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Radiologic Clinics of North America May 2023Traumatic brain injury is one of the most common causes of morbidity and mortality and significantly impacts the patients' quality of life and socioeconomic status. It... (Review)
Review
Traumatic brain injury is one of the most common causes of morbidity and mortality and significantly impacts the patients' quality of life and socioeconomic status. It can be classified into primary and secondary injuries. Primary injury occurs at the time of the initial head trauma, such as skull fracture, extra-axial hemorrhage, brain contusion, and diffuse axonal injury. Secondary injury develops later as complications such as diffuse cerebral edema, brain herniation, and chronic traumatic encephalopathy. This article describes the indication for imaging, imaging modalities, recommended imaging protocols, and imaging findings of primary and secondary injuries, including pitfalls of each pathology.
Topics: Humans; Quality of Life; Craniocerebral Trauma; Diagnostic Imaging; Skull Fractures; Brain Injuries, Traumatic
PubMed: 36931768
DOI: 10.1016/j.rcl.2023.01.008 -
Current Opinion in Otolaryngology &... Aug 2019Frontal sinus fracture management is evolving. This article will highlight recent literature and provide an evidence-based algorithm in the contemporary management of... (Review)
Review
PURPOSE OF REVIEW
Frontal sinus fracture management is evolving. This article will highlight recent literature and provide an evidence-based algorithm in the contemporary management of frontal sinus fractures.
RECENT FINDINGS
The role of transnasal endoscopic treatment of frontal sinus fractures has expanded to include fracture reduction and posterior table reconstruction. Evidence continues to support the safety of nonoperative management in select frontal sinus outflow tract fractures.
SUMMARY
The management of frontal sinus fractures with frontal sinus outflow tract injury continues to evolve with a trend toward observation and minimally invasive approaches. Restoration of the frontal sinus outflow tracts with transnasal endoscopic techniques is being used increasingly in the acute and delayed setting. For severe fractures, the role of conservative treatment paradigms requires further research.
Topics: Facial Injuries; Fracture Fixation; Frontal Sinus; Humans; Plastic Surgery Procedures; Skull Fractures
PubMed: 31116143
DOI: 10.1097/MOO.0000000000000546 -
Der Radiologe Jul 2020Injuries of the skull and the cervical spine are common trauma sequelae and prompt diagnosis is of utmost importance to prevent neurologic complications. (Review)
Review
BACKGROUND
Injuries of the skull and the cervical spine are common trauma sequelae and prompt diagnosis is of utmost importance to prevent neurologic complications.
OBJECTIVES
The different imaging modalities for the diagnosis of skull and cervical spine fractures are presented and discussed in the context of the current literature.
MATERIALS AND METHODS
Common fractures of the skull and cervical spine and their classification systems are described. Indications for imaging are discussed within the context of the literature.
RESULTS
Fractures of the head can affect the cranial vault, the base of the skull, and the petrous bone. Injuries to the dura are associated with an open craniocerebral trauma. Fractures of the cervical spine can be subdivided into fractures of the craniocervical junction and subaxial fractures.
CONCLUSIONS
The imaging modality of choice in the acute setting is computed tomography (CT). Skull fractures can be differentiated into open and closed craniocerebral traumas and accompanying intracranial trauma sequelae must be recognized. In the case of petrous bone fractures, attention must always be paid to the middle and inner ear structures. In cervical spine fractures, decisive is whether the fracture is stable or unstable and whether there has been an accompanying injury to the myelon.
Topics: Cervical Vertebrae; Head Injuries, Closed; Humans; Retrospective Studies; Skull; Skull Fractures; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 32451570
DOI: 10.1007/s00117-020-00702-5 -
The Journal of Craniofacial Surgery Jun 2021Soccer is one of the most popular sports in the world. Despite the concept that soccer is not a violent game, it can lead to several injuries in amateur and professional...
Soccer is one of the most popular sports in the world. Despite the concept that soccer is not a violent game, it can lead to several injuries in amateur and professional settings, including facial fractures. Previous studies of facial fractures in soccer were all retrospective and, to date, no prospective studies are available in the literature.The authors performed a comprehensive literature search using the terms "soccer" AND "facial fracture" OR "craniofacial fracture" and "football" AND "facial fracture" OR "craniofacial fracture" and retrieved 693 articles. After applying inclusion and exclusion criteria, 11 articles were included in the present study.A total of 647 patients had suffered facial trauma, with a male-to-female ratio of 63.7:1. The patients' mean age was 27.3 years.The articles reported 670 fractures as follows: 219 (32.7%) in the zygoma, 197 (29.4%) in the nasal bone, 153 (23.6%) in the mandibula, 54 (8.0%) in the orbital wall, 12 (1.8%) in the frontal sinus, 10 (1.5%) in the alveolar bone, 3 (0.4%) in the maxilla, 3 (0.4%) in a Le Fort pattern, and 1 (0.1%) in a naso-orbito-ethmoid (NOE) pattern.Sports are a frequent cause of maxillofacial trauma and are responsible for 9.2% to 33.2% of such injuries. Soccer is a contact sport more associated with lower-limb injuries, but with a significant rate of facial fractures. As soccer is a popular sport played without facial protection and involving high-intensity movements and contact, the prevention of facial fractures related to this sport is crucial to improve the players' safety.
