[Main theme: multiple trauma--III. Interdisciplinary treatment of facial injuries. Facial injuries in multiple injured patients. Otorhinolaryngological aspects].
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Ear↗
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Results for “FACIAL INJURIES”
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Sports-related facial injuries.
Facial injuries suffered by the athlete will range from very minor to extremely complex. Regardless, all injuries can be accurately diagnosed if one is familiar with normal anatomy and conducts a thorough physical examination. Radiographs are then obtained as directed by the physical examination. Specific and timely treatment directed at correcting functional and cosmetic deformities will help to avoid lifelong disability and deformity. With adherence to these guidelines, many of the injuries suffered by athletes can be safely treated by a variety of physicians. More complex soft-tissue and bone injuries should be referred to a surgeon familiar and comfortable with facial plastic and reconstructive surgery.
Athletic Injuries↗
Head injury and facial injury: is there an increased risk of cervical spine injury?
A series of 8285 blunt trauma victims from one hospital were analyzed to establish the possible association of cervical spine injuries with craniocerebral and facial injuries. Patients with clinically significant head injuries were at greater risk of cervical spine injuries than those without head trauma (4.5% vs. 1.1%, significant by Chi-squared analysis). Patients with Glasgow Coma Scale scores of 8 or less were at even greater risk of cervical spine injuries (7.8%). Facial injuries were not associated with cervical spine injuries. Procedures to achieve airway control in patients with serious head injuries must reflect these findings so that protection is afforded to the cervical spine during trauma resuscitation.
Abbreviated Injury Scale↗
Traumatic injuries: imaging of facial injuries.
Facial injuries are common and require radiologic evaluation to plan treatment. The role of imaging is to detect fractures, describe their morphology and topography, and evaluate adjacent soft tissue damage. Computed tomography is the imaging method of choice for an accurate diagnosis and for depicting the complex anatomic structures of the maxillo-facial region. Magnetic resonance imaging plays a limited role, mainly in the assessment of lesions of orbital soft tissues. This paper reviews the most common traumatic injuries of facial bones, paranasal sinuses, orbits and mandible.
Facial Bones↗
Athletic facial injuries.
Most facial injuries that occur during athletic activities are of a minor nature, consisting of lacerations, contusions, and abrasions. These are usually treated by a team physician or an emergency department physician. However, minor injuries must be differentiated from the more significant injuries, especially those involving facial bone fractures. Significant facial trauma must be diagnosed accurately and treated with precision to avoid permanent facial deformity. Soft-tissue trauma as well as fractures are included in this review, and evaluation of the injured athlete is emphasized. A systematic approach is developed for diagnosing and treating common facial injuries in athletes.
Athletic Injuries↗
Walk-through injuries: glass door facial injuries.
During 1998, 13 patients were treated in the Tel-Aviv Sourasky Medical Center for complex facial soft-tissue injuries caused by passing through large, clear glass doors. All epidemiological details were gathered and analyzed. Of 1,100 soft-tissue facial injury admissions in 1 year, 13 patients had a substantial soft-tissue facial injury after passing through a glass barrier. Nine were injured during leisure time activity, five in a shopping mall, and four in their residence. Interestingly, the authors found a common pattern of facial injuries in all patients. It consisted of large, irregular, composite skin and soft-tissue flaps as well as large, tom, irregular skin lacerations. The nose was injured predominantly, and the injury was particularly complex. Their recommended management of these injuries is a thorough and careful evaluation of flap viability. Surgical management of avulsed, viable flaps includes margin debridement and repositioning. If the flap is narrow enough, it can be debrided and the margins adapted primarily. If viability of part of the flap is in doubt, that part should be debrided and used as a composite graft. When this graft dies, a full-thickness graft is taken from another facial site. The cosmesis of such a graft is better than using the debrided, thin segment as a skin graft that is too thin. The authors emphasize that there is a need to encourage authorities to reinforce regulations relating to injury prevention from architectural glass. The first is to use special glazing, either tempered glass, laminated glass, or both. The other method of improving safety is by indicating glass using decorations or warning stickers, or by making it partly translucent. Unless these regulations are obeyed, fatal or complex trauma may occur.
Adult↗
[Initial management of severe facial injuries].
