Search Results (31)

Sports-related oral and maxillofacial trauma exhibits distinct injury mechanisms depending on the type of sport; however, comprehensive analyses integrating these characteristics remain limited. This study aimed to elucidate the clinical features of sports-related oral and maxillofacial trauma. This single-center retrospective study included 1615 patients (mean age 41.04 years; 64.8% male) treated between 2012 and 2025 in Shimane University Hospital, Department of Oral and Maxillofacial Surgery/Maxillofacial Trauma Center, Shimane, Japan. Among them, 239 (14.8%) had sports-related injuries and were significantly younger and more frequently male (p < 0.001). Multivariable analysis showed that nasal bone (odds ratio [OR] 5.900, 95% confidence interval [CI] 3.309–10.521), orbital wall (OR: 8.044, 95% CI: 4.664–13.874), zygomatic and zygomatic arch (OR: 3.239, 95% CI: 1.455–7.213), and naso-orbito-ethmoidal fractures (OR: 6.507, 95% CI: 1.971–21.483), as well as contusions (OR: 2.601, 95% CI: 1.385–4.885), were positively associated, whereas mucosal lacerations (OR: 0.485, 95% CI: 0.290–0.811) and referral from dental/medical clinics (OR: 0.312, 95% CI: 0.178–0.546) were negatively associated (all p < 0.01). However, panfacial fractures occurred less frequently. Sports-related trauma was primarily associated with nasal, orbital wall, zygoma and zygomatic arch, and naso-orbito-ethmoidal fractures. These findings indicate that sports-related oral and maxillofacial trauma is characterized by distinct and predominantly midfacial fracture patterns. Full article

Background: Modern warfare has introduced novel mechanisms of injury, particularly drone-induced blast trauma, resulting in complex craniomaxillofacial injuries. These injuries differ substantially from typical ballistic wounds and require adapted surgical strategies. This study was conducted to evaluate the clinical characteristics, management approaches, and long-term outcomes of midfacial blast injuries. Methods: A retrospective analytical study was conducted on 41 patients with drone-induced midfacial blast injuries treated at a tertiary referral center in Armenia following the 2020 Nagorno-Karabakh War. All patients underwent surgical management after initial stabilization and were followed for 5 years. Clinical outcomes, complications, and reconstructive needs were assessed. Results: All patients presented with comminuted midfacial fractures, which were frequently associated with polytrauma (87.8%). Burns were observed in 82.9% of cases. Surgical management included radical debridement and early definitive osteosynthesis using titanium fixation systems. No cases of postoperative osteomyelitis, bone sequestration, or implant failure were observed during the 5-year follow-up period. Patients with extensive soft tissue defects, particularly nasal and lip amputations, required multiple reconstructive procedures. Long-term follow-up revealed progressive soft tissue thinning over titanium meshes, especially in the zygomatico-orbital region, necessitating secondary interventions such as lipofilling. Conclusions: Drone-induced midfacial blast injuries represent a distinct and severe form of trauma. Early definitive reconstruction following adequate debridement was associated with favorable outcomes. However, soft tissue reconstruction remains challenging and often requires staged procedures. Long-term follow-up is essential to manage delayed complications and optimize aesthetic outcomes. Full article

Background and Clinical Significance: This case report describes an unusual complication in an 8-year-old female patient undergoing ME (maxillary expansion) with a tooth-supported maxillary expander with the hyrax screw. Case presentation: After the 36th screw turn in the 5th week of treatment, the patient reported pressure and pain symptoms and the patient’s parents observed a bone elevation at the bridge of the nose. The patient was referred to for clinical examination which revealed a bilateral infraorbital hematoma and a movable, and highly sensitive, nasal area upon palpation. A cone-beam computed tomography (CBCT) scan confirmed a displaced nasal bone fracture. Conservative treatment was immediately initiated by reversing the hyrax screw four times, followed by ten additional turns over the next 7 days for a total of 14 back-turns. This procedure led to an immediate improvement in symptoms. An 8-week follow-up CBCT confirmed the physiological repositioning of the nasal bones and healing of the fracture. Conclusions: Although nasal bone fracture is a rare complication of ME, particularly in children, clinicians should be aware of this potential risk and remain vigilant for symptoms of high pressure and pain in the orbito-nasal area. If a nasal fracture is suspected during orthodontic treatment, the orthodontist should immediately cease screw activation. In selected cases, careful reversal of the screw, as described in this report, may be considered as a conservative treatment. Full article

