Maxillofacial Fractures in Older Patients

Yamamoto, Kazuhiko; Matsusue, Yumiko; Murakami, Kazuhiro; Horita, Shoichiro; Sugiura, Tetsuro; Kirita, Tadaaki

doi:10.1016/j.joms.2011.02.115

Cited by 57 publications

(93 citation statements)

References 31 publications

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“…In both developed and developing countries, despite seat belt and alcohol legislation, maxillofacial injuries are likely associated with traffic accidents, being the main cause of facial trauma. Other etiological factors often described include physical agressions, falls, interpersonal violence, sports or work-related activities, and animal-related accidents 3,[7][8][9][10][11][12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Factors affecting hospital discharge in maxillofacial trauma patients: a retrospective study

Galvão-Moreira¹,

Cantanhede²,

Neto³

et al. 2017

Braz. J. Oral Sci.

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Aim: To determine factors that may affect the time of discharge from hospital in patients who underwent maxillofacial trauma. Methods: The sample included 115 patients seen at a public hospital in Brazil, to whom surgical maxillofacial treatment was delivered. Data were obtained from patients' medical records and then followed by a statistical analysis using a 5% significance level. Results: The location of fractures and other clinical features such as the presence of edema and ecchymosis were found to be significantly associated with increased time of discharge from hospital (P < 0.05). When data were modeled using a GML approach, male gender was associated with a lower likelihood of prolonged hospital discharge (OR = 0.84; 95% CI: 0.72-0.98; P < 0.05), while the presence of edema was associated with greater time of hospital discharge (OR = 1.30; 95% CI: 1.14-1.49; P < 0.001). No significant association with age, etiology of trauma, and number of fractures was observed (P > 0.05). Conclusion: Female gender was associated with greater time of hospital discharge, and further concerns should be addressed to the management of lesions following maxillofacial trauma surgical interventions.

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Section: Introductionmentioning

confidence: 99%

Factors affecting hospital discharge in maxillofacial trauma patients: a retrospective study

Galvão-Moreira¹,

Cantanhede²,

Neto³

et al. 2017

Braz. J. Oral Sci.

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“…Another issue related to atrophic mandibular fractures is the comorbidities that are often exhibited by aged patients, which can increase the risk of general anesthesia (Yamamoto et al, 2011;Clayman and Rossi, 2012). In addition, the physiologically decreased osteogenesis process, together with local factors relating to atrophic cortical bone and inadequate blood supply, contribute to make this surgery challenging to physicians (Wongchuensoontorn et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

The role of bone marrow aspirate cells in the management of atrophic mandibular fractures by mini-invasive surgical approach: Single-institution experience

Mannelli

Arcuri

Conti

et al. 2017

Journal of Cranio-Maxillofacial Surgery

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Elderly patients management Bone marrow aspirate cells Min-invasive surgical approach a b s t r a c t Purpose: The treatment of fractures involves addressing the biology of fracture repair and the mechanical stability of fracture fixation. Traditionally it has included the addition of bone graft to enhance healing. New advances in the understanding of the cellular and molecular mechanisms of fracture repair have led to the use of growth factors to accelerate bone healing. This study aimed to assess the advantages of autologous stem cell use for atrophic mandibular fracture treatment in comparison to standard technique. Materials and methods: A total of 35 patients (14 male and 21 female) were treated for fractures of atrophic mandibles between January 2011 and December 2014. Surgical technique provided miniinvasive open reduction with or without immediate homologous bone graft, while selected patients received autologous bone marrow aspirate cell grafts in addition to the standard treatment. Demographic data and details of treatment and outcomes were recorded. Results: Patients were categorized according to the use of autologous stem cells, leaving 17 patients treated with standard technique and autologous stem cells (Group A) and 18 treated with standard osteosynthesis only (Group B). Of the 35 patients, 26 had bilateral fractures; most patients had significant medical co-morbidities. Immediate bone graft was used in 37.1% of patients (7 in group A and 6 in group B). Complications occurred in 5 patients (14.3%). Two patients in group B (11.1%) showed non-union of the fracture. One patient in group A (5.8%) and one patient in group B (5.5%) showed wound dehiscence and were treated conservatively; one patient in group B had a local infection (5.5%), one out of 35 (2.8%), that was managed by prolonged antibiotic treatment. Conclusions: Despite the advanced age and medical co-morbidities of the vast majority of patients, miniinvasive open approach with autologous bone graft ensures a fast and excellent recovery. Moreover, the management of atrophic mandibular fractures by bone marrow aspirate cells is a safe and useful procedure which has a lower complication rate when compared to standard technique.

