DOCSLIB.ORG

Analysis of Pediatric Maxillofacial Trauma in North China: ✩ ,✩✩ Epidemiology, Pattern, and Management

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Analysis of Pediatric Maxillofacial Trauma in North China: ✩ ,✩✩ Epidemiology, Pattern, and Management Injury 51 (2020) 1561–1567 Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury Analysis of pediatric maxillofacial trauma in North China: ✩ ,✩✩ Epidemiology, pattern, and management ∗∗ Wei Zhou, Jingang An, , Yang He, Yi Zhang Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China a r t i c l e i n f o a b s t r a c t Article history: Purpose: To analyze epidemiology, pattern, and management of pediatric maxillofacial trauma in North Accepted 25 April 2020 China. Patients and Methods: Clinical records of patients aged 0–18 years with maxillofacial trauma, from Jan- Keywords: uary 2008 to December 2016 were reviewed. 390 patients with an average age of 9.8 ±5.8 years (range: Children 8 months–18 years) and a male:female ratio of approximately 2:1 were included in the study. Epidemio- Maxillofacial Trauma logical features (age, sex, etiology), characteristics of injuries (locations, types, associated injuries), treat- Pediatric Trauma Fracture ments, and complications were analyzed. Results: Among 55 patients with soft tissue injuries, palate was the most common site (32.7%). Among 335 fracture cases, the most common age group was 16–18 years (25.1%); falls was the main cause (38.2%). Overall, there were 450 fractures (1.78 per capita), primarily mandible (69.3%), followed by zy- goma (12.9%), maxilla (7.7%) and other sites. Multiple fractures occurred in 61.5% of patients. The most common site of mandibular fractures was condyle. The proportion of mid-face fractures to mandibular fractures increased with age (p < 0.01) and stabilized gradually after 12 (approximately 1.14:1). 77.5% of fractures were treated surgically. There was an independent association of surgical intervention with age older than 6 years old (p < 0.05). Absorbable plates were mainly applied to mandibular fractures in patients aged 0–7 and only 1 was removed because of insufficient fixation strength. Conclusions: The primary cause of pediatric maxillofacial fractures in North China was falls; traffic acci- dents led more multiple fractures and associated injuries. Palate and mandible were the most common sites of pediatric maxillofacial soft tissue injuries and fractures, respectively. The proportion of mandibu- lar fractures to mid-face fractures decreased with the increase of age until 12. ©2020 Elsevier Ltd. All rights reserved. Maxillofacial trauma is infrequent in pediatric population [1 , 2] . Management of maxillofacial trauma must be planned by taking Studies have shown that maxillofacial fractures in children un- into account the fact that unlike adults, children are in the growth der 16 years old account for 1%–14% of all fractures, while and development stage. If not appropriately managed, complica- those in children under 5 years old account for only 0.87%–1% tions such as growth disturbances and temporomandibular joint [3 , 4] . This reduced incidence may be explained by the flexibil- (TMJ) ankylosis may occur [8 , 11 , 12] . Therefore, understanding the ity of pediatric skeleton, the large quantities of facial soft tis- characteristics of pediatric maxillofacial trauma can help clinicians sues, the presence of unerupted teeth, the lack of paranasal si- in performing accurate diagnosis and selecting appropriate treat- nus pneumatization, as well as being protected by parents and ment methods [6] . schools [5–10] . Owing to the influence of social, environmental, and economic factors, the characteristics of pediatric maxillofacial trauma are as- sociated with time and region, with a certain degree of variation [7 , 13–15] . Only a few studies have been conducted on pediatric maxillofacial trauma in China in the past decade. The purpose of ✩ Declarations of interest: none this article was to analyze the epidemiology, pattern, and manage- ✩✩ This research did not receive any specific grant from funding agencies in the ment of pediatric maxillofacial trauma treated at our institution in public, commercial, or not-for-profit sectors. ∗ Correspondence author. the past 9 years. Our study was approved by the medical ethics E-mail address: [email protected] (J. An). committee in our hospital. https://doi.org/10.1016/j.injury.2020.04.053 0020-1383/© 2020 Elsevier Ltd. All rights reserved. 1562 W. Zhou, J. An and Y. He et al. / Injury 51 (2020) 1561–1567 Fig. 2. Location of soft injury by percentage. Fig. 1. Annual distribution of patients. Patients and methods Study sample 390 consecutive patients aged 0–18 years with maxillofacial trauma, from January 2008 to December 2016 were eligible for this study. The mean age was 9.8 ± 5.8 years and ranged from 8 months to 18 years. 