Study Design: Retrospective cohort study. Objective: To determine the association of social determinants of health with rates of closed nasal bone reduction. Methods: A retrospective analysis of the National Trauma Data Bank (NTDB) from 2011 to 2019 was performed, including only adult patients with isolated nasal bone fractures. Logistic regression modeling was used to estimate the association between closed nasal bone reduction and sociodemographic variables. Results: A total of 149,312 patients were included, with an average age of 50. Most patients were male (68%), White (72%), and non-Hispanic/Latino (77%), with Medicare insurance (25%). Most patients were cared for at non-university (54%) and non-profit hospitals (88%). A total of 39% were cared for at an ACS level 1 trauma center. Finally, 3.3% of the patients in this study underwent closed reduction. The odds of undergoing reduction decreased with increasing age (OR: 0.99, CI: (0.99, 0.99)). Compared to White patients, Asian and Black/African American patients had decreased odds of closed reduction (Asian: OR (CI) 0.71 (0.53, 0.95); Black: OR (CI): 0.71 (0.65, 0.79)). Patients with government insurance or who were uninsured had lower odds of closed reduction compared to private/commercial insurance, with Medicaid, Medicare, and not billed/self-pay odds ratios of 0.83 (CI: (0.76, 0.90)), 0.81 (CI: (0.73, 0.89)), and 0.79 (CI: (0.72, 0.86)), respectively. Conclusions: Social determinants of health are associated with differential rates of inpatient closed nasal bone reduction. Further studies in the outpatient setting are needed to determine if these associations remain consistent. Full article

Background: High-frequency ultrasonography (US) is increasingly used to guide closed reduction in nasal bone fractures, but near-field resolution over the curved nasal dorsum depends critically on the acoustic coupling medium. We aimed to determine whether a semi-solid standoff gel pad (PAD) provides superior image contrast and signal stability compared with a liquid gel barrier (LGB) during intraoperative nasal bone fracture sonography. Methods: In this prospective, single-center, within-subject crossover study, 30 adults with isolated nasal bone fractures underwent intraoperative high-frequency US of the nasal dorsum under two coupling conditions differing only by the medium used: a 7 mm hydrogel standoff pad (PAD) and a custom-made 7 mm liquid gel barrier (LGB). All scans were acquired on the same platform using fixed B-mode presets (10 MHz, 4.0 cm depth, single focal zone at the cortex). Rectangular regions of interest (ROIs) were placed on the cortical interface (bone ROI) and adjacent soft tissue (soft-tissue ROI) at matched depth. For each subject and condition, contrast-to-noise ratio (CNR) and two signal-to-noise ratios (SNR_bone, SNR_soft) were derived from ROI gray-level statistics and compared using paired t-tests. Results: The PAD yielded a significantly higher CNR at the cortical interface compared to the LGB (3.46 ± 0.17 vs. 2.50 ± 0.19; mean paired difference 0.96, 95% CI 0.88–1.04; p < 0.0001). SNR_bone was also higher with PAD (4.31 ± 0.35 vs. 3.63 ± 0.34; difference 0.68, 95% CI 0.52–0.83; p < 0.0001). Using the soft-tissue ROI as the noise reference (SNR_soft), PAD again outperformed LGB (7.64 ± 0.73 vs. 6.68 ± 0.78; difference 0.96, 95% CI 0.59–1.33; p = 0.000012). Conclusions: Compared with a liquid gel barrier of similar thickness, a semi-solid standoff gel pad provides higher near-field CNR and SNR at the nasal cortical interface under standardized intraoperative conditions. These quantitative differences support the use of a gel pad as a practical coupling medium for real-time ultrasound guidance during closed reduction in nasal bone fractures, although the impact on clinical outcomes remains to be determined. Full article

