Sagittal Maxillary Fracture: Diagnosis and Management

Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.

Unanticipated Fractures of the Zygomatic-Maxillary Suture in LeFort III Internal Distraction: Salvage of Midfacial Advancement via Rigid External Distraction of an Orphaned LeFort II Segment

Currently, the most common approach for treating midface hypoplasia in syndromic craniosynostoses patients is the LeFort III with distraction osteogenesis. Distraction osteogenesis can be performed through either internal or external distraction systems. Each modality offers unique advantages and disadvantages. A rare complication associated with internal distraction is fracture of the zygomatic-maxillary suture caused by distraction forces on this area. This complication has been reported in patients with Pfeiffer and Apert syndromes, related to convexity of temporal bones increasing force on the zygomatic-maxillary suture. In the current report, we present the first case in the literature of an internal distraction associated zygomatic-maxillary fracture in a patient with Crouzon syndrome. We also present a subunit osteotomy salvage approach. Through mobilization of a LeFort II segment and rigid external distraction to advance orphaned segments of the midface, a favorable aesthetic result was salvaged from this complication.

National Analysis of Risk Factors for Nasal Fractures and Associated Injuries in Trauma

Nasal fractures account for up to 58% of facial fractures. However, the literature characterizing associated injuries and risk factors for nasal fractures is sparse and is mostly composed of single-center experiences. This study sought to provide a large descriptive analysis and identify associated injuries and risk factors for nasal fractures in trauma using a national database. A retrospective analysis of the National Trauma Data Bank (NTDB) from 2007 to 2015 was performed. Patients ≥18 years of age with nasal fractures were included. A multivariable logistic regression model was used to identify predictors for nasal fracture in trauma. Of 5,494,609 trauma patients in the NTDB, 255,533 (4.6%) had a nasal fracture. Most were male (74.8%) with a mean age of 45.6 years. Blunt trauma accounted for 90.5% of fractures, with motor vehicle accident being the most common mechanism (27.5%). Closed fractures occurred in 93.0% of patients. Concomitant injuries included traumatic brain injury (TBI; 56.9%), malar/maxillary fracture (27.9%), and open wound of the face (38.6%) and nose (9.5%). Of all patients, 10.1% underwent closed or open reductions at index hospitalization. The strongest associated injuries with nasal fracture included open wound of the nose (odds ratio [OR]: 8.71, 95% confidence interval [CI]: 8.49–8.94, p < 0.001), epistaxis (OR: 5.26, 95% CI: 4.59–6.02, p < 0.001), malar/maxillary fracture (OR: 4.38, 95% CI: 4.30–4.45, p < 0.001), and orbital fracture (OR: 3.99, 95% CI: 3.91–4.06, p < 0.001). Nasal fractures are common traumatic injuries with more than 90% occurring by blunt mechanism and over half suffering from a concomitant TBI. The strongest associated injury with nasal fracture is an open wound of the nose.

TEMPORARY DISABILITY OF PATIENTS WITH INJURIES OF MAXILLOFACIAL REGION

Introduction: Temporary disability cases in patients with maxillofacial injuries treated in dental medical organizations for 11 years. Objective: to study the group of traumatic maxillofacial injuries affecting the duration of temporary disability cases in the Republic of Tatarstan (RT) in 2007-2017. Material and methods: accounting-and-reporting forms 16-ВН, 036/у, 035/у, 043/у in dental medical organizations for the period 2007-2017. Results: The traumatic maxillofacial injuries leading to temporary disability are in the second place in the structure of diseases with temporary disability and make up 14%; the authors established the type of maxillofacial injuries with temporary disability. When comparing the patients’ age with maxillofacial injuries, it was revealed that the patients with open unilateral mandibular fracture, closed zygomatic fracture, as well as maxillary fracture are significantly young. A bilateral mandibular fracture (both open and closed), an angular mandibular fracture, a wound and hematoma, as well as other injuries are characteristic of older people. The maxillofacial injuries leading to temporary disability are divided as follows, depending on gender: male patients - 58.1%, female patients - 41.9%. The greatest number of temporary disability cases associated with a group of injuries was detected in 2013, the smallest number - in 2008. The average duration of temporary disability cases ranged from 6.69±1.62 to 22.43±2.38 days. The authors established the statistically significant differences in the hospitalization rate depending on the type of maxillofacial injury (p