nach oben

Erschienen in:

03.08.2019 | Original Article

Maxillofacial injuries in severely injured patients after road traffic accidents—a retrospective evaluation of the TraumaRegister DGU® 1993–2014

verfasst von: Sebastian Pietzka, Peer W. Kämmerer, Silke Pietzka, Alexander Schramm, Lorenz Lampl, Rolf Lefering, Dan Bieler, Martin Kulla

Erschienen in: Clinical Oral Investigations | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Objectives

It was the aim of the study to analyse the prevalence of maxillofacial trauma (MFT) in severely injured patients after road traffic accidence (RTA) and to investigate associated factors.

Materials and methods

In a retrospective study, data from patients after RTA by the TraumaRegister DGU® from 1993 to 2014 were evaluated for demographical and injury characteristics. The predictor variable was mechanism of injury and the outcome variables were type of injury, severity and hospital resources utilization.

Results

During the investigation period, n = 62,196 patients were enclosed with a prevalence of maxillofacial injuries of 20.3% (MFT positive). The injury severity score of MFT-positive patients was higher than in the MTF-negative subgroup (27 ± 12.8 vs. 23.0 ± 12.7). If MFT positive, 39.8% show minor, 37.1% moderate, 21.5% serious and 1.6% severe maxillofacial injuries. Injuries of the midface occurred in 60.3% of MTF-positive patients. A relevant blood loss (> 20% of total blood volume) occurred in 1.9%. MFT-positive patients had a higher coincidence with cervical spine fractures (11.3% vs. 7.8%) and traumatic brain injuries (62.6% vs. 34.8%) than MFT-negative patients. There was a noticeable decrease in the incidence of facial injuries in car/truck drivers during the study period.

Conclusions

Every 5th patient after RTA shows a MFT and the whole trauma team must be aware that this indicates a high prevalence of traumatic brain and cervical spine injuries.

Clinical relevance

Even if sole injuries of the face are seldom life threatening, maxillofacial expertise in interdisciplinary trauma centres is strongly recommended.

Jin Z, Jiang X, Shang L (2014) Analysis of 627 hospitalized maxillofacial-oral injuries in Xi'an, China. Dent Traumatol 30:147–153. https://doi.org/10.1111/edt.12044 CrossRefPubMed

Yokoyama T, Motozawa Y, Sasaki T, Hitosugi M (2006) A retrospective analysis of oral and maxillofacial injuries in motor vehicle accidents. J Oral Maxillofac Surg 64:1731–1735. https://doi.org/10.1016/j.joms.2005.11.104 CrossRefPubMed

Ramli R, Oxley J, Noor FM, Abdullah NK, Mahmood MS, Tajuddin AK, McClure R (2014) Fatal injuries among motorcyclists in Klang Valley, Malaysia. J Forensic Legal Med 26:39–45. https://doi.org/10.1016/j.jflm.2014.06.007 CrossRef

Schneider D, Kämmerer PW, Schon G, Dinu C, Radloff S, Bschorer R (2015) Etiology and injury patterns of maxillofacial fractures from the years 2010 to 2013 in Mecklenburg-Western Pomerania, Germany: a retrospective study of 409 patients. J Craniomaxillofac Surg 43:1948–1951. https://doi.org/10.1016/j.jcms.2015.06.028 CrossRefPubMed

Nobrega LM, Cavalcante GM, Lima MM, Madruga RC, Ramos-Jorge ML, d'Avila S (2014) Prevalence of facial trauma and associated factors in victims of road traffic accidents. Am J Emerg Med 32:1382–1386. https://doi.org/10.1016/j.ajem.2014.08.054 CrossRefPubMed

Dempf R, Hausamen JE (2000) [Fractures of the facial skull) Gesichtsschädelfrakturen. Unfallchirurg 103:301–313CrossRefPubMed

Esmer E, Delank KS, Siekmann H, Schulz M, Derst P (2016) Facial injuries in polytrauma - which injuries can be expected? A retrospective evaluation from the TraumaRegister DGU(R). Notfall Rettungsmed 19:92–98CrossRef

Rothweiler R, Bayer J, Zwingmann J, Suedkamp NP, Kalbhenn J, Schmelzeisen R, Gutwald R (2018) Outcome and complications after treatment of facial fractures at different times in polytrauma patients. J Craniomaxillofac Surg 46:283–287. https://doi.org/10.1016/j.jcms.2017.11.027 CrossRefPubMed

Reich W, Surov A, Eckert AW (2016) Maxillofacial trauma - underestimation of cervical spine injury. J Craniomaxillofac Surg 44:1469–1478. https://doi.org/10.1016/j.jcms.2016.06.017 CrossRefPubMed

10.