Introduction: Canine sinonasal aspergillosis (SNA) can present singular as a primary disease or secondary to concurrent sinonasal pathology. We hypothesized that treatment response and prognosis differ between both forms, particularly when sinusitis is present. Methods: In this retrospective study, 30 dogs with SNA were categorized as either group pA (primary aspergillosis) or group sA (secondary aspergillosis; with additional sinonasal pathology). History, diagnostics, endoscopic therapeutic intervention of affected nose and sinus, and follow-up data were analyzed. Results: Group pA included 19/30 dogs (63%), with 15 dogs (79%) showing concurrent sinusitis. Group sA included 11/30 dogs (37%; additional conditions: foreign bodies, dental pathologies, frontal bone fracture). Only 2/11 sA dogs (18%) had sinusitis. Follow-ups in group pA were more frequent than in group sA (p = 0.04). Need for re-treatments differed significantly between groups (p = 0.02) and in dogs with sinusitis, regardless of group (p < 0.001). In group sA, treating the underlying condition plus single endoscopic debridement ± antifungal therapy led to clinical resolution in 11 of 12 dogs (92%). Conclusions: Primary SNA is frequently associated with sinusitis, requires aggressive repeated antifungal therapy, and may not achieve a definitive cure. Secondary SNA is usually confined to the nasal cavity, responds well to underlying condition treatment, carries better prognosis, and requires fewer antifungal treatments. Full article

Background: Open fractures in pediatric patients are uncommon but clinically relevant, often resulting from high-energy trauma or sports-related incidents. This study analyzes the demographic patterns, types of sports, injury mechanisms, treatment strategies, and outcomes in children and adolescents with sports-related open fractures. Methods: In this retrospective study, 74 pediatric patients with sports-related open fractures treated at a level 1 trauma center between 2002 and 2023 were documented. Parameters such as age, sex, fracture location, sport type, treatment modality, complications, and outcomes were evaluated. Results: The cohort included 74 patients, with a mean age of 13 ± 3.6 years. Open fractures of the upper extremity were most common (seen in 34 patients). Moreover, 10 open craniofacial and 27 open nasal fractures represented 50.0% of injuries, mainly in male athletes involved in contact sports. Soccer was the leading injury-related sport (n = 14; 18.9%). Surgical treatment was required in 28 patients (37.8%), most frequently using elastic stable intramedullary nailing, Kirschner wire fixation in the upper extremities or nasal bone reduction. Antibiotics were administered in 46 patients (62.2%), with a mean documented duration of 2.7 ± 3.1 days. An excellent outcome was documented in 95%. Conclusions: Sports-related open fractures in children primarily affect male adolescents in contact sports and involve the upper extremities and facial region. Conservative management is effective in stable, non-displaced and low-grade injuries. Surgical treatment is frequently indicated in open forearm fractures. The implementation of a structured trauma care protocol, incorporating early debridement, definitive treatment, and antibiotics, has been demonstrated to yield a safe and effective treatment outcome with a favorable prognosis for sports-related open fractures in children. Full article

Background/Objectives: The nasal bone is critical to both the functional integrity and esthetic contour of the facial skeleton. Nasal bone fractures constitute the most prevalent facial fracture presentation in emergency departments. The identification of these fractures and the determination of immediate intervention requirements pose significant challenges for inexperienced residents, potentially leading to oversight. Methods: A retrospective analysis was conducted on facial trauma patients undergoing cranial radiography (Waters’ view) during initial emergency department assessment between March 2008 and July 2022. This study incorporated 2099 radiographic images. Surgical indications comprised the displacement angle, interosseous gap size, soft tissue swelling thickness, and subcutaneous emphysema. A deep learning-based artificial intelligence (AI) algorithm was designed, trained, and validated for fracture detection on radiographic images. Model performance was quantified through accuracy, precision, recall, and F1 score. Hyperparameters included the batch size (20), epochs (70), 50-layer network architecture, Adam optimizer, and initial learning rate (0.001). Results: The deep learning AI model employing segmentation labeling demonstrated 97.68% accuracy, 82.2% precision, 88.9% recall, and an 85.4% F1 score in nasal bone fracture identification. These outcomes informed the development of a predictive algorithm for guiding conservative versus surgical management decisions. Conclusions: The proposed AI-driven algorithm and criteria exhibit high diagnostic accuracy and operational efficiency in both detecting nasal bone fractures and predicting surgical indications, establishing its utility as a clinical decision-support tool in emergency settings. Full article

