Orbital fractures in the emergency department: a review of early assessment and management

Delpachitra, Seth; Rahmel, B.

doi:10.1136/emermed-2015-205005

Cited by 11 publications

(4 citation statements)

References 47 publications

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“…Maxillofacial fractures are of special medico-legal implications as they are considered medico-legal cases and a part of poly-trauma conditions. Maxillofacial injuries are commonly encountered in the emergency medicine; most patients with these injuries have multisystem trauma that requires coordinated management between emergency physicians and surgical specialists in maxillofacial surgery, otolaryngology, plastic surgery, and general surgery (Delpachitra and Rahmel 2016). Maxillofacial fractures include fractures extending from the frontal bone down to the base of the skull and include fracture of the frontal bone, zygoma, maxilla, nasal bone, ethmoid, and mandible (Fama et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Medico-legal evaluation and trend of the different patterns of maxillofacial fractures concomitant with closed head injury in Upper Egypt: retrospective study

Shehaby

Farahat

Shahine

et al. 2020

Egypt J Forensic Sci

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Background: Maxillofacial fractures are of great medico-legal implications because they are of common occurrence with other injuries, predominantly head injuries that might involve serious esthetic and functional problems, and so clinically described as consequential injuries. The aims were to assess the medico-legal aspects of maxillofacial fractured cases concomitant with closed head injury over a 6-year period (2011-2016) in the Trauma Unit of Assiut University Hospitals, Egypt, and to evaluate the demographic feature and the trend of different patterns of such fractures. Patient and methods: A descriptive hospital-based study included all cases of maxillofacial fractures combined with closed head injury attending the Trauma Unit of Assiut University Hospitals in the period of January 2011 to December 2016. Results: The study included 1221 cases, the percent of maxillofacial fractures with a closed head injury was 4%, the age group 18-40 years was having the highest incidence, and mean age was 25.9 ± 15.3 years with male to female ratio of 7:1. Road traffic accidents were the main etiology of injury (69.7%), followed by falls (15.1%) and violent assaults (10.2%) while firearm injuries were the last (5%). Unintentional injuries were the commonest in 83.1% followed by homicidal (16.3%); only 7 cases were due to suicidal attacks. The mandibular fracture was the commonest (49.7%) followed by fracture maxilla (19.2%), fracture zygoma (16.8%), and lastly frontal bone and nasal fracture. The trend of maxillofacial fractures over the 6-year period tended to be increased with the highest number in 2011 (21.5%) and the lowest in 2014 (13.3%). Conclusion: Maxillofacial fracture with a closed head injury in Upper Egypt is common in the middle age with male predominance. Road traffic accident is the main etiologic factor, and accidental trauma is the commonest manner. Mandibular fractures are the commonest pattern followed by fracture maxilla. Traumatic head injuries in cases of maxillofacial fractures were mild in about half of the cases. The trend of maxillofacial fractures over the 6year period of the study (2011-2016) tended to be increased with the highest number in 2011 and the lowest in 2014.

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Section: Introductionmentioning

confidence: 99%

Medico-legal evaluation and trend of the different patterns of maxillofacial fractures concomitant with closed head injury in Upper Egypt: retrospective study

Shehaby

Farahat

Shahine

et al. 2020

Egypt J Forensic Sci

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“…CBCT scanners are dedicated to the oral and maxillofacial region and datasets are acquired while the system rotates around the patient [22,33,70]. A probable explanation is that the system can only be used on patients with isolated midfacial trauma, or patients for whom the initial management did not provide evidence of additional injuries [71]. For that reason, the availability of CBCT scanners in the emergency department is usually limited, and the systems are mostly used in outpatient clinics.…”

Section: Radiological Imagingmentioning

confidence: 99%

Diagnostic accuracy of physical examination findings for midfacial fractures: a systematic review and meta-analysis

et al. 2022

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Objectives To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of physical examination findings and related clinical decision aids for midfacial fractures in comparison to computed tomography and cone beam computed tomography. Material and methods A systematic review was performed by searching the MEDLINE, Cochrane, EMBASE, and CINAHL databases. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity, and diagnostic odds ratios with the corresponding 95% confidence intervals were calculated for each physical examination finding and reported clinical decision aids. Results After screening 2367 records, 12 studies were included. High risk of patient selection bias was detected in three studies (25%). Additionally, high concerns regarding applicability were found for the patient selection in five studies (41.7%), and for the reference standard in eleven studies (91.7%). Of the total 42 individual physical examination findings, only 31 were suitable for a meta-analysis. High specificity and low sensitivity were found for most findings. The pooled diagnostic odds ratio ranged from 1.07 to 11.38. Clinical decision aids were reported by 8 studies, but none were constructed specifically for midfacial fractures. Conclusion Based on the current available evidence, the absence of physical examination findings can successfully identify patients who do not have a midfacial fracture, but the presence of individual findings does not necessarily mean that the patient has a midfacial fracture. Although various clinical decision aids were presented, none focused on exclusively midfacial fractures. Clinical relevance The diagnostic accuracy of physical examination findings can be used to diagnose a midfacial fracture so as to reduce unnecessary imaging, health care costs, and exposure to ionizing radiation.

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“…Oral and maxillofacial trauma is a common presentation at outpatient and emergency care centers. More than 50% of patients with maxillofacial injuries have multiple injuries and they require coordinated examinations by multidisciplinary teams that include specialists in maxillofacial surgery, general surgery, otorhinolaryngology, plastic surgery, ophthalmology, and neurosurgery 1 . In addition, patient safety is associated with a necessary sequence of steps for a multidisciplinary care.…”

Section: Introductionmentioning

confidence: 99%

Checklist for the initial evaluation of oral and maxillofacial trauma

Souza

Fernandes

Galvão

et al. 2020

Dental Traumatology

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Background/Aim The standardization of the maxillofacial examination using a validated checklist is highly important. A checklist can also be a valuable tool for epidemiological studies, as it provides all clinical information related to maxillofacial trauma. The aim of this study was to propose a new checklist for the initial evaluation of maxillofacial trauma. Material and Methods The development and validation of the new checklist were performed in four consecutive phases: (a) determination of items and development of the checklist; (b) analysis by experts; (c) pre‐test; and (d) pilot study. The checklist was designed as follows: (a) Specific signs and symptoms (Part 1); (b) Specific signs and symptoms (Part 2); (c) Intraoral signs and symptoms; and (d) Imaging examination. Results A good level of agreement was found among the experts and no items were excluded during the validation step. The administration of the instrument to the target population revealed the lack of some important aspects of the clinical evaluation, such as halitosis, otorrhea, petechiae, eyelid ptosis, hypo/hyperacusis, and temporomandibular join sounds. These missing signs were included in the final version. Conclusions This checklist is a practical guide that can be used by specialists or students in oral and maxillofacial surgery and it can contribute to the quality of health care at outpatient and oral‐maxillofacial surgery services for patients with maxillofacial trauma.

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Orbital fractures in the emergency department: a review of early assessment and management

Cited by 11 publications

References 47 publications

Medico-legal evaluation and trend of the different patterns of maxillofacial fractures concomitant with closed head injury in Upper Egypt: retrospective study

Medico-legal evaluation and trend of the different patterns of maxillofacial fractures concomitant with closed head injury in Upper Egypt: retrospective study

Diagnostic accuracy of physical examination findings for midfacial fractures: a systematic review and meta-analysis

Checklist for the initial evaluation of oral and maxillofacial trauma

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