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“…Few studies were published recently investigating the incidence and causes of facial-bone-trauma and prevalence of zygoma-tripod, -quadripod, -arch and orbital floor-fractures in the growing elderly population of 70 years + in various parts of the world [6][7][8][9][10][11] but only isolated studies suggest therapy-guidelines for treatment modalities in this increasing patient-group with mostly general chronic-disease anamnesis [12,13] which should be based on a multidisciplinary…”

Section: Introductionmentioning

confidence: 99%

“…1 -2,7 mm) and no fracture-stages/fracture-crepitations/maxillary mobility palpable in clinical investigation (Figure 2) b) Fractures with dislocations above critical-size-defects (2,7mm [17]) and/or fracture-stages/fracture-crepitations/maxillary mobility palpable in clinical investigation ( Figure 3) According to the category of the fracture-classification, patients were sorted into two therapy-groups from the CMF-surgeons point of view, basically with a less invasive approach than proposed in the literature [18,19]. Basically a more conservative surgical treatment approach was followed [8,9] in favour of only closed transcutaneous fracture reduction [20] and only optional open reduction, osteosynthesis and orbital-floor-reconstruction.…”

mentioning

confidence: 99%

Treatment-assessment of Zygoma-tripod, -quadripod, -arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (1995-2015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatm

Troedhan¹

2015

Int J Oral Craniofac Sci

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The ever growing population of elderly patients aged 70 years and onwards are prone to facial injuries caused by a general degrading medical and mental state. Main cause for zygoma-tripod, -quadripod, -arch and orbital floor fractures are falls, followed by traffic accidents and only to a small extent violence. Surgical reduction for these types of fractures is recommended but not correlated to the general medical and mental state of this patient-group. Aim of the study was to compare the outcomes of surgical treatment versus non-surgical observation.Between 1995 and 2014 a total of 1318 patients -hospitalized for isolated zygoma-and correlated fractures -were initially screened for cause of accident, pain, hyp/anaesthesia of the corresponding infraorbital nerve, mandible mobility, facial emphysema/haematoma and diplopia and then distributed into three different groups: no functional and/or cosmetic surgery indication (X), surgery indication but denied by internist and/or anaesthesist due to high general medical risks (Y) and surgery indication and released for surgery by internist/anaesthesist (Z). Follow up for each group was performed on day 5, 7 and 1 month after date of injury.Pain assessment revealed a significant higher pain-load for group Z on the 5 th and 7 th day after injury. Mandible mobility, facial emphysema/haematoma and diplopia improved significantly better in group X and Y on day 5, 7 and after 1 month compared to group Z. Hyp/anaesthesia of the corresponding infraorbital nerve improved generally but not significant between all three groups.The results of this study suggest that indication for closed or even more for open-reduction surgery of isolated midface-bone fractures should be applied very restrictive and only in accordance with specialists for internal medicine and anaesthesiology for elderly patients and non-surgical observation might lead to better results both for life-quality and remaining life-time from the patients point of view. Few studies were published recently investigating the incidence and causes of facial-bone-trauma and prevalence of zygoma-tripod, -quadripod, -arch and orbital floor-fractures in the growing elderly population of 70 years + in various parts of the world [6][7][8][9][10][11] but only isolated studies suggest therapy-guidelines for treatment modalities in this increasing patient-group with mostly general chronic-disease anamnesis [12,13] which should be based on a multidisciplinary

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Maxillofacial Fractures in Older Patients

Cited by 57 publications

References 31 publications

Factors affecting hospital discharge in maxillofacial trauma patients: a retrospective study

Factors affecting hospital discharge in maxillofacial trauma patients: a retrospective study

The role of bone marrow aspirate cells in the management of atrophic mandibular fractures by mini-invasive surgical approach: Single-institution experience

Treatment-assessment of Zygoma-tripod, -quadripod, -arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (1995-2015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatm

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