Einy S, Abdel Rahman N, Siman-Tov M, Aizenbud D, Peleg K (2016) Maxillofacial trauma following road accidents and falls. J Craniofac Surg 27:857–861. https://doi.org/10.1097/SCS.0000000000002555 CrossRefPubMed

11.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X CrossRef

12.

Ruchholtz S, Lefering R, Lewan U, Debus F, Mand C, Siebert H, Kuhne CA (2014) Implementation of a nationwide trauma network for the care of severely injured patients. J Trauma Acute Care Surg 76:1456–1461. https://doi.org/10.1097/TA.0000000000000245 CrossRefPubMed

13.

Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B (2014) Update of the trauma risk adjustment model of the TraumaRegister DGU: the revised injury severity classification, version II. Crit Care 18:476. https://doi.org/10.1186/s13054-014-0476-2 CrossRefPubMedPubMedCentral

14.

Wirtz M (2004) On the problem of missing data: how to identify and reduce the impact of missing data on findings of data analysis. Rehabilitation (Stuttg) 43:109–115. https://doi.org/10.1055/s-2003-814839 CrossRef

15.

O'Connor RC, Shakib K, Brennan PA (2015) Recent advances in the management of oral and maxillofacial trauma. Br J Oral Maxillofac Surg 53:913–921. https://doi.org/10.1016/j.bjoms.2015.08.261 CrossRefPubMed

16.

Rashid A, Eyeson J, Haider D, van Gijn D, Fan K (2013) Incidence and patterns of mandibular fractures during a 5-year period in a London teaching hospital. Br J Oral Maxillofac Surg 51:794–798. https://doi.org/10.1016/j.bjoms.2013.04.007 CrossRefPubMed

17.

Caldas IM, Magalhaes T, Afonso A, Matos E (2008) Orofacial damage resulting from road accidents. Dent Traumatol 24:410–415. https://doi.org/10.1111/j.1600-9657.2008.00584.x CrossRefPubMed

18.

Manan M, Varhelyi A (2012) Motorcycle fatalities in Malaysia. IATSS Res 36:30–39CrossRef

19.

Corazza M, Trincone S, Virgili A (2004) Effects of airbag deployment: lesions, epidemiology, and management. Am J Clin Dermatol 5:295–300CrossRefPubMed

20.

Huber CD, Lee JB, Yang KH, King AI (2005) Head injuries in airbag-equipped motor vehicles with special emphasis on AIS 1 and 2 facial and loss of consciousness injuries. Traffic Inj Prev 6:170–174. https://doi.org/10.1080/15389580590931644 CrossRefPubMed

21.

Al-Khateeb T, Abdullah FM (2007) Craniomaxillofacial injuries in the United Arab Emirates: a retrospective study. J Oral Maxillofac Surg 65:1094–1101. https://doi.org/10.1016/j.joms.2006.09.013 CrossRefPubMed

22.

Moafian G, Aghabeigi MR, Heydari ST, Hoseinzadeh A, Lankarani KB, Sarikhani Y (2013) An epidemiologic survey of road traffic accidents in Iran: analysis of driver-related factors. Chin J Traumatol 16:140–144PubMed

23.

Hogg NJ, Stewart TC, Armstrong JE, Girotti MJ (2000) Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada, between 1992 and 1997. J Trauma 49:425–432CrossRefPubMed

24.

Kuhne CA, Krueger C, Homann M, Mohr C, Ruchholtz S (2007) Epidemiology and management in emergency room patients with maxillofacial fractures. Mund Kiefer Gesichtschir 11:201–208. https://doi.org/10.1007/s10006-007-0063-7 CrossRefPubMed

25.

Joos U, Piffko J, Meyer U (2001) Treatment of frontobasal trauma and polytrauma. Mund Kiefer Gesichtschir 5:86–93. https://doi.org/10.1007/s100060000283 CrossRefPubMed

26.

van Hout WM, Van Cann EM, Abbink JH, Koole R (2013) An epidemiological study of maxillofacial fractures requiring surgical treatment at a tertiary trauma Centre between 2005 and 2010. Br J Oral Maxillofac Surg 51:416–420. https://doi.org/10.1016/j.bjoms.2012.11.002 CrossRefPubMed

27.

Walker TW, Donnellan J, Byrne S, McArdle N, Kerin MJ, McCann PJ (2012) West of Ireland facial injury study. Part 2. Br J Oral Maxillofac Surg 50:e99–e103. https://doi.org/10.1016/j.bjoms.2011.09.026 CrossRefPubMed

28.

Tsang KK, Whitfield PC (2012) Traumatic brain injury: review of current management strategies. Br J Oral Maxillofac Surg 50:298–308. https://doi.org/10.1016/j.bjoms.2011.03.004 CrossRefPubMed

29.

