2017 Sec 1 Green Book

The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014

TABLE 1. Distribution of Fractures Observed

Male

Female

Total

Number of patients

222 14.7 328 118

63

285 14.2 431 139 125

Mean age, y

12.7 103

Number of fractures Mandible fractures Orbital fractures Zygoma fractures Nasal fractures

21 33

92 26 48 21

9

35 69 36

21 15

Frontal bone/sinus fractures

Palate fractures

5

2 2

7

Le Fort variant fractures

18

20

reason for this is likely related to the high-energy mechanism often associated with fracture of the facial skeleton. The objective of this study is to examine associations between modes of presentation, fracture patterns, and concomitant life-threatening injuries in all facial fractures diagnosed via a radiographic study at a level 1 trauma center during a predetermined period. METHODS After institutional review board approval, all facial fractures occurring at a level 1 trauma center (University Hospital, Newark, NJ) between January 2000 and December 2012 were collected based on International Classification of Disease, Revision 9, codes. These results were further refined to include only those patients in the pediatric population (age of 18 years or younger). Patient demo- graphics were collected as well as mechanism of injury, Glasgow Coma Scale (GCS) on presentation, fracture locations, concomitant injuries, and fracture management strategies. Comparisons were made between type of fracture, mechanism of injury, GCS on presentation,

FIGURE 1. Concomitant injuries.

length of hospital stay, and life-threatening injuries such as cervi- cal spine injury and intracranial hemorrhage. A significance value of 5% was used.

RESULTS During this period, there were 3147 patients with facial fractures treated at our institution, 353 of which were pediatric patients. Upon further review, 68 patients were excluded because of insufficient data for analysis, leaving 285 patients for review, with a total of 431 fractures. The mean age of patients was 14.2 years with a strong male predominance (78%). The mandible was the most common bone fractured followed by fractures of the orbit (Table 1). Figure 1

TABLE 2. Fracture Types and Concomitant Injuries

Lumbar/ Thoracic Spine Fracture

No Lumbar/Thoracic

Cervical Spine Fracture

No Cervical Spine Fracture

Odds Ratio (95% CI)

Spine Fracture Odds Ratio

ICH

No ICH Odds Ratio

Mandible fracture

3 1 4 8 5 3

136

NS NS

3 2 2 8 6 3

136

NS

16

123

0.22 (0.12 – 0.41)*

Palatal fracture Zygoma fracture Orbital fracture Nasal fracture Frontal bone/sinus fracture Le Fort fracture Mandible fracture Palatal fracture Zygoma fracture Orbital fracture Frontal bone/sinus fracture Le Fort fracture Nasal fracture

6

5

11.9 (2.0 – 70.1) †

3

4

NS

33

4.9 (1.3 – 18.2) †

35

NS NS

16 48 30 25

21 79 39 11

2.7 (1.3 – 5.6) 3.8 (2.1 – 6.7)* 3.4 (1.9 – 6.1)* 10.3 (4.7 – 22.5)*

119 5.2 (1.1 – 25.1) †

119

64 33

NS NS

63 33

4.0 (1.2 – 13.6) †

NS

2

18

NS

1

19

NS

8

12

NS

Skull Fracture No Skull Fracture

Odds Ratio Long Bone Fracture

No Long Bone Fracture

Odds Ratio Abdominal/Pelvic/ Thoracic Injury

No Abdominal/Pelvic/ Thoracic Injury

Odds Ratio

14

125 0.33 (0.17 – 0.64)* 14

125

NS

12

126

NS NS NS NS

4

3

6.6 (1.4 – 30.2)*

4 5

3

10.3 (2.2 – 47.9)*

2 6

5

10 38 16 26

27 89 53

NS

32

NS NS NS NS

31

4.8 (2.4 – 9.4)*

19 10

108

16 12

111

NS

59 31

57 29

2.3 (1.0 – 5.1) †

10 23.3 (10.1 – 53.9)* 5

7

NS

8

12

3.4 (1.3 – 8.9)*

4

16

NS

6

14

4.3 (1.5 – 12.2)*

* P < 0.01; † P < 0.05. CI, confidence interval; ICH, intracranial hemorrhage; NS, not significant.

© 2014 Mutaz B. Habal, MD

38