Background and Objectives: Interpersonal violence (IPV) has overtaken road traffic collisions as a leading cause of facial fractures, yet regional data from Southern Europe are limited. Materials and Methods: We retrospectively reviewed all adults (≥18 y) treated between 1 January 2011 and 31 December 2022 for radiologically confirmed IPV-related facial fractures. Recorded variables were demographics, AO-CMF (Arbeitsgemeinschaft für Osteosynthesefragen—Craniomaxillofacial) fracture site, Facial Injury Severity Score (FISS), presence of facial soft-tissue wounds, treatment modality, and length of stay; associations between variables were explored. Results: A total of 224 victims were identified; 94% were men (median age 26 y, IQR 22–34). The mandible was the most frequently involved bone (42%), followed by the orbit (25%); 14% sustained fractures at multiple sites. Facial soft-tissue wounds occurred in 9% of cases, three-quarters of which were associated with mandibular injury (p = 0.005). The median FISS was 2 and was higher in males, patients > 34 y, those with multiple fractures, and those with wounds (all p < 0.05). FISS showed a weak positive correlation with hospital stay (r = 0.23), which averaged 4.1 ± 1.6 days. Open reduction and internal fixation were required in 78% of patients, most often 24–72 h after admission. Annual IPV-related admissions remained stable throughout the 12-year period. Conclusions: IPV in this region consistently injures young men, with the mandible and orbit most at risk. FISS is a practical bedside indicator of resource use. The unchanging incidence—likely underestimated because isolated nasal fractures and minor injuries are often managed outside maxillofacial services or never reported—highlights the urgency of targeted prevention programs, routine screening, and streamlined multidisciplinary pathways. Full article

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data Bank (NTDB) for the years 2013 to 2016. Main outcome measures: Trauma mechanism and mortality rates between closed and open fractures were conducted. Results: This study involved 122,574 closed and 9704 open nasal fractures to elucidate demographic, hospital, and clinical characteristics. Significant risk factors for open nasal fractures included a higher injury severity score, self-inflicted intent, unintentional causes, and firearm mechanism compared to assault injuries. Conclusions: Significant factors associated with open nasal fractures include injury severity, self-inflicted intent, trauma type, and firearm mechanisms, which notably increase the likelihood of open fractures. Findings highlight the need for targeted prevention, efficient resource allocation, and risk screening to enhance the management of complex facial traumas in the national trauma system. Full article

Background and Objectives: Postoperative recovery from general anesthesia is a multidimensional process, and patient-centered outcome assessment should be considered an important indicator of recovery quality. This study compared the effectiveness of intraoperative lidocaine and magnesium on postoperative recovery in nasal bone fracture surgery, using the quality of recovery-40 questionnaire (QoR-40) to assess recovery quality and pain intensity. Materials and Methods: A total of 74 patients scheduled for elective closed reduction surgery for isolated nasal bone fracture were assigned to the intraoperative infusions of lidocaine or magnesium. Immediately after anesthetic induction, 1.5 mg/kg lidocaine or 20 mg/kg magnesium was administered over 10 min, followed by a continuous infusion of 2 mg/kg/h lidocaine or 20 mg/kg/h magnesium until the end of the surgery. The primary outcome variable was the QoR-40 survey on postoperative day 1. The secondary outcome variables included postoperative pain intensity, sedation score, the incidence of postoperative nausea and vomiting, and other side effects. Results: The global QoR-40 score at postoperatively 24 h was comparable between the intraoperative lidocaine and magnesium groups. Postoperative pain 30 min after surgery was significantly lower in the lidocaine group than in the magnesium group (p = 0.01), along with lower rescue analgesic consumption (p = 0.003), but pain intensity was not different at other time points (2, 6, and 24 h). The incidence of nausea and vomiting and the sedation score in the post-anesthetic care unit were not significantly different between the two groups. Conclusions: Intraoperative lidocaine and magnesium had no difference in the scores of postoperative QoR-40, but lidocaine was associated with lower postoperative pain scores and analgesic requirement in comparison to magnesium in the closed reduction of nasal bone fractures. Full article

