the most common site was the body. Most patients with midfacial fractures had fractures of the zygomaticomaxillary region (36%), while fractures of the parasymphyseal region were more common in the mandible 156 (31%). The most common treatment for jaw fractures was mandibulomaxillary fixation (MMF). Stable zygomatic complex fractures were reduced (elevated) intraorally, and unstable ones were supported by antral packs.Conclusions:This study highlights facial fractures secondary to RTC as a serious public health problem in our environment. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of RTC. It also bring to the fore the necessity to shift to open reduction and internal fixation (ORIF) of fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Facial fracture management in Northwest Nigeria

Taiwo

Soyele

Godwin

et al. 2013

J Surg Tech Case Report

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“…119 Military operations include many potential sources of blunt impact during an IED attach including direct contact with unpadded vehicle interiors. 15 Thermal Exposure…”

Section: Blunt Impactmentioning

confidence: 99%

Brain Injuries from Blast

et al. 2011

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Traumatic brain injury (TBI) from blast produces a number of conundrums. This review focuses on five fundamental questions including: (1) What are the physical correlates for blast TBI in humans? (2) Why is there limited evidence of traditional pulmonary injury from blast in current military field epidemiology? (3) What are the primary blast brain injury mechanisms in humans? (4) If TBI can present with clinical symptoms similar to those of Post-Traumatic Stress Disorder (PTSD), how do we clinically differentiate blast TBI from PTSD and other psychiatric conditions? (5) How do we scale experimental animal models to human response? The preponderance of the evidence from a combination of clinical practice and experimental models suggests that blast TBI from direct blast exposure occurs on the modern battlefield. Progress has been made in establishing injury risk functions in terms of blast overpressure time histories, and there is strong experimental evidence in animal models that mild brain injuries occur at blast intensities that are similar to the pulmonary injury threshold. Enhanced thoracic protection from ballistic protective body armor likely plays a role in the occurrence of blast TBI by preventing lung injuries at blast intensities that could cause TBI. Principal areas of uncertainty include the need for a more comprehensive injury assessment for mild blast injuries in humans, an improved understanding of blast TBI pathophysiology of blast TBI in animal models and humans, the relationship between clinical manifestations of PTSD and mild TBI from blunt or blast trauma including possible synergistic effects, and scaling between animals models and human exposure to blasts in wartime and terrorist attacks. Experimental methodologies, including location of the animal model relative to the shock or blast source, should be carefully designed to provide a realistic blast experiment with conditions comparable to blasts on humans. If traditional blast scaling is appropriate between species, many reported rodent blast TBI experiments using air shock tubes have blast overpressure conditions that are similar to human long-duration nuclear blasts, not high explosive blasts.

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“…14 Bullets and fragments of mortar shells were the most common causes of maxillofacial injuries in the Iraq-Iran conflict according to Akhlaghi and AframianFarnad, 15 and Will et al reported that half the maxillofacial injuries in Iraq were caused by fragmentation after detonation of improvised explosive devices, 16 which is in agreement with the study by Breeze et al about the Iraq and Afghanistan conflicts. 17 Explosive injuries were also responsible for many craniomaxillofacial injuries. 18 We found that the mandible was the most injured part of the facial skeleton in Iranian veterans.…”

Section: Discussionmentioning

confidence: 99%

“…15 It has been mentioned that personal protective equipment could protect infantry soldiers against fragmentation injurieswhich were the major cause of facial injuries in our study -and that current items of protective clothing protect the eyes but not the remaining face. 17 It should be mentioned that a simple helmet was the only protection that most of the Iranian veterans had during the Iraq-Iran conflict, which reflects the large number of facial (and particular mandibular) injuries. The newest British military prototypes are of a mandibular protector and protective glasses.…”

Section: Discussionmentioning

confidence: 99%