262 were males and 128 were females, with a male-to-female ratio of approximately 2:1. The medical records of them were retrospectively retrieved and analyzed for prevalence, etiology, pattern, management, and complications of maxillofacial trauma. Fig. 3. Distribution of patients in different age groups by sex. Variables Patients were divided into 6 age groups: 0–3, 4–6, 7–9, 10–12, 13–15, and 16–18 years. The mechanism of trauma included falls, motor vehicle accidents (MVA), bicycle accidents, sports, violence, and others. MVA included car accidents, motorcycle accidents, and car-pedestrian accidents. Trauma was divided into two types: soft tissue injuries and fractures. Soft tissue injuries were classified as injuries in palate, lips, tongue, cheek, and other sites. Fractures were categorized as mandible, maxilla, zygoma, orbit and naso-orbital-ethmoid (NOE). Sites of mandibular fractures included symphysis, parasymphysis, body, angle, ramus, coronoid, condyle, and alveolar process. As a special type of maxillary fracture, Le Fort fracture was separately Fig. 4. Mechanisms of injury by percentage. analyzed. received debridement and sutures. In addition, 7 patients sustained Statistical analysis facial nerve injury, and 6 of them underwent facial nerve anasto- mosis. Two patients experienced parotid duct injury, one of whom Following data were subjected to statistically analysis: age, sex, received parotid duct anastomosis while the other received parotid etiology, location and type of injuries, associated injuries, and duct ligation. treatment methods. Chin-square test was performed using SPSS version 20.0 (SPSS, Chicago, IL), with a 2-sided significance level set at p < 0.05. Maxillofacial fracture Results Fracture was diagnosed in 335 patients. The incidence was highest in the 16–18 years age group (25.1%) and lowest in the 10– There were 55 cases of soft tissue injuries and 335 cases of frac- 12 years age group (9.3%). Two peaks were found at the ages of 6 ≤ tures. Figure 1 shows patient distribution during the entire study and 16–18, respectively ( Fig. 3 ). The male-to-female ratio aged 12 > period. years was 1.6:1, while it increased to 2.9:1 in patients aged 12 years. Maxillofacial soft tissue injury Mechanism of injury Most of the 55 patients with soft tissue injuries were children The primary mechanism of fractures was falls (38.2%), followed aged < 5 years (38/55). The most common site was palate, followed by MVA (19.4%) ( Fig. 4 ). Mechanism of fractures was associated by cheek, lips, tongue, and other sites ( Fig. 2 ). Two patients were with patient age. Falls was the most common etiology in children not treated owing to their general conditions, and the remaining aged ≤6 years (56.5%), while in those aged > 6 years, the leading W. Zhou, J. An and Y. He et al. / Injury 51 (2020) 1561–1567 1563 Table 1 Concomitant Injuries Injured Organ System Type of Injury n % of total Head and neck Cerebral injury 28 12.8 Dental injury 103 47.2 Cervical spine injury 2 0.9 Eye injury 8 3.7 Ear injury 2 0.9 Facial nerve palsy 4 1.8 Parotid duct damage 1 0.5 Thorax Rib fracture 3 1.4 Pneumothorax/hemothorax 7 3.2 Lung contusion 7 3.2 Abdomen Liver 3 1.4 Fig. 5. Distribution of different fractures in each age group. Spleen 1 0.5 Bladder 1 0.5 Gastrointestinal hemorrhage 1 0.5 Upper limbs Upper limb fracture 23 10.6 Lower limbs Lower limb fracture 24 11.0 etiology was MVA (35.7%) (p < 0.001). Isolated fractures were pri- marily caused by falls, while multiple fractures were mostly caused by MVA (p < 0.001). Associated injury In total, 159 (57.9%) patients sustained associated injuries. The Fig. 6. Mandibular symphysis fracture in a 4-year-old boy (fracture line crossing the canine bud). most common associated injury was dental injury (47.2%), which was categorized as avulsion (51.6%), tooth fracture (34.9%), extru- sion (10.3%) and intrusion (3.2%). Other high prevalence of asso- Treatment and outcome ciated injuries included cerebral injury (12.8%), lower limb frac- Among the 335 patients, 77.5% of fractures were treated sur- ture (11.0%), and upper limb fracture (10.6%) ( Table 1 ). Among pa- gically whereas 22.5% of fractures were treated conservatively. tients with associated injuries, MVA was the most common cause Surgical treatment included closed reduction and open reduction (45.9%). ( Fig. 7 ). Conservative treatment consisted of observation, diet man- agement, maxillomandibular fixation (MMF), and splints. Treat- Location and type of fracture ments by fracture sites were summarized in Table 2 . A significant A total of 597 fractures were registered in the 335 study pa- correlation was noted between treatment method and fracture lo- tients (average: 1.78). Of these, 129 patients (38.5%) sustained iso- cation (p < 0.001) ( Table 4 ). The proportion of surgical treatment lated fractures and 206 patients (61.5%) sustained multiple frac- in patients aged ≤6 years was significantly lower compared with tures. The mandible was the most common fracture site (69.3%), those aged > 6 years (p < 0.05) ( Table 5 ).
