The Le Fort system revisited: Trauma velocity predicts the path of Le Fort I fractures through the lateral buttress

Roumeliotis, Grayson; Ahluwalia, Romy; Jenkyn, Thomas R.; Yazdani, Arjang

doi:10.1177/229255031502300111

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…Further, those presenting with these severe fractures were more likely to receive higher levels of neurosurgical intervention involving craniotomies, craniectomy, and burr holes compared with only EVDs or ICP monitors. This is consistent with the initial hypothesis that the high-velocity impacts required to produce the more severe type 2 and 3 Le Fort type fractures 22 26 are also more likely to lead to more severe neurologic injury. These results also support previous investigations that showed associations between midface fractures and more severe TBI.…”

Section: Discussionsupporting

confidence: 89%

“…4 21 This is likely due to diffuse axonal injury, epidural, and subdural hematomas secondary to the high-velocity facial trauma required to produce these fractures. 4 22 Despite these findings, little is known about how fracture types predict TBI severity and which patients eventually require neurosurgical intervention. Thus, the present study is designed to develop an improved algorithm for the management of TBI in the context of known facial fractures with a hypothesis that patients with midface fractures are at increased risk for severe TBI warranting more aggressive neurosurgical intervention.…”

Section: Introductionmentioning

confidence: 99%

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Facial Fractures: Independent Prediction of Neurosurgical Intervention

et al. 2022

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Context Over half of patients with facial fractures have associated traumatic brain injury (TBI). Based on force dynamic cadaveric studies, Le Fort type 2 and 3 fractures are associated with severe injury. Correlation to neurosurgical intervention is not well characterized. Aims This study characterizes fracture pattern types in patients requiring neurosurgical intervention and assesses whether this is different from those not requiring intervention. Settings and Design Retrospective data was collected from the trauma registry from 2010 to 2019. Methods and Materials Patients over 18 years, with confirmed facial fracture, reported TBI, available neuroimaging, and hospital admission were included. Statistical Analysis Retrospective contingency analysis with fraction of total comparison was used with chi-square analysis for demographic and injury characteristic data. Results Note that 1,001 patients required no neurosurgical intervention and 171 required intervention. The intervention group had a significantly greater number of patients with Glasgow Coma Scale (GCS) < 8 compared with the nonintervention group. Subset analysis revealed a twofold increase in Le Fort type 2 fractures and notable increase in Le Fort type 3 and panfacial fractures in the intervention group. Patients requiring craniectomy, craniotomy, or burr holes were much more likely to have Le Fort type 2 or 3 fractures compared with those only requiring external ventricular drains or intracranial pressure monitoring. Subset analysis accounting for GCS supported these results. Conclusion Le Fort type 2 and type 3 fractures are significantly associated with requiring neurosurgical intervention. An improved algorithm for managing these patients has been proposed in the discussion. Ongoing work will focus on validating and refining the algorithm to improve patient care.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Facial Fractures: Independent Prediction of Neurosurgical Intervention

et al. 2022

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“…In particular, the leading cause of trauma in our series was represented by motorcycle accidents. Therefore, the reduction of such traumatic events can be obtained only by an insistent traffic education program and the routine use of craniofacial protection 31, 32. Moreover, in our opinion, the highest frequency of facial fractures in the 3rd–4th decades of life is related to the most intense phase of life.…”

Section: Discussionmentioning

confidence: 89%

Maxillofacial and concomitant serious injuries: An eight-year single center experience

Famà

Cicciù

Sindoni

et al. 2017

Chinese Journal of Traumatology

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PurposeMaxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas.MethodsWe retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different institutions, pediatric trauma patients and adult patients who were transferred in accordance with pre-existing agreements in case of paucity of beds were excluded. Finally we included 447 (0.2%) patients over the 8 years. Data were evaluated with emphasis on epidemiology (age, gender, mechanism of trauma), primary survey and abnormalities and pattern of trauma.ResultsThe most frequent cause of maxillofacial trauma was road accidents (319 patients, 71.4%), among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients; 443 (99.1%) patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries (χ2 = 557.2, p < 0.0001). Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas (χ2 = 17.13, p < 0.0001 vs minor lesions). All of the neglected lesions occurred in paucisymptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hematoma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms.ConclusionAmong the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit, diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial major lesions.

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“…AMAs occur with high speed and energy, and such high velocity trauma generates more extensive fractures at different heights in the complex facial skeleton. [25][26] In our study, ocular region injuries were more likely to occur in the EBA and AR groups, which may account for a correlation between ocular region injuries and zygomatic complex fractures, given that the orbital wall bone is very thin and easy to fracture. 26 Cerebral injuries were more likely to occur in the AMA and MCA groups, which is consistent with the results of other studies.…”

Section: Discussionmentioning

confidence: 56%

“…Some studies also reported that mandibular fractures were probably most common because of the mandible's mobility, projection, and anatomy. 18,[23][24][25] In the EBA group, zygomatic complex fracture was the most common type (66.56%, n ¼ 215 of 323 cases), because the structural design of electric bicycles is different from that of bicycles and motorcycles, which require that the riders' legs are placed in front of the body. In the AMA group, panfacial fracture was the most common type.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Maxillofacial Fractures Based on the Etiology in Southeast China

Huang

Jiang

Lin

et al. 2020

Journal of Craniofacial Surgery

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Background: The aim of this study was to explore the characteristics and correlation of maxillofacial fractures and concurrent injuries with different injury causes. Methods: In this retrospective study, data were collected from patients treated for maxillofacial fractures in 3 oral and maxillofacial surgery departments in Southeast China, from January 2010 to December 2019. The information was obtained from clinical notes and surgical records using a standardized data collection form, and some causes of injuries were confirmed by telephone follow-ups and police records. These patients were divided into 7 groups according to the etiology: bicycle accident, electric bicycle accident, motorcycle accident, automobile accident, fall at ground level, fall from a height, and assaultrelated accident. Statistical tests were performed using R software (version 3.1.1), and all P-values were computed based on Chi-square tests and set at 0.05. Results: During this 10-year retrospective study, a total of 1772 patients with definite causes were analyzed. The average age was approximately 35.04 years (9 months-94 years). All patients were treated with open reduction and rigidly internal fixation, and the average duration was approximately 6.51 days (range 0 day-50 days), that from the time of the injury to the time of treatment. Traffic accidents were identified as the main cause of maxillofacial fracture (57.62%; n ¼ 1021 of 1772 cases). In different etiology groups, there were statistically significant differences in the distribution of age, sex, maxillofacial fracture type, and concurrent injuries (all P < 0.001). However, the main cause of maxillofacial injuries was falls (fall at ground level and fall from a height) in children, and the highest incidence of the cause of maxillofacial injuries was bicycle accident in adolescents. Compared with the other groups, zygomatic complex fracture was more common in the electric bicycle accident group, panfacial fracture was more common in the automobile accident group, and mandible fracture was more common in the other groups. Conclusion:The results of this study suggest that patients with maxillofacial fractures caused by different injuries had their own unique characteristics. These findings may assist us in avoiding misdiagnosis and treatment delays, and may make treatment plans faster.

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The Le Fort system revisited: Trauma velocity predicts the path of Le Fort I fractures through the lateral buttress

Cited by 8 publications

References 18 publications

Facial Fractures: Independent Prediction of Neurosurgical Intervention

Facial Fractures: Independent Prediction of Neurosurgical Intervention

Maxillofacial and concomitant serious injuries: An eight-year single center experience

Analysis of Maxillofacial Fractures Based on the Etiology in Southeast China

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