Study Design: A retrospective study. Objective: The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly affect symptomatology and management. We hypothesize that NOE fractures will present differently based upon their severity: Type I injuries are likely to present with medial nasal bone displacement (in-fracture), whereas Type III fractures will be more prone to lateral displacement (out-fracture). Methods: A retrospective review was performed for all patients with NOE fractures who were evaluated by the plastic surgery department at a level 1 trauma center over a 6-year period. Computed tomography data were evaluated to assess for directionality of fracture segment displacement. Frequencies of medial, lateral, and non-displacement across NOE types were compared by Chi-Squared Goodness of Fit and Fisher’s Exact Tests. Results: 111 patients met inclusion criteria. The patient population was 73.9% male and averaged 51.2 years old. When bilateral fractures were counted independently, there were 141 cases in total: 115 Type I, 20 Type II, and 6 Type III. Type I fractures were most commonly in-fractured (48.7%), while Type III injuries were consistently out-fractured (100%) (p < 0.001). Conclusions: While Type II and III NOE fractures have dominated clinical focus, this study highlights the prevalence of impaction within Type I fractures. These findings advocate for a more comprehensive approach to the evaluation of Type I NOE fractures and their potential risks, including traumatic hypotelorism and nasal airway obstruction. Full article

Study Design: Facial bone fractures in women are less common than in men in the United States. However, little is known about the epidemiology of women who sustain facial fractures. Objective: Our aim is to describe the patient population of women seeking emergency care for facial fractures in the United States and they type and cost of care received in this setting. Methods: This is a retrospective cohort study using the 2019 National Emergency Department Sample. The inclusion criterion was diagnosis of facial fracture. The primary outcome was patient characteristics. The secondary outcomes are emergency department (ED) characteristics, discharge disposition, total visit charges, and most common cause. Diagnoses and procedures were identified using ICD10-CM codes. Outcomes were compared to men. Results: Thirty-seven percent of ED facial fractures were encountered in women. Both women and men were most likely adult, Caucasian, from the lowest median income quartile, sustained nasal bone fractures, and presented to a southern, metropolitan, private nonprofit, non-trauma ED. Conclusions: Women were older, more likely insured by Medicare and less likely by private insurance, discharged home, and had lower ED charges than their male counterparts. However, the financial burden of emergency care for facial fractures among women was $1.6 billion. Full article

Introduction: Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. Materials and Methods: Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. Results: OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12–4.25%) OCs accompanying OFs were observed after MFT. Conclusions: The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis. Full article

This paper reported a study on the 3-dimensional deep-learning-based automatic diagnosis of nasal fractures. (1) Background: The nasal bone is the most protuberant feature of the face; therefore, it is highly vulnerable to facial trauma and its fractures are known as the most common facial fractures worldwide. In addition, its adhesion causes rapid deformation, so a clear diagnosis is needed early after fracture onset. (2) Methods: The collected computed tomography images were reconstructed to isotropic voxel data including the whole region of the nasal bone, which are represented in a fixed cubic volume. The configured 3-dimensional input data were then automatically classified by the deep learning of residual neural networks (3D-ResNet34 and ResNet50) with the spatial context information using a single network, whose performance was evaluated by 5-fold cross-validation. (3) Results: The classification of nasal fractures with simple 3D-ResNet34 and ResNet50 networks achieved areas under the receiver operating characteristic curve of 94.5% and 93.4% for binary classification, respectively, both indicating unprecedented high performance in the task. (4) Conclusions: In this paper, it is presented the possibility of automatic nasal bone fracture diagnosis using a 3-dimensional Resnet-based single classification network and it will improve the diagnostic environment with future research. Full article