A case report of sub-gingival cervical crown fracture reattachment using fiber post- A 22 months follow up

A 15‐year‐old male presented to the Department of Conservative Dentistry and Endodontics immediately after a facial injury having complain of persistent pain in the teeth and the front upper lips. Upon examination it was revealed trauma of the upper incisors, also injury to the marginal gingiva of the front teeth. Further inspections showed slight laceration of the oral mucosa in the lower labial sulcus. Radiographic examination revealed fracture of crown of maxillary central incisor. The treatment plan which was decided comprised of complete removal of fractured crown followed by root canal therapy and immediate post placement and reattachment of the crown.

Indicação anestésica para o tratamento dos fraturados da face

The anesthesia for the treatment of maxilo-facial fractures should be good enough to the confort of the patient and assuring a quite operating field for the surgeon. Regional anesthesia is often used in the treatment of small fractures of the bones of the face. In children and non cooperative adults the general anesthesia is mandatory. In the great injuries of the face and in patients with “multiple trauma the general anesthesia is the best. choice. The orotraqueal entubations must be always performed and the traqueostomy should be done only in cases where the facial injury do not allow the orotraqueal entubations. In this brief discussion we also call attention for some points in general case of the patient such as treatment of the shock, respiratore failure and problems related.

Classifying and standardizing panfacial trauma according to anatomic categories and Facial Injury Severity Scale: a 10-year retrospective study

Background The purpose of this study was to identify the epidemiologic factors of panfacial fractures (PFs), and to evaluate the significance of anatomic PF categories and the Facial Injury Severity Scale (FISS) in classifying and standardizing panfacial injuries. Methods A retrospective review of all patients treated with PFs at our institution between June 2010 and April 2021 was performed. PF was defined as a concurrent fracture in at least 3 of 4 facial subunits (frontal, upper midface, lower midface, and mandible). Data regarding patient demographics, causes of injury, location of fractures, major concomitant injuries, and postinjury complications were collected, and the FISS score was collected from each patient. Statistical analysis was performed using IBM SPSS Statistics version 22.0. Results A total of 227 patients were enrolled. The most commonly fractured bones were the maxillary sinus wall (92.1%), mandible (82.8%), and zygomatic arch (75.3%), and the most common fracture sites in PFs were graphically presented. Four PF patterns were defined: FULM (n = 60), FUL (n = 39), ULM (n = 127), and FUM (n = 1). There was a significant association between PF patterns and sex (p = 0.018), the number of concomitant injuries (p = 0.014), and early surgical airway management (p = 0.003). Different PF patterns were significantly correlated with different types of concomitant injuries and complications. The FISS score showed a significant difference with PF patterns (p = 0.000) and sex (p = 0.007), and a FISS value of 11 or more is the appropriate cutoff for the prediction of multiple concomitant injuries and complications. Conclusions Both the anatomic PF categories and FISS were significantly correlated with various concomitant injuries and complications. The combination of PF categories and FISS provided a better positive and negative prediction of concomitant injuries and complications for PF patients. Patients with FULM and FISS > 11 had an obviously higher proportion of the need for multiprofessional treatment.

КЛІНІКО-АНАТОМІЧНІ ОСОБЛИВОСТІ ПЕРЕЛОМІВ ВЕРХНЬОЇ ЩЕЛЕПИ У ПАЦІЄНТІВ ІЗ РІЗНИМ ТИПОМ ЇЇ ПНЕВМАТИЗАЦІЇ

Індивідуальна анатомія кісток середньої зони облич-чя (КСЗО) позначається на особливостях їх руйну-вання та ускладнює процес лікування та реабілітації пацієнтів із травматичними переломами.Мета. Вивчення взаємозв’язків між клініко-рентгенологічними характеристиками переломів вер-хньої щелепи (ВЩ) та особливостями її будови, зок-рема ступенем пневматизації.Матеріали і методи. Проаналізовано та порівняно значення кількості щілин переломів, кількості улам-ків, частоту утворення дефектів на ділянках контр-форсів, показник Facial Injury Severity Scale у пацієн-тів із різним значенням індексу пневматизації (ІП).Результати. Пневматичний тип будови КСЗО хара-ктеризується збільшенням ступеня фрагментації та утворенням дефектів контрфорсів ВЩ у порівнянні з нормальним типом будови (66 % та 58 % відповідно, р>0,999).Висновки. Характеристики переломів ВЩ залежать від особливостей її архітектоніки, а саме від ІП, що необхідно враховувати при плануванні лікувальних заходів.