Load more

Recommended publications
  • Saving Smiles Avulsion Pathway (Page 20) Saving Smiles: Fractures and Displacements (Page 22)
    Greater Manchester Local Dental Network SavingSmiles Improving outcomes following dental trauma First Edition I Spring 2017 Practitioners’ Toolkit Contents 04 Introduction to the toolkit from the GM Trauma Network 06 History & examination 10 Maxillo-facial considerations 12 Classification of dento-alveolar injuries 16 The paediatric patient 18 Splinting 20 The AVULSED Tooth 22 The BROKEN Tooth 23 Managing injuries with delayed presentation SavingSmiles 24 Follow up Improving outcomes 26 Long term consequences following dental trauma 28 Armamentarium 29 When to refer 30 Non-accidental injury 31 What should I do if I suspect dental neglect or abuse? 34 www.dentaltrauma.co.uk 35 Additional reference material 36 Dental trauma history sheet 38 Avulsion pathways 39 Fractues and displacement pathway 40 Fractures and displacements in the primary dentition 41 Acknowledgements SavingSmiles Improving outcomes following dental trauma Ambition for Greater Manchester Introduction to the Toolkit from The GM Trauma Network wish to work with our colleagues to ensure that: the GM Trauma Network • All clinicians in GM have the confidence and knowledge to provide a timely and effective first line response to dental trauma. • All clinicians are aware of the need for close monitoring of patients following trauma, and when to refer. The Greater Manchester Local Dental Network (GM LDN) has established a ‘Trauma Network’ sub-group. The • All settings have the equipment described within the ‘armamentarium’ section of this booklet to support optimal treatment. Trauma Network was established to support a safer, faster, better first response to dental trauma and follow up care across GM. The group includes members representing general dental practitioners, commissioners, To support GM practitioners in achieving this ambition, we will be working with Health Education England to provide training days and specialists in restorative and paediatric dentistry, and dental public health.
    [Show full text]
  • Pathophysiological Mechanisms of Root Resorption After Dental Trauma: a Systematic Scoping Review Kerstin M
    Galler et al. BMC Oral Health (2021) 21:163 https://doi.org/10.1186/s12903-021-01510-6 RESEARCH ARTICLE Open Access Pathophysiological mechanisms of root resorption after dental trauma: a systematic scoping review Kerstin M. Galler1*, Eva‑Maria Grätz1, Matthias Widbiller1 , Wolfgang Buchalla1 and Helge Knüttel2 Abstract Background: The objective of this scoping review was to systematically explore the current knowledge of cellular and molecular processes that drive and control trauma‑associated root resorption, to identify research gaps and to provide a basis for improved prevention and therapy. Methods: Four major bibliographic databases were searched according to the research question up to Febru‑ ary 2021 and supplemented manually. Reports on physiologic, histologic, anatomic and clinical aspects of root resorption following dental trauma were included. Duplicates were removed, the collected material was screened by title/abstract and assessed for eligibility based on the full text. Relevant aspects were extracted, organized and summarized. Results: 846 papers were identifed as relevant for a qualitative summary. Consideration of pathophysiological mechanisms concerning trauma‑related root resorption in the literature is sparse. Whereas some forms of resorption have been explored thoroughly, the etiology of others, particularly invasive cervical resorption, is still under debate, resulting in inadequate diagnostics and heterogeneous clinical recommendations. Efective therapies for progres‑ sive replacement resorptions have not been established. Whereas the discovery of the RANKL/RANK/OPG system is essential to our understanding of resorptive processes, many questions regarding the functional regulation of osteo‑/ odontoclasts remain unanswered. Conclusions: This scoping review provides an overview of existing evidence, but also identifes knowledge gaps that need to be addressed by continued laboratory and clinical research.