Aladelusi T, Akinmoladun V, Olusanya A, Akadiri O, Fasola A (2014) Analysis of road traffic crashes-related maxillofacial injuries severity and concomitant injuries in 201 patients seen at the UCH, Ibadan. Craniomaxillofac Trauma Reconstr 7:284–289. https://doi.org/10.1055/s-0034-1378183 CrossRefPubMedPubMedCentral

30.

Haug RH, Savage JD, Likavec MJ, Conforti PJ (1992) A review of 100 closed head injuries associated with facial fractures. J Oral Maxillofac Surg 50:218–222CrossRefPubMed

31.

Surgeons ACo (2012) American College of Surgeons Committee on trauma: advanced trauma life support(R) student course manual Chicago

32.

Pehle B, Kuehne CA, Block J, Waydhas C, Taeger G, Nast-Kolb D, Ruchholtz S (2006) The significance of delayed diagnosis in multiply tramatised patients. A study of 1187 trauma room patients. Unfallchirurg 109:964–974CrossRefPubMed

33.

LewisVL J, Manson PN, Morgan RF, Cerullo LJ, Meyer PR Jr (1985) Facial injuries associated with cervical fractures: recognition, patterns, and management. J Trauma 25:90–93CrossRef

34.

Jamal BT, Diecidue R, Qutob A, Cohen M (2009) The pattern of combined maxillofacial and cervical spine fractures. J Oral Maxillofac Surg 67:559–562. https://doi.org/10.1016/j.joms.2008.07.010 CrossRefPubMed

35.

Mulligan RP, Mahabir RC (2010) The prevalence of cervical spine injury, head injury, or both with isolated and multiple craniomaxillofacial fractures. Plast Reconstr Surg 126:1647–1651CrossRefPubMed

36.

Sargent LA, Rogers GF (1999) Nasoethmoid orbital fractures: diagnosis and management. J Craniomaxillofac Trauma 5:19–27PubMed

37.

Scholz R, Scholz F, Sudasch G, Schobel G, Schober C (1991) Delayed primary management of midfacial fractures. Fortschr Kiefer Gesichtschir 36:79–80PubMed

38.

Christie B, Block L, Ma Y, Wick A, Afifi A (2018) Retrobulbar hematoma: a systematic review of factors related to outcomes. J Plast Reconstr Aesthet Surg 71:155–161. https://doi.org/10.1016/j.bjps.2017.10.025 CrossRefPubMed

39.

Nastro Siniscalchi E, Catalfamo L, Pitrone A, Papa R, Fama F, Lo Giudice G, Cervino G, Cicciu M, De Ponte FS (2016) Traumatic Pseudoaneurysm of the internal maxillary artery: arare life-threatening hemorrhage as a complication of maxillofacial fractures. Case Rep Med 2016:9168429. https://doi.org/10.1155/2016/9168429 CrossRefPubMedPubMedCentral

40.

Debus F, Lefering R, Frink M, Kuhne CA, Mand C, Bucking B, Ruchholtz S (2015) Numbers of severely injured patients in Germany. A retrospective analysis from the DGU (German Society for Trauma Surgery) trauma registry. Dtsch Arztebl Int 112:823–829. https://doi.org/10.3238/arztebl.2015.0823 CrossRefPubMedPubMedCentral

41.

Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG, and Working Group on Polytrauma of the German Trauma S (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461. https://doi.org/10.1016/S0140-6736(09)60232-4 CrossRefPubMed

42.

Palm HG, Kulla M, Wettberg M, Lefering R, Friemert B, Lang P, TraumaRegistrer DGU (2017) Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-Centre study based on the trauma registry of the German trauma society (TraumaRegister DGU((R))). Eur J Trauma Emerg Surg 44:759–766. https://doi.org/10.1007/s00068-017-0870-y CrossRefPubMed

43.

Ringdal KG, Skaga NO, Hestnes M, Steen PA, Roislien J, Rehn M, Roise O, Kruger AJ, Lossius HM (2013) Abbreviated injury scale: not a reliable basis for summation of injury severity in trauma facilities. Injury 44:691–699. https://doi.org/10.1016/j.injury.2012.06.032 CrossRefPubMed

Titel: Maxillofacial injuries in severely injured patients after road traffic accidents—a retrospective evaluation of the TraumaRegister DGU® 1993–2014
verfasst von: Sebastian Pietzka
Peer W. Kämmerer
Silke Pietzka
Alexander Schramm
Lorenz Lampl
Rolf Lefering
Dan Bieler
Martin Kulla
Publikationsdatum: 03.08.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Oral Investigations / Ausgabe 1/2020
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-019-03024-6

Bestellen Sie unseren kostenlosen Newsletter Update Zahnmedizin und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Maxillofacial injuries in severely injured patients after road traffic accidents—a retrospective evaluation of the TraumaRegister DGU® 1993–2014