Initial Assessment of the Facial Trauma Patient

The initial evaluation of the craniofacial trauma patient must be systematic, thorough, and consistent to ensure that injuries are not missed. Life-threatening conditions are first identified using ATLS principles, and focused head and neck examination conducted by a specialist then follows. Imaging is used to guide operative planning, as many craniofacial injuries ultimately benefit from repair to prevent permanent cosmetic or functional deformity. Peri-operative care is often multi-disciplinary in nature, and specialist consultation should be performed in an efficient fashion. Finally, it should be noted that surgeons operating in the maxillofacial region are at high risk for transmission of COVID-19, and risk of COVID-19 sequelae must be balanced with risks associated with the delay of treatment of craniofacial injury.

Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

Potential role of artificial intelligence in craniofacial surgery

The field of artificial intelligence (AI) is rapidly advancing, and AI models are increasingly applied in the medical field, especially in medical imaging, pathology, natural language processing, and biosignal analysis. On the basis of these advances, telemedicine, which allows people to receive medical services outside of hospitals or clinics, is also developing in many countries. The mechanisms of deep learning used in medical AI include convolutional neural networks, residual neural networks, and generative adversarial networks. Herein, we investigate the possibility of using these AI methods in the field of craniofacial surgery, with potential applications including craniofacial trauma, congenital anomalies, and cosmetic surgery.

Nasal and Naso-orbito-ethmoid Fractures

Craniofacial fractures are common among trauma patients. Nasal fractures are the most common craniofacial fracture. Understanding how to evaluate and manage craniofacial fractures is important for the craniofacial trauma consultant. This manuscript describes the appropriate workup and management of nasal and naso-orbito-ethmoid fractures.