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[Prejudice related to facial injuries].

These related prejudices primarily include cosmetic handicap and pain, and represent a non-negligible part of the compensations paid to patients suffering facial injury. For the specialists, cosmetic prejudice raises problems of indications for surgical repair, and more particularly for assessment of the damage sustained. Attempts have been made to evaluate the suffering endured, but the scales that have been worked out are probably not perfectly adapted to this type of lesions. Despite the subjective character of such prejudices, the epidemiological studies that were carried out permit to conclude to a certain uniformity of the evaluations.

Adult↗

Helmet-mounted displays and facial injury in US Army AH-64A Apache accidents.

There is concern that the helmet display unit (HDU) used by AH-64 Apache helicopter pilots might contribute to facial injury in a crash. The US Army accident database was searched for HDU-related injuries in survivable Apache accidents 1985-1995. Four aviators in three crashes sustained HDU-related injury. These involved three periorbital contusions and two minor eye injuries. There were no sequelae. This equates to an incidence of 0.57 injured individuals per 100,000 flying hours or 8.0 injured aviators per 100 survivable Class A-C accidents in which the HDU was worn. Applying these data to the projected UK Army Apache flying hour programme suggests that one HDU-related injury might be encountered approximately every 10.1 years. This estimate should be interpreted with caution. Serious injury remains a possibility due to the proximity of the HDU to the eye and face.

Accidents, Aviation↗

Traffic accidents, facial injuries, and psychiatry.

The extent to which emotional factors play a direct or indirect role in the causation of traffic accidents has been presented along with the early and late emotional response of individuals to facial injuries as a result of traffic accidents. Illustrated case histories are presented.

Accidents, Traffic↗

Then and now--severe facial injuries: emergency care.

Looking back through old copies of 'NATNews' of twenty years ago we found an article by W. D. Mackennan, then Consultant Dental Surgeon at the Royal Infirmary, Edinburgh. Its title was 'Severe Facial Injuries--Emergency Hospital Care'--NATNews Summer 1970. Principles of care were based on the four Cs: Control of the airway. Control of the haemorrhage. Control of the shock. Control of the fractured fragments. Emergency care included clearing the airway, responses to air or blood in the chest, oedema of the neck and so on. Positioning was regarded as vital and use of trachaeostomy was discussed--'elective trachaeostomy is always preferable to that carried out in an emergency'. The discussion of haemorrhage control ranged over pressure bandaging, digital pressure and use of the recently introduced product, Surgicel.

Emergency Medical Services↗

[Facial injuries caused by dog bite].

Dog bite injuries occur statistically in urban areas every three days. Thirty such injuries to the face were treated at the Ear-Nose-Throat University Hospital, Erlangen-Nuremberg, between 1973 and 1990. The average age of the patients was 15 years. The dogs most frequently involved were the Alsatian wolfhound (43%) and the badger dog (21%). The majority of the victims were family members (59%) or at least known to the owner of the dog (28%). Only in 14% of the cases was no correlation found. Dog bite injuries most frequently happened during playing with the dog (53%) or when the victim bowed to the dog (33%). Dog bites without cause were uncommonly found (7%). Of all facial injuries the nose was most frequently involved (50%) and severely afflicted. In our experience, replantation of the avulsed part always resulted in necrosis. In contrast, the most favorable results were achieved when defects were reconstructed immediately.

Adolescent↗

Falls in elderly people that result in facial injuries.

Falls in elderly people are increasing. Injuries of the upper limb that result from a fall usually suggest that an outstretched hand was used to curb the fall. Conversely, maxillofacial injuries in elderly people may result from alterations in consciousness as a result of a pre-existing medical condition. We investigated the nature of falls in an elderly population and compared two cohorts of patients-those presenting with maxillofacial injuries, and those with isolated upper limb injuries, and there were 25 patients in each cohort. Comprehensive personal data and medical history were recorded together with details of the fall. We found a significant correlation between the nature of the injury and recollection of the event (P <0.01). Patients who sustain facial injuries are less likely to recall the event. This may be the result of the injury itself, but an underlying medical condition may have been responsible for the fall and should be excluded.

Accidental Falls↗

Emergency care of severe facial injuries.

In the absence of other life-threatening problems and with the airway adequate and bleeding contained, the emergency phase is now under control. At this point, priorities can be assigned for additional diagnostic procedures and definitive care. Further, as indicated above, one should be able to list precautions necessary in obtaining x-rays, in transporting the patient, or in other necessary manipulations. And finally, before progressing any further in diagnosis and treatment, record the data base of acute care and examination. This document anticipates problems and is essential if the patient's status later changes. Further, since most serious injuries involve liability considerations, the creation of an accurate initial record is totally dependent upon the attending physician. In summary, during the acute or emergency phase of care, the only considerations related to facial injury are airway maintenance, bleeding control, and determining whether more serious problems are present. Then and only then does the face itself merit attention.

Airway Obstruction↗

Motor cycle helmets and facial injuries.

The design of motor cycle helmets has been changing over the years and at the present time there are two basic types in popular use: "full-face" and "jet" helmets. Both helmet types give good protection to the brain, but, one would think, different degrees of facial protection. A special study of traffic crashes has indicated that full-face helmets provide significantly greater protection against facial injury than do jet helmets. The study also indicated that the wearers of full-face helmets have no greater risk of involvement in road traffic crashes than do the wearers of jet helemts. It is suggested that the use of full-face helmets should be encouraged and consideration given to the revision of helmet standards to require the provision of facial protection.

Accidents, Traffic↗

Bite marks, oral and facial injuries--harbingers of severe child abuse?

Bite mark evidence has been admitted in a vast number of cases in courts throughout the United States, as well as other countries. Because there is variation in the dentition of humans, if bite marks are noted in a victim, it is possible in many cases to determine the identity of the perpetrator depending on the quality of the bite mark, its age, lack of distortion and documentation. In other cases, facial injuries, including damage to the frenum and teeth in addition to the face, may point to nonaccidental injury if the history corroborates this condition.

Bites and Stings↗

Progressive dyspnoea following facial injury.

Synchronous laryngeal injury should be considered and diagnosed in patients presenting with maxillo-facial injuries who develop progressive dyspnoea. Surgical emphysema, a cardinal sign, may develop later. Clinical awareness of the problem and prompt referral, will lead to confirmation of the diagnosis. Early management may minimise long term morbidity.

Adult↗