Topics: Adult; Female; Humans; Male; Athletic Injuries; Facial Bones; Maxillofacial Injuries; Orbital Fractures; Retrospective Studies; Skull Fractures; Soccer
PubMed: 33654033
DOI: 10.1097/SCS.0000000000007575 -
Otolaryngology--head and Neck Surgery :... Jun 2021To evaluate the specific mechanism and trend of injury resulting in pediatric basilar skull fractures.
OBJECTIVES
To evaluate the specific mechanism and trend of injury resulting in pediatric basilar skull fractures.
STUDY DESIGN
Retrospective chart review of a trauma database.
SETTING
Tertiary care children's hospital.
METHODS
Patients ≤18 years old with basilar skull fractures were identified via the trauma database for admissions from 2007 to 2018. Patients were identified with codes (801.0, 801.1, 801.2, 801.3 or 801.4) and codes (S02.1, S02.10, S02.11, S02.19) for skull base fractures ( and ).
RESULTS
A total of 729 patients were included: 251 females and 478 males. The 2 most common mechanisms of injury are multilevel falls and unhelmeted rider falls. Multilevel falls occur more in the toddler age group (average age, 4 years), and unhelmeted rider falls are seen in the older age group (average age, 11.2 years). Helmeted rider and motor vehicle accident basilar skull injuries are relatively uncommon. There was a spike in television/entertainment center mechanisms of injury in toddlers from 2007 to 2011 but has since decreased.
CONCLUSION
Pediatric basilar skull fractures are costly to the health care system, as patients spent more time in intensive care unit beds with a charge limited to hospital rooms between $1.7 and $2.7 million per year. The protective effect of helmets is demonstrated by unhelmeted rider injuries being the second-most common mechanism of basilar skull fractures and by helmeted rider injuries being rare. The small proportion of basilar skull fractures from motor vehicle accidents is an example of policy and behavioral changes resulting in decreased injury.
Topics: Child; Child, Preschool; Female; Humans; Male; Retrospective Studies; Skull Fracture, Basilar; Time Factors
PubMed: 32988270
DOI: 10.1177/0194599820960727 -
Skull Fracture Patterns and Morphologies Among Fatal Motorcycle Traffic Accident Victims in Vietnam.The American Journal of Forensic... Mar 2021We aim to describe morphological structures of skull fractures and relevant factors in motorcycle accident victims in Vietnam. This work represents a retrospective...
We aim to describe morphological structures of skull fractures and relevant factors in motorcycle accident victims in Vietnam. This work represents a retrospective cross-sectional study based on forensic reports of fatal motorcycle accident victims. Between January 2013 and August 2019, a total of 226 fatal motorcycle accident patients with skull fracture diagnoses were enrolled. Linear and depressed fractures were the common patterns (46.0% and 37.2% of cases, respectively), whereas stellate (11.5%) fractures were rare. Fractures of the temporal bone (68.6% of cases) and basilar skull (60.6%) were the most common, whereas fractures of the parietal bone were the least common (9.7%). Two or more patterns of skull fracture were recorded in 25.5% of cases, and 2 or more fracture locations were recorded in 76.6% of cases. Fractures of the parietal bone were associated with victims not wearing a helmet. In addition, fractures of the basilar skull were more likely to occur among victims with alcohol consumption. We found the common pattern of skull fractures was linear and depressed fractures, and the common location of skull fractures was temporal and basilar bone. Further studies that include larger sample sizes and collect more information should be conducted to better understand relationships between skull fractures and related factors.
Topics: Accidents, Traffic; Adult; Alcohol Drinking; Cross-Sectional Studies; Female; Fractures, Multiple; Humans; Male; Middle Aged; Motorcycles; Retrospective Studies; Skull Fractures; Vietnam; Young Adult
PubMed: 33074839
DOI: 10.1097/PAF.0000000000000627 -
Journal of Oral and Maxillofacial... Jul 2023Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair.
BACKGROUND
Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair.
PURPOSE
This study aims to identify factors associated with antibiotic prescribing patterns and measures the association between antibiotic exposure and postoperative infections.
STUDY DESIGN, SETTING, SAMPLE
In this retrospective cohort study, TriNetX, a research database, was used to gather data on patients under 18 years of age who underwent repair of facial fractures. The records were obtained from 2003 to 2021. Current Procedural Terminology codes for facial fracture procedures were used to identify patients.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE
Antibiotic use, defined as a binary categorical variable of whether or not patients received perioperative antibiotics. The secondary predictor variable was timing of antibiotic administration, categorized by pre, intra, and postoperative administration.