    [Show full text]
  • Guideline on Management of Acute Dental Trauma
    rEfErence manual v 32 / No 6 10 / 11 Guideline on Management of Acute Dental Trauma Originating Council Council on Clinical Affairs Review Council Council on Clinical Affairs Adopted 2001 Revised 2004, 2007, 2010 Purpose violence, and sports.7-10 All sporting activities have an asso- The American Academy of Pediatric Dentistry (AAPD) ciated risk of orofacial injuries due to falls, collisions, and intends these guidelines to define, describe appearances, and contact with hard surfaces.11 The AAPD encourages the use set forth objectives for general management of acute trau- of protective gear, including mouthguards, which help dis- matic dental injuries rather than recommend specific treat- tribute forces of impact, thereby reducing the risk of severe ment procedures that have been presented in considerably injury.13,14 more detail in text-books and the dental/medical literature. Dental injuries could have improved outcomes if the public were aware of first-aid measures and the need to seek Methods immediate treatment.14-17 Because optimal treatment results This guideline is an update of the previous document re- follow immediate assessment and care,18 dentists have an vised in 2007. It is based on a review of the current dental ethical obligation to ensure that reasonable arrangements and medical literature related to dental trauma. An elec- for emergency dental care are available.19 The history, cir- tronic search was conducted using the following parameters: cumstances of the injury, pattern of trauma, and behavior Terms: “teeth”, “trauma”, “permanent teeth”, and “primary of the child and/or caregiver are important in distin- teeth”; Field: all fields; Limits: within the last 10 years; guishing nonabusive injuries from abuse.20 humans; English.
    [Show full text]
  • Pediatric Orbital Fractures
    Review Article 9 Pediatric Orbital Fractures Adam J. Oppenheimer, MD1 Laura A. Monson, MD1 Steven R. Buchman, MD1 1 Section of Plastic Surgery, Department of Surgery, University of Address for correspondence and reprint requests Steven R. Buchman, Michigan Hospitals, Ann Arbor, Michigan MD, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, Craniomaxillofac Trauma Reconstruction 2013;6:9–20 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340 (e-mail: [email protected]). Abstract It is wise to recall the dictum “children are not small adults” when managing pediatric Keywords orbital fractures. In a child, the craniofacial skeleton undergoes significant changes in ► orbit size, shape, and proportion as it grows into maturity. Accordingly, the craniomaxillo- ► pediatric facial surgeon must select an appropriate treatment strategy that considers both the ► trauma nature of the injury and the child’s stage of growth. The following review will discuss the ► enophthalmos management of pediatric orbital fractures, with an emphasis on clinically oriented ► entrapment anatomy and development. Pediatric orbital fractures occur in discreet patterns, based on 12 years of age. During mixed dentition, the cuspid teeth are the characteristic developmental anatomy of the craniofacial immediately beneath the orbit: hence the term eye tooth in skeleton at the time of injury. To fully understand pediatric dental parlance. It is not until age 12 that the maxillary sinus orbital trauma, the craniomaxillofacial surgeon must first be expands, in concert with eruption of the permanent denti- aware of the anatomical and developmental changes that tion. At 16 years of age, the maxillary sinus reaches adult size occur in the pediatric skull.
