Management of Frontal Bone Fracture in a Tertiary Neurosurgical Care Center—A Retrospective Study

Aim We present our experience in the management of frontal bone fractures using the previously described radiologic classification of frontal bone fractures. Methodology A retrospective study was conducted, which reviewed the medical records and computed tomographic (CT) scan images of patients with frontal bone fracture from January 2016 to February 2019. Patients with complete medical records and a follow-up of minimum 1 year were included in the study. Demographic details, mechanism of injury, associated intracranial injuries, maxillofacial fractures, management, and complications were analyzed. CT scan images were used to classify the frontal bone fractures using the novel classification given by Garg et al (2014). The indications for surgical treatment were inner table frontal sinus fracture with cerebrospinal fluid (CSF) leak, intracranial hematoma with significant mass effect requiring surgical evacuation, and outer table comminuted fracture that is either causing nasofrontal duct obstruction or for cosmetic purpose. Results A total of 55 patients were included in the study. Road traffic accidents as the commonest cause of frontal bone fractures. The most common fracture pattern was type 1 followed by type 5 and depth B followed by depth A. Four patients presented with CSF rhinorrhea. CSF rhinorrhea was more frequent with fracture extension to the skull base (depth B, C, D), which was statistically significant (p < 0.001). Conclusion Frontal bone fracture management has to be tailor-made for each patient based on the extent of the fracture, presence of CSF leak, and associated intracranial and maxillofacial injuries.

Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury – Is It Safe? Radiological Simulation in a Healthy Volunteer

Introduction Cervical spine (C-spine) injury is present in up to 10% of patients with maxillofacial fractures. Uncertainty over the status of the C-spine and permitted head movements may delay maxillofacial surgical intervention, resulting in prolonged patient discomfort and return to oral nutrition, reducing quality of life. This study aimed to investigate the effects on the C-spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations – neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. Results In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4–C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1–2) joints. Conclusion Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.

Role of Ultrasonography and Conventional Radiography in the Detection of Maxillofacial Fractures: A Comparative Study

Objective: With the collaboration of the trauma department, our study was designed to compare the effectiveness of ultrasonography (USG) and conventional radiography in the detection of bony fractures related to oral and maxillofacial regions. Methodology: This comparative study was conducted from March 2020 to March 2021 by the Radiology department of Sarghoda medical college hospital with the collaboration of the trauma department. Ultrasonography was performed by using GE- USG machine along with a linear extraoral transducer (frequency range 7-15 MHZ). Patients were asked to sit in a seated position facing the sinologist. Transducers were placed over the site by applying the sterile gel. Results: The overall sensitivity and specificity rate of ultrasonography was reported as 83.33% and 98.88% respectively in all sites whereas the sensitivity and specificity rate of conventional radiographs were reported as 70.24%, 100%. The negative predictive value of USG was reported as 96.17% along with 94.59% positive predictive value. In the contrast, conventional radiography gave a better positive predictive value (100%) than USG In our study we found better results of ultrasonography in terms of sensitivity and negative predictive value. Conclusion: In conclusion, our study depicts that ultrasonography is an economical, useful diagnostic tool for examining the bony fractures of facial trauma with a better sensitivity rate when compared to conventional radiographs.

Evaluation of preoperative oral hygiene in patients with maxillofacial fractures: a retrospective clinical study

The purpose of this study was to know the oral epidemiological profile of patients admitted in a public hospital in the state of Ceará in the immediate preoperative period using the Simplified Oral Hygiene Index (IHO-S). This is a cross-sectional retrospective study of 40 male patients and 4 female patients hospitalized who underwent surgical treatment of maxillofacial fractures. The mean age of the patients was 31.27 years, presenting 21 patients (52.5%) with good oral condition, 18 patients (45%) regular condition and only 1 (2.5%) with poor oral condition. Although oral hygiene has been considered good, studies that emphasize the removal of bacterial biofilms should be performed for patients who have obtained the worst results, in order to reduce the problems that these poor results may cause. Through this study the importance of the dental surgeon in a hospital environment is apparent, acting in the treatment and prevention of factors associated with the oral cavity during the period of hospitalization.