1239 Postoperative Complication Rate of Facial Injury Repairs Treated by Maxillofacial On-Call Team: Surgical Audit

Introduction A significant aspect of Oral and Maxillofacial Surgery workload relates to trauma, particularly soft-tissue injuries. Contingent on the aetiology of injury, facial wounds require debridement and rapid closure to reduce risk of infection and degree of scarring. The aim was to identify possible risks and frequency of postoperative complications, including problems identified by patients following treatment of facial injuries by the Maxillofacial on-call team. Method Data was retrospectively collected from patients who sustained soft-tissue facial injuries treated by the Maxillofacial team and provided with follow-up appointments from January to August 2020. Computerised clinical notes were accessed to determine patient demographics, mechanism and site of injury, location and time of repair, operator grade and postoperative complications (if any). Results 153 patients required debridement and suturing of a facial injury under local or general anaesthetic. Among these, the male to female ratio was 65:35. 47% of facial injuries resulted from mechanical fall. Lips were found to be the most common site (31%) of injury. Postoperative complication rate was 8% within the 8-month period, with reports of infection, wound dehiscence and haematoma requiring further treatment. 58% of complications resulted from treatment carried out between 5pm-5am with a sole operator (DCT/SHO). 83% of complications followed treatment carried out within the Emergency Department rather than Maxillofacial clinical setting. Conclusion Following facial injury repair, just less than 8% of patients experienced complications, which required corrective treatment. Although facial injuries require immediate care, careful planning and performing treatment in a specialised setup may improve perioperative care, thus clinical outcomes.

626Epidemiology of facial injuries in the context of fatal family violence in the Victorian population

Background The oral cavity is reported to be a key focus of physical injury in family violence (FV). Our purpose is to explore the potential opportunity for dentists to assist in the prevention of serious injuries in FV. This paper aims to describe the patterns of orofacial injuries in FV homicides. Methods All FV homicides in Victoria, Australia January 2006-December 2018, were identified amongst closed cases of assaults screened for eligible victim-offender relationships. Epidemiologic trends in FV in the Victorian population over the 12-year period were determined. Sociodemographic, interpersonal, incident and injury characteristics including ICD-10 coding were studied and compared across facial and non-facial injury FV subgroups. Results There was a non-significant downward trend in FV homicide over the period. Of 170 adult cases, 150 were included for facial injury analysis. Of these, 117 (78%) showed orofacial injuries in the 12-year period. Two-step cluster analysis revealed blunt force and threat to breathing injury mechanisms to be significantly associated with facial FV and sharp force with nonfacial FV. Among the additional 26 child homicides, descriptive analysis elucidated patterns in 20 cases eligible for facial injury analysis. Coding limitations were found for the FV homicide cases. Conclusions This population study reports significant involvement of the orofacial region in the FV homicide population during the 12-year study period, potentially informing dental practice and the related policy framework in Victoria and internationally. Key messages The significant involvement of the orofacial region in FV homicides may inform optimal intervention outcomes in FV in Victoria.

The Epidemiology of Facial Trauma Presentations during and after the Implementation of COVID-19 Social Distancing Measures—The Coventry-Warwickshire (UK) Experience

Purpose: The COVID-19 pandemic resulted in the institution of strict public health measures aimed at reducing virus transmission. This coincided with a well-documented alteration to the frequency and characteristics of maxillofacial trauma presentations. The aim was to examine the incidence and characteristics of maxillofacial trauma at a large tertiary hospital in the United Kingdom to determine whether these previously reported changes persisted after the relaxation of COVID-19 “lockdown” legislation. Method: This was a retrospective cohort study of patients who sustained a facial injury during the 8-week period of 16th March 2020 to 11th May 2020 (strict COVID lockdown) compared to the 11th May 2020 to 6th July 2020 (relaxation of COVID lockdown). Cohorts were compared on the incidence and characteristics of facial injury. Results: Compared to the peak of COVID-19 lockdown, the subsequent period during which these laws were eased saw an increase in the frequency of maxillofacial trauma presentations (n = 78 vs n = 37). Despite this absolute increase, the incidence remained statistically below seasonal expectation. Operative management remained persistently low (45% in 2020 vs 67% in 2019). Conclusion: This is the first study to report the characteristics of facial trauma after the easing of COVID-19 lockdown legislation. Compared to previously published reports from Australia, there has not yet been a clear return to baseline epidemiology in the UK, perhaps reflecting the severity of the pandemic in that region.

The Frequency and Characteristics of Facial Injury Following COVID-19 Social Distancing Laws: Newcastle, (Australia) Observations

The imposition of COVID-19 social distancing laws serendipitously decreased the frequency and altered the characteristics of facial injury presentation. The purpose of this study was to determine whether the devolution of social distancing laws had the opposite effect. Materials and methods: The authors undertook a retrospective study of the clinical records of a cohort of patients who sustained a facial injury during COVID-19 social distancing devolution. The primary predictor valuable was the 8 week devolution of social distancing. Other variables consisted of a heterogeneous set of factors grouped into logical categories: demographic, injury specifics, and treatment. A descriptive statistical analysis was undertaken on the assembled results. Results: The study found that the absolute numbers of facial injury presentation rose from 73 to 120; a 64% increase. The study also found that there was an alteration to the characteristics of facial injury presentation across the study variables. Conclusion: The initial imposition and subsequent devolution of COVID-19 social distancing measures had a serendipitous public health benefit. Initially there was a decrease in the frequency of facial injury presentation followed by an increase upon cessation of social distancing restrictions