    [Show full text]
  • The Impact of Sport Training on Oral Health in Athletes
    dentistry journal Review The Impact of Sport Training on Oral Health in Athletes Domenico Tripodi, Alessia Cosi, Domenico Fulco and Simonetta D’Ercole * Department of Medical, Oral and Biotechnological Sciences, University “G. D’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; [email protected] (D.T.); [email protected] (A.C.); [email protected] (D.F.) * Correspondence: [email protected] Abstract: Athletes’ oral health appears to be poor in numerous sport activities and different diseases can limit athletic skills, both during training and during competitions. Sport activities can be considered a risk factor, among athletes from different sports, for the onset of oral diseases, such as caries with an incidence between 15% and 70%, dental trauma 14–70%, dental erosion 36%, pericoronitis 5–39% and periodontal disease up to 15%. The numerous diseases are related to the variations that involve the ecological factors of the oral cavity such as salivary pH, flow rate, buffering capability, total bacterial count, cariogenic bacterial load and values of secretory Immunoglobulin A. The decrease in the production of S-IgA and the association with an important intraoral growth of pathogenic bacteria leads us to consider the training an “open window” for exposure to oral cavity diseases. Sports dentistry focuses attention on the prevention and treatment of oral pathologies and injuries. Oral health promotion strategies are needed in the sports environment. To prevent the onset of oral diseases, the sports dentist can recommend the use of a custom-made mouthguard, an oral device with a triple function that improves the health and performance of athletes.
    [Show full text]
  • Sideline Emergency Management
    Lecture 13 June 15, 2018 6/15/2018 Sideline Emergency Management Benjamin Oshlag, MD, CAQSM Assistant Professor of Emergency Medicine Assistant Professor of Sports Medicine Columbia University Medical Center Disclosures Nothing to disclose ©AllinaHealthSystems 1 Lecture 13 June 15, 2018 31 New Orleans Criteria • Single center, 1429 patients from 1997-99 • CT needed if patient meets one of the following: –Headache –Vomiting –Age >60 –Drug or alcohol intoxication –Persistent anterograde amnesia –Visible trauma above the clavicle –Seizure • 6.5% of patients (93/1429) had intracranial injuries, 0.4% (6/1429) required neurosurgical intervention • 100% sensitive for intracranial injuries, 25% specific 32 Canadian Head CT Rule • Prospective cohort study at 10 sites in Canada (N=3121) (2001) • Apply only to: –GCS 13-15 –Amnesia or disorientation to the head injury event or +LOC –Injury within 24 hours •Exclusion –Age <16 –Oral anticoagulants –Seizure after injury –Minimal head injury (no LOC, disorientation, or amnesia) –Obvious skull injury/fracture –Acute neurologic deficit –Unstable vitals –Pregnant ©AllinaHealthSystems 16 Lecture 13 June 15, 2018 33 Canadian Head CT Rule • High Risk Criteria (need for NSG intervention) –GCS <15 at 2 hours post injury –Suspected open or depressed skull fracture –Any sign of basilar skull fracture > Hemotympanum, racoon eyes, Battle’s sign, CSF oto/rhinorrhea –>= 2 episodes of vomiting –Age >= 65 –100% sensitivity 34 Canadian Head CT Rule • Medium Risk Criteria (positive CT that usually requires admission) –Retrograde
    [Show full text]
  • PAMELA R.SINGLETARY, D.D.S. JEFFREY B. GREGERSON, D.M.D. TEXAS TOOTH FAIRIES PEDIATRIC DENTISTRY 3401 El SALIDO PKWY, CEDAR PARK TX 78613
    PAMELA R.SINGLETARY, D.D.S. JEFFREY B. GREGERSON, D.M.D. TEXAS TOOTH FAIRIES PEDIATRIC DENTISTRY 3401 El SALIDO PKWY, CEDAR PARK TX 78613 Child’s Name ___________________________ Preferred Name ______________ Age _____ DOB _________Sex: F/M Child’s Physician __________________________________ Phone #_____________________________ Person accompanying child to appointment: ________________________________________________________ Preferred method of contact for appointment reminder notifications: Text Email Phone Call Has your home address/phone number/email changed? YES or NO (If YES, please fill out the following) Address/City/Zip: __________________________________________________________________________________________________ Home Phone : __________________________ Work: ___________________________ Cell# ______________________________ Email Address: ____________________________________________________________________________________________________ Has your dental insurance changed? YES or NO (If YES, please fill out the following and/or allow us to see your card) Insured Name ___________________________________________________________ SSN/ID __________________________________ DOB _____________________________ Relationship to Child __________________________________________ Place of Employment _______________________________________________ Occupation ____________________________________ Work Phone# _____________________________ Name of Dental Carrier _________________________________________________________ Group# _____________________________
    [Show full text]
  • Dental Emergencies
    Dental Emergencies ED visits for dental care are on the rise. Some dental conditions can progress to life-threatening complications; stabilizing patients in such cases is incumbent on the emergency physician, as is management of pain and, to some extent, of the dental condition or injury itself. This article reviews basic dental anatomy as well as nontraumatic and traumatic causes of dental pain. Sandra A. Deane, MD, and Reina Parker, MD he ED is increasingly utilized by pa- patients utilizing the ED for dental care were of a tients for dental care. In 2002, ap- lower income bracket.2 In California during the pe- proximately 2.7% of ED visits were riod from 2005 to 2007, more than 80,000 ED visits attributed to dental problems1; since per year were made for preventable dental prob- Tthen, the circumstances leading to this rate of usage lems, with a seven-times higher incidence of visits have persisted or worsened. Many patients lack den- for those without private insurance.3 To complicate tal insurance, and those who have it often have lim- matters, many physicians do not feel they have ad- ited benefits. Furthermore, Medicaid has decreased equate training with regard to dental care.4 In ad- its dental coverage. According to a recent survey of dition, many patients are not aware that physicians persons with dental problems, 7.1% visited the ED, typically have very limited training in the care of 14.3% visited primary care physicians, and 90.2% dental problems. This article reviews common dental visited a dental professional.2 The majority of those problems seen in the ED.
    [Show full text]
  • The Treatment of Traumatic Dental Injuries
    ENDODONTICS Colleagues for Excellence Summer 2014 The Treatment of Traumatic Dental Injuries Published for the Dental Professional Community by the American Association of Endodontists www.aae.org/colleagues Cover artwork: Rusty Jones, MediVisuals, Inc. ENDODONTICS: Colleagues for Excellence hen treating dental trauma, the timeliness of care is key to saving the tooth in many cases. It is, therefore, important for Wall dentists to have an understanding of how to diagnose and treat the most common dental injuries. This is especially critical in the emergency phase of treatment. Proper management of dental trauma is most often a team effort with general dentists, pediatric dentists or oral surgeons on the front line of the emergency service, and endodontic specialists joining the effort to preserve the tooth with respect to the pulp, pulpal space and root. An informed and coordinated effort from all team members ensures that the patient receives the most efficient and effective care. Recently, a panel of expert members of the American Association of Endodontists prepared an updated version of Guidelines for the Treatment of Traumatic Dental Injuries (1, 2). These guidelines were based, in part, on the current recommendations of the International Association of Dental Traumatology (see www.iadt-dentaltrauma.org for more information). This issue of ENDODONTICS: Colleagues for Excellence provides an overview of the AAE guidelines; the complete guidelines are available for free download at www.aae.org/clinical-resources/trauma-resources.aspx. The benefit of adhering to guidelines for treatment of dental trauma was recently shown in a study by Bucher et al. (3). The study found that, compared to cases treated without compliance to guidelines, cases that adhered to guidelines produced more favorable outcomes, including significantly lower complication rates.