Severe facial injuries may be treated within the first 12-h-period or delayed for several days while the patient is transferred to an appropriate hospital. The goal of treatment should be optimal primary reconstruction of all the damaged structures. Specialized experience, instruments and a well-equipped operative theatre are necessary. Adequate primary treatment may so prevent functional losses or deficits and mutilations and reduce secondary plastic surgical interventions to a minimum. Typical case examples are demonstrated.
Facial Bones↗
Hampson, D: facial injury: a review of biomechanical studies and test procedures for facial injury assessment.
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Accidents, Traffic↗
Facial injury: a review of biomechanical studies and test procedures for facial injury assessment.
A review of biomechanical studies that have attempted to measure fracture tolerances of facial bones has been carried out. The particular bones of interest were the mandible, the zygoma, the maxilla and the nasal bones. Numerical values have been given for the peak force and pressure fracture tolerances for these bones. A study of these values illustrates just how variable the bone strength of various individuals is. A review of various methods that have attempted to measure and quantify the physical effects of a blow to the face has also been carried out. Three major types of test procedure exist, namely frangible elements, peak force and pressure sensing elements and deformable elements. Frangible and deformable elements generally replace the face of a standard test dummy, fracturing and deforming at appropriate impact force levels, respectively. These surrogate face forms are used for two different reasons; either they are used to measure the damage to the human face for some impact scenario or they are simply used to better simulate the response of the whole head to impact by simulating the compliance of the face. Peak force and pressure sensing elements take the form of piezoelectric sensors and pressure-sensitive, colour 'Fuji film'. Both these methods are complicated and really only suitable for research purposes only. Finally, it is recommended that a mathematical model approach be used to establish the principal injury mechanism and support further development of an acceptable face form test.
Biomechanical Phenomena↗
Management of severe maxillo-facial injuries.
Maxillo-facial injuries have increased in incidence in Singapore due mainly to road traffic accidents. Approximately 450 cases are seen annually in the Singapore General Hospital. A review of 50 consecutive cases of severe maxillo-facial injuries seen in the Department of Plastic Surgery showed that the majority were Lefort II type fractures (64%) followed by Lefort I fractures (14%) and Lefort III fractures (8%). There were seven cases which had a combination of multiple facial fractures. The significant associated injuries occurred in the limbs (32%), the head (30%) and in the chest (8%). The emergency management of maxillo-facial trauma is discussed in some detail and some of the problems in the treatment of severe or multiple facial fractures are also highlighted in this paper.
Adult↗
[Management of concomitant fractures in facial injuries].
Today facial fractures should be treated by open reduction. Extensive exposure of the affected areas, anatomical reduction and rigid fixation of skeletal segments are critical for the restoration of function and aesthetics. Specially designed implants according to the different anatomical areas and selftapping screws make internal plate fixation a fast and safe procedure.
Bone Plates↗
Facial injuries in basketball players.
As the popularity of basketball increases and the style of the game becomes more physical, there is an increasing number of basketball-related injuries. Although most facial injuries sustained while playing basketball are relatively minor, severe and permanent injuries do occur. This article reviews the most common facial injuries incurred by basketball players with emphasis on diagnosis, early treatment, and prevention.
Basketball↗
Epidemiologic features of facial injuries among motorcyclists.
STUDY OBJECTIVE: To describe the extent, nature, and severity of facial injuries among motorcyclists injured in a crash requiring hospital treatment. METHODS: The study population consisted of 5,790 motorcycle riders who sustained a nonfatal crash injury during 1991, 1992, or 1993 in 10 California counties. The injured riders were identified in 28 hospitals during 1991 and 1992 and in 18 of these 28 hospitals in 1993. Information was collected from crash reports and hospital records. All injuries were coded according to the 1990 Abbreviated Injury Scale. RESULTS: Facial injury was present in 24.3% of injured riders, a high proportion of them young men. Among riders wearing helmets, 36.8% had facial injuries, compared with 53.8% of those not wearing helmets. Soft tissue injuries and facial fractures were present in 72% and 22% of the injured, respectively. The maxilla (22%), orbit (16%), and nasal (16%) bones were the most frequently fractured facial bones. The frequency of multiple facial injuries, severity of facial injuries, and incidence of high-severity facial fractures was greater among nonhelmeted riders compared with helmeted riders. Upper facial fractures were more common among riders without helmets compared with those wearing helmets. CONCLUSION: This study provides evidence of the protective value of helmets to reduce risk of facial injury. Information on the positive effect of facial injury sparing provided by helmet use should be incorporated into helmet promotion programs.