MAIN OUTCOME VARIABLES
Postoperative infection, determined by International Classification of Diseases, 9th and 10th Revision codes within patient charts.
COVARIATES
Covariates included demographic variables such as age, sex, race, ethnicity, geographic location, and fracture characteristics, such as number of fractures and location of fracture.
ANALYSES
χ analyses were used for categorical variables and two sample t tests for quantitative variables. Multivariable logistic regression was used to evaluate patient infection and antibiotic use with adjustment for covariates. P-values were 2-tailed and statistical significance was defined as P < .05.
RESULTS
This cohort included 5,413 patients of which 70.4% were male, 74.4% identified as white, and 83.3% identified as non-Hispanic or Latino. There were no differences in postoperative infections in patients who received antibiotics compared to those who did not (0.9 vs 0.5%, respectively, P = .12). Nevertheless, antibiotic prescriptions have increased over the years. After controlling for relevant covariates, antibiotic use did not decrease the odds of infection (adjusted odds ratio 1.1, 95% CI 0.53 to 2.34, P = .79). There was a significant association between the timing of antibiotic use and infection (P = .044), with increased odds of infection when antibiotics were given postoperatively (adjusted odds ratio 3.8, 95% CI 1.2 to 12.07, P = .023).
CONCLUSION AND RELEVANCE
While antibiotic prescriptions have increased over the years, this study demonstrates there is no difference in postoperative infection rates for pediatric patients prescribed antibiotics and those where were not.
Topics: Humans; Male; Child; Adolescent; Female; Anti-Bacterial Agents; Retrospective Studies; Postoperative Complications; Skull Fractures
PubMed: 37116541
DOI: 10.1016/j.joms.2023.03.017 -
Laryngo- Rhino- Otologie Mar 2020Associated injuries are a common feature in pediatric facial fractures, which reinforce the importance of a complete initial assessment of a child with facial...
Associated injuries are a common feature in pediatric facial fractures, which reinforce the importance of a complete initial assessment of a child with facial trauma.Particular kinds of fracture tend to occur at specific anatomic sites in children, with the severity and extent of the fracture varying according to the patient's age and the stage of skeletal development. The frequency of severe fractures increases with age, as does the frequency of surgically treated fractures. Maxillofacial surgical intervention is indicated only for the repair of severely displaced fractures that are likely to cause functional impairment, esthetic deformity, or both. The effect of treatment on long-term growth and development must be the cornerstone when choosing the optimal therapeutic option. While internal fixation is routinely used for adult facial trauma patients, the application of these surgical techniques in children is controversial as subperiosteal dissection might disturb the growth of the bone.
Topics: Adult; Child; Facial Bones; Fracture Fixation, Internal; Humans; Maxillofacial Injuries; Skull Fractures; Traumatology
PubMed: 32120439
DOI: 10.1055/a-1071-2061 -
Oral and Maxillofacial Surgery Clinics... Nov 2023Fractures of the pediatric midface are infrequent, particularly in children in the primary dentition, due to the prominence of the upper face relative to the midface and... (Review)
Review
Fractures of the pediatric midface are infrequent, particularly in children in the primary dentition, due to the prominence of the upper face relative to the midface and mandible. With downward and forward growth of the face, there is an increasing frequency of midface injuries seen in children in the mixed and adult dentitions. Midface fracture patterns seen in young children are quite variable; those in children at or near skeletal maturity mimic patterns seen in adults. Non-displaced injuries can typically be managed with observation. Displaced fractures require treatment with appropriate reduction and fixation and longitudinal follow-up to evaluate growth.
Topics: Adult; Humans; Child; Child, Preschool; Zygomatic Fractures; Maxillary Fractures; Skull Fractures; Mandible; Tomography, X-Ray Computed
PubMed: 37302948
DOI: 10.1016/j.coms.2023.04.004 -
Otolaryngologic Clinics of North America Dec 2023Nasal fractures are very common. The literature describes early intervention (<14 days) with closed techniques as cost-effective, minimizing the need for possible... (Review)
Review
Nasal fractures are very common. The literature describes early intervention (<14 days) with closed techniques as cost-effective, minimizing the need for possible secondary surgeries and improved early patient satisfaction. However, the authors observe a measurably high rate of subsequent open treatment after closed treatment, particularly where there is significant septal involvement in the fracture. Moreover, delayed intervention (>3 months) with an open approach has many advantages over early closed technique, including lower revision rate, improved ability for rigid fixation and support, and the ability to correct severe dorsal or caudal L-strut deformities, nasal valve issues, and severe nasal bony deviation/deformities.
Topics: Humans; Nasal Bone; Rhinoplasty; Nasal Septum; Retrospective Studies; Patient Satisfaction; Skull Fractures; Treatment Outcome
PubMed: 37353368
DOI: 10.1016/j.otc.2023.05.004