    [Show full text]
  • Nace Facial Trauma II.Pptx
    Disclosures: Facial Trauma ! None Sara R. Nace, MD American Society of Head & Neck Radiology 50th Annual Meeting Thursday, September 8th, 2016 Objectives Facial Bones ! Briefly review role of facial bones and structural pillars ! Societal importance, perception ! Discuss diagnosis of facial trauma (Multi-detector CT) ! Communication ! Review key points of “simple” midface fractures: nasal bone, ! Nutrition maxilla/palate, zygoma and orbit ! Housing and protection of proximal airway and organs of special ! Identify complex midface fracture patterns, relevant classification sense systems & commonly associated complications ! “Cushion” for the neurocranium and cervical spine • Le Fort (I, II, & III) • Nasoethmoidal • Zygomaticomaxillary Complex Fractures Facial Buttresses Facial Buttresses ! Thickened skeletal buttresses evolved in part to distribute vertical & axial (grinding) masticatory forces Sagittal ! Compartmentalize the face and provide attachment points for soft PTERYGO- NASO- • Nasomaxillary (medial) MAXILLARY MAXILLARY tissue structures • Zygomaticomaxillary Sagittal Axial Coronal (lateral) • Pterygomaxillary ZYGOMATICO • Nasomaxillary (medial) • Frontal bar • Anterior plane -MAXILLARY (posterior) • Zygomaticomaxillary • Upper maxillary • Posterior plane • +/- Vertical mandible (lateral) • Lower maxillary VERTICAL • Pterygomaxillary • +/- Skull base MANDIBLE (posterior) • +/- Vertical mandible Facial Buttresses Facial Buttresses FRONTAL BAR Axial • Frontal bar Coronal • Upper maxillary • UPPER • Anterior plane Lower maxillary
    [Show full text]
  • Complications of Oral Piercing
    Y T E I C O S L BALKAN JOURNAL OF STOMATOLOGY A ISSN 1107 - 1141 IC G LO TO STOMA Complications of Oral Piercing SUMMARY A. Dermata1, A. Arhakis2 Over the last decade, piercing of the tongue, lip or cheeks has grown 1General Dental Practitioner in popularity, especially among adolescents and young adults. Oral 2Aristotle University of Thessaloniki piercing usually involves the lips, cheeks, tongue or uvula, with the tongue Dental School, Department of Paediatric Dentistry as the most commonly pierced. It is possible for people with jewellery in Thessaloniki, Greece the intraoral and perioral regions to experience problems, such as pain, infection at the site of the piercing, transmission of systemic infections, endocarditis, oedema, airway problems, aspiration of the jewellery, allergy, bleeding, nerve damage, cracking of teeth and restorations, trauma of the gingiva or mucosa, and Ludwig’s angina, as well as changes in speech, mastication and swallowing, or stimulation of salivary flow. With the increased number of patients with pierced intra- and peri-oral sites, dentists should be prepared to address issues, such as potential damage to the teeth and gingiva, and risk of oral infection that could arise as a result of piercing. As general knowledge about this is poor, patients should be educated regarding the dangers that may follow piercing of the oral cavity. LITERATURE REVIEW (LR) Keywords: Oral Piercings; Complications Balk J Stom, 2013; 17:117-121 Introduction are the tongue and lips, but other areas may also be used for piercing, such as the cheek, uvula, and lingual Body piercing is a form of body art or modification, frenum1,7,9.
    [Show full text]
  • Step Guide to Managing Dental Trauma in General Practice
    FEATURE A step-by- step guide to managing dental trauma in general practice By Rana Fard, a dentist based in Kent ©Jian Fan/iStock/Getty Images Plus ©Jian Fan/iStock/Getty Dental trauma management in cheek bones, nose, maxilla and the lower border patient has symptoms, a chest X-ray must be general practice of the mandible. Note any asymmetry (such as considered to investigate whether the fragment Te management of dental trauma can be a fattening of the cheek bones), step deformities has been inhaled. For more information on very challenging and overwhelming experience or tenderness. It is important to also assess the maxillofacial referral considerations and how especially in general practice. Tis is mainly due occlusion and jaw movements as well. Step to manage simple sof tissue injuries and to a lack of experience or updated knowledge deformity of the lower border of the mandible, lacerations in practice you can refer to the based on revised guidelines. It is important for gingival tear and sublingual haematoma Saving Smiles Practitioners’ Toolkit.1 dental professionals to understand how to best (bruising) is suggestive of a mandible fracture. manage dental trauma, especially in the acute For more detailed information on history taking 3. Make a correct dental trauma phase, as this will result in improved long term as well as clinical and radiographic examination diagnosis outcomes for the patient. Tis article aims to refer to the Saving Smiles Practitioners’ Toolkit1 In order to make sure the traumatised tooth is highlight the main principles of dental trauma or the article by Chauhan et al.2 treated appropriately both acutely and in the management and it will signpost resources to long term it is important to classify and diagnose help update your knowledge and boost your 2.
    [Show full text]