Adult↗
Emergency care of maxillo-facial injuries.
Maxillo-facial injuries require immediate first-aid treatment such as the establishment of a free airway, control of hemorrhage and treatment of shock. Support of the facial structures and positioning of the patient face-downwards are essential life-saving measures. Anxiety concerning facial appearance has an adverse influence on the patient's recovery. Early evacuation to an Advanced Treatment Centre for medical and dental care is of prime importance.
Accidents↗
Soft tissue facial injuries in sport (excluding the eye).
Facial injuries in sport have until recently received little publicity. Certainly, compared to other forms of injury, particularly orthopaedic, they seem neither to occur as frequently nor to have the same significance in relationship to complications, resulting in time off the sport, or long-term problems. Obtaining figures relating to the frequency of facial injuries in different sports is not easy because they are often trivial or considered so to be. Record-keeping by club staff can be erratic to say the least and many injuries do not reach hospitals. Increased interest in facial injuries is occurring as a result of a number of factors, including fears regarding transfer of blood-spread infections in contact sports and the increasing aggression occurring in some sports resulting in injuries to players, officials, and supporters during or even after the event. Possible reasons for this are discussed, as will be the implications.
Athletic Injuries↗
Effectiveness of bicycle safety helmets in preventing serious facial injury.
OBJECTIVE: To assess the effectiveness of helmets in preventing facial injuries. DESIGN: Case-control study between March 1, 1992, and August 31, 1994. SETTING: Seven Seattle, Wash, area hospitals including the regional trauma center and a large staff-model health maintenance organization. PATIENTS: Cases were patients with serious facial injury, ie, fractures or lacerations; controls were patients who had injuries other than facial. Minor facial injuries were excluded to avoid ascertainment bias in those seeking care for serious injuries to other areas. RESULTS: Serious facial injuries occurred to 700 (20.7%) patients. Helmets were used by 47% of cases and 57% of controls. After adjusting for age, sex, speed, and surface, we found that helmets reduced the risk of injury to the upper face (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.26-0.49) and middle face (OR, 0.35; 95% CI, 0.24-0.50) but had no significant effect on serious injury to the lower face (OR, 0.88; 95% CI, 0.72-1.07). CONCLUSIONS: Bicycle helmets offer substantial protection for the upper and mid face in addition to their known protection against head injuries. Helmets do not appear to offer any protection for the lower face.
Adolescent↗
Facial injuries in hockey players.
As otolaryngologists become more involved with maxillofacial trauma, we are encountering an increasing number of athletic injuries. Ice hockey accounts for a large number of these facial injuries. The fast moving and random nature of the game, frequent body and equipment contact and lack of protective devices, predisposes the hockey player to facial injury. Because of the roughly tenfold increase in hockey participation over the last decade, the problem of facial injury prevention has become a significant public health problem in North America. Review of the medical literature shows a paucity of interest in the subject of facial injury prevention in hockey. Several articles have dealt with ocular injury, while other articles have dealt with the general subject of hockey injury with only scant attention paid to the facial area. A retrospective study was carried out to more clearly define the scope of the facial injury problem. Four levels of hockey play were examined. Individuals from the youngest and most inexperienced to seasoned professionals were studied. An individually completed questionnaire was received from players in each group. It is the purpose of this paper to indicate the rates of injury for the various types of facial trauma, present their mechanisms of occurrence and discuss means of preventing facial injury in hockey players.
Athletic Injuries↗
A case-control study of the effectiveness of bicycle safety helmets in preventing facial injury.
In a case-control study we sought to assess the potential effectiveness of helmets in preventing facial injuries. Our study included 212 bicyclists with facial injuries and 319 controls with injuries to other body areas, who were treated in emergency rooms of five Seattle area hospitals over a one-year period. Using regression analyses to control for age, sex, education and income, accident severity, and cycling experience we found no definite effect of helmets on the risk of serious facial injury (odds ratio 0.81; 95 percent confidence interval = 0.45, 1.5), but protection against serious injuries to the upper face (odds ratio 0.27; 95% CI = 0.1, 0.8). No protection was found against serious injuries to the lower face. The independent effect of helmet use on facial injury was difficult to isolate due to the association of head and facial injuries. Our results suggest that bicycle helmets as presently designed may have some protective effect against serious upper facial injuries.
Adolescent↗