Maxillofacial trauma in the elderly

doi:10.1016/S0278-2391(99)90812-1

Journal of Oral and Maxillofacial Surgery

Volume 57, Issue 7, July 1999, Pages 777-782

https://doi.org/10.1016/S0278-2391(99)90812-1 Get rights and content

Abstract

Purpose: This article gives a general description of the incidence, causes, and complexity of maxillofacial fractures in the elderly and discusses whether modification is required in assessment, surgical indications, and techniques in such cases.

Patients and Methods: A retrospective clinical and radiologic study evaluated 222 patients older than 60 years of age (mean age, 70.3) hospitalized with maxillofacial trauma over the period 1987 to 1996 in the Division of Maxillofacial Surgery, University of Turin. The patients were classified according to the following parameters: age, cause of injury, site of trauma, presence of associated fractures, pertinent medical history, type of treatment, length of hospitalization, and complications. The data were compared with those from a control group consisting of 178 adult patients younger than 60 years of age.

Results: The presence of a preexisting systemic pathologic condition was the most important factor in determining hospitalization time, which was greater than in the control group. In 89 patients (40.1%), no treatment was considered necessary, whereas 133 patients (59.9%) were treated by surgery. In 115 patients (86.5%), the fractures were treated by open reduction and internal fixation, whereas closed reduction was used in 18 patients (13.5%). There were complications with six patients (2.7%), and one died in the hospital.

Conclusions: The findings of this study suggest that surgical intervention is less frequently indicated in facial trauma of the elderly because of physiologic, psychologic, and social changes brought on by the aging process. The principles of treatment, the results, and the complications do not differ greatly in this group when compared with the normal adult population.

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Cited by (60)

Complications of Mandibular Fracture Repair
2023, Otolaryngologic Clinics of North America
An epidemiologic retrospective study of maxillofacial traumatology in the elderly
2022, Journal of Stomatology, Oral and Maxillofacial Surgery
Citation Excerpt :
Moreover, age-related changes, such as the loss of reflexes and systemic pathologic conditions, contribute to an increase in the number of maxillofacial injuries. The principles for the management of facial fractures are basically the same as in young adults, but some characteristics such as bone atrophy, edentulous jaws, and reduced capacity for tissue repair, impact treatment modalities [2]. Thus, for several reasons, the option of surgical treatment in this population is more open to debate.
Introduction: The elderly population, which is more active than before, is increasingly suffering from trauma (loss of reflexes and systemic pathologic conditions). Surgical management may be more controversial due to the potential consequences of general anesthesia and the sometimes negligible consequences of functional management. The main objective of this study was to analyze the causes and location of facial fractures in subjects older than 65 years. The secondary objective was to evaluate the management of these fractures (surgical or functional) according to comorbidities.
Material & methods: In this retrospective study (over a five-year period), we analyzed the causes and management of facial fractures in patients aged over 65 years, and the medical history of each patient was investigated.
Results: One hundred and nineteen patients with 198 facial fractures were included. The main cause of fractures was a fall (50%). The zygomatic region (39.9%) and mandible (27.8%) were the sites of the most frequent fractures. Comorbidities were found in 84.9% of patients, the majority of which were cardiovascular diseases (82.3%). 75.8% of fractures were treated surgically and 4.8% of patients had complications.
Discussion: This work is a help to understanding the causes and consequences of facial trauma in the elderly population. The management of these facial fractures requires a multidisciplinary assessment, taking into account the patient's medical history and evaluating the risks and benefits of a surgical procedure with general anesthesia.
Complications of locking and non-locking plate systems in mandibular fractures
2019, International Journal of Oral and Maxillofacial Surgery
This systematic review and meta-analysis was performed to critically assess the methodological quality of the existing systematic reviews, and to evaluate the postoperative complications of the mandibular fractures treated with locking and non-locking plate systems. An electronic search was conducted in PubMed, Embase, Web of Science, Cochrane library’s electronic databases and grey literate using a combination of Medical Subject Heading terms and key words, until September 2018. No restrictions were applied to the search strategy. In total, three relevant systematic reviews were included, and the quality of these studies was low. A total of 33 studies (20 randomized studies and 13 non-randomized studies) were included in this systematic review, and 16 of them were included in meta-analysis. Most of the included randomized studies had an unclear risk of bias (Cochrane Collaboration); the quality of non-randomized studies ranged between 6 and 17 (Methodological Index for Non-Randomized Studies − MINORS). Based on the results of our meta-analysis, we conclude that locking plates are superior only with respect to the need for mandibulomaxillary fixation (MMF) in the early postoperative period.
Associated Injuries Are Frequent and Severe Among Geriatric Patients With Zygomatico-Orbital Fractures
2019, Journal of Oral and Maxillofacial Surgery
Associated injuries (AIs) are hypothesized to be frequent in geriatric zygomatico-orbital (ZMO) fractures. The study aim was to determine the relation between ZMO fractures and AIs in geriatric patients compared with younger adult patients.
A retrospective case-and-control study was carried out on geriatric patients at least 65 years of age (n = 93) and younger adult patients 20 to 30 years of age (n = 68) diagnosed with pure unilateral ZMO fractures. The main exposure was age, the primary outcome was AI outside the face, and the secondary outcomes were type and severity of AI, ocular injuries, restriction of mandibular movement, and ZMO buttress asymmetry. The confounding variables were gender, trauma mechanism, type of ZMO fracture, and dislocation. