Clinical Paper
Trauma
Complications related to midfacial fractures: operative versus non-surgical treatment

https://doi.org/10.1016/j.ijom.2010.08.006Get rights and content

Abstract

The treatment of midfacial fractures depends on the dislocation of the fracture and patient-related limitations. Surgical treatment risks iatrogenic complications. In 740 patients with midfacial fractures, the age, sex, fracture type, concomitant injuries, cause of accident and the decision to use operative or non-surgical treatment were recorded. Follow-up was performed 6 and 12 months after the injury. In 41% the fractures were isolated; they were multiple in 59%. Initially, hypaesthesia of the infraorbital nerve was present in 10% of the single and 16% of the multiple fracture patients. Surgical treatment was performed in 57% of the single and in 75% of the multiple fracture patients. Women underwent surgical treatment considerably less frequently than men. After 6 and 12 months, significantly more complications were present in the surgically treated cohort. Nerve disturbances and ‘meteorosensitivity’ were most prominent. These results, together with previous findings, indicate that there is a need for prospective clinical investigations that fulfil the criteria of evidence-based medicine to generate guidelines for decision making in trauma surgery. In the meantime, the decision to use surgical treatment for midfacial fractures has to be made carefully.

Introduction

Patients with midfacial fractures often present to maxillofacial emergency departments following sport accidents, traffic accidents or violence.8 Owing to the heterogeneous presentation of midfacial injuries and the concomitant injuries, deciding on treatment may be difficult and possible complications and their relative risk play a crucial role in the decision. The decision making process is complicated by the frequent presence of multiple fractures and concomitant injuries, and iatrogenic complications.

The initial diagnostic management is well established and standardized2, 10. A precise clinical and radiological examination includes the orbit, eye ball and soft tissues, and neighbouring structures8, 11, 12. Concomitant injuries are common and include haematomas, ocular injuries, and nerve disturbances. The incidence of infraorbital nerve (ION) paraesthesias is common1, 7, 13. The underlying pathophysiology is heterogeneous; the nerve can be injured because it lies within the fracture or it can be affected by haemorrhage or oedema. The influence of surgical procedures on the nerve's regenerative capacity is also controversial. Another complication of midfacial fractures is meteorosensitivity (pain or discomfort caused by certain weather conditions), which is often mentioned by patients as a reason for decreased quality of life after osteosynthetically treated midfacial fractures.

These complications can also be provoked iatrogenically or can be reduced by the choice of treatment. Although many studies have investigated the complications related to different surgical treatments or types of fractures, little attention has been paid to complications related to non-surgical treatment.

The aim of this study is to investigate and evaluate complications related to midfacial trauma and to the non-surgical or surgical treatment used to treat it.

Section snippets

Materials and methods

The authors carried out a retrospective review of the records 844 patients with midfacial injuries introduced to their department between January 2001 and December 2003. These patients were treated either non-surgically or surgically. Surgical treatment is defined as active closed or open reduction with osteosynthesis; non-surgical treatment includes any other treatment option. The criteria for surgical treatment were displacement and/or impairment of functionality.

Initially the following

Results

Between January 2001 and December 2003, the data from 844 patients with midfacial injuries were recorded in a database. 740 patients (88%) presented had fractures in the midface and were included in this investigation. The main causes of these fractures and the concomitant injuries were sports accidents (33%) followed by road accidents (15%), violence (10%) and accidents at work (8%) (Table 1).

Discussion

Midfacial fractures are a common injury in oral and maxillofacial surgery. At the authors’ institution in Innsbruck, near the Alps, the cause is mainly related to sports activities8. Sport-related injuries tend to lead to midfacial fractures6. Midfacial fractures affect a variety of neighbouring anatomical structures that are likely to be involved in the patho-mechanism of concomitant injuries. Treatment depends on the seriousness of the injury. The indication for surgical intervention is

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

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