Interdisciplinary management of unilateral maxillary hypoplasia: sequela of facial trauma

Study Design: Violence against women is a challenge in public health. It involves women of all ages, socioeconomic statuses, cultures, and religions. Objective: The objective of this study was to perform an epidemiological survey of facial trauma among women who experienced physical aggression by an intimate partner. Methods: Electronic medical records from a public tertiary referral hospital for trauma in the Brazilian state of Espírito Santo were analyzed between 2013 and 2018. Results: Patients were most commonly between 20 and 29 years of age (33.9%), and 50% of the patients were of mixed race. When separated by days of the week, facial trauma was most commonly inflicted on Sundays (24.2%) and on Saturdays (22.6%). Of the 62 women included in the study, 47 had facial fractures, and 7 had more than 1 concomitant fracture. Forty of the total fractures (72.7%) were on the middle and upper thirds of the face, while 15 fractures (27.3%) were on the lower third of the face. The most commonly observed signs and symptoms of these injuries were edema (56.5%), periorbital ecchymosis (35.5%), deviated nasal dorsum (22.6%), and hematoma (16.1%). Conclusions: Facial trauma may be considered an important marker of attempted femicide. Health care professionals must be aware of and attentive to this correlation, since many cases of attempted femicide go unnoticed or are attributed to another etiology.

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Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621996108 ◽

2021 ◽

pp. 105566562199610

Author(s):

Buddhathida Wangsrimongkol ◽

Roberto L. Flores ◽

David A. Staffenberg ◽

Eduardo D. Rodriguez ◽

Pradip. R. Shetye

Keyword(s):

Retrospective Study ◽

Outcome Measures ◽

Cleft Lip ◽

Outcome Measure ◽

Cleft Lip And Palate ◽

Inclusion Criteria ◽

Maxillary Hypoplasia ◽

Main Outcome Measure ◽

Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

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Injury Patterns in Pediatric Facial Fractures Unique to an Urban Environment

Facial Plastic Surgery ◽

10.1055/s-0041-1724121 ◽

2021 ◽

Author(s):

Anthony P. Sclafani ◽

Matthew Scott Sclafani ◽

Sallie Long ◽

Tasher Losenegger ◽

Daniel Spielman ◽

...

Keyword(s):

Urban Environment ◽

Older Patients ◽

High Energy ◽

Urban Setting ◽

Cranial Bone ◽

Csf Leak ◽

Facial Trauma ◽

Trauma Patients ◽

Associated Injuries ◽

Facial Fractures

AbstractThis study aimed to define better the clinical presentation, fracture patterns, and features predictive of associated injuries and need for surgery in pediatric facial trauma patients in an urban setting. Charts of patients 18 years or younger with International Classification of Disease 9th and 10th revision (ICD-9/ICD-10) codes specific for facial fractures (excluding isolated nasal fractures) at NY-Presbyterian/Weill Cornell Medical Center between 2008 and 2017 were retrospectively reviewed. Of 204 patients, most were referred to the emergency department by a physician's office or self-presented. Children (age 0–6 years) were most likely to have been injured by falls, while more patients 7 to 12 years and 13 to 18 years were injured during sporting activities (p < 0.0001). Roughly half (50.5%) of the patients had a single fracture, and the likelihood of surgery increased with greater numbers of fractures. Older patients with either orbital or mandibular fractures were more likely to undergo surgery than younger ones (p = 0.0048 and p = 0.0053, respectively). Cranial bone fractures, CSF leaks, and intracranial injuries were more common in younger patients (p < 0.0001) than older patients and were more likely after high energy injuries; however, 16.2% of patients sustaining low energy injuries also sustained cranial bone, CSF leak, or intracranial injury. In an urban environment, significant pediatric facial fractures and associated injuries may occur after nonclassic low kinetic energy traumatic events. The age of the patient impacts both the injuries sustained and the treatment rendered. It is essential to maintain a high index of suspicion for associated injuries in all pediatric facial trauma patients.

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Pediatric Fronto-Orbital Skull Reconstruction

Facial Plastic Surgery ◽

10.1055/s-0041-1722920 ◽

2021 ◽

Author(s):

Andrew M. Ferry ◽

Rami P. Dibbs ◽

Shayan M. Sarrami ◽

Amjed Abu-Ghname ◽

Han Zhuang Beh ◽

...

Keyword(s):

Central Nervous System ◽

Facial Trauma ◽

Limited Data ◽

Significant Morbidity ◽

Craniofacial Skeleton ◽

Optimal Care ◽

Orbital Reconstruction ◽

Safety And Efficacy ◽

The Central Nervous System ◽

Orbital Region

AbstractCraniofacial surgery in children is a highly challenging discipline that requires extensive knowledge of craniofacial anatomy and pathology. Insults to the fronto-orbital skeleton have the potential to inflict significant morbidity and even mortality in patients due to its proximity to the central nervous system. In addition, significant aesthetic and ophthalmologic disturbances frequently accompany these insults. Craniosynostosis, facial trauma, and craniofacial tumors are all pathologies that frequently affect the fronto-orbital region of the craniofacial skeleton in children. While the mechanisms of these pathologies vary greatly, the underlying principles of reconstruction remain the same. Despite the limited data in certain areas of fronto-orbital reconstruction in children, significant innovations have greatly improved its safety and efficacy. It is imperative that further investigations of fronto-orbital reconstruction are undertaken so that craniofacial surgeons may provide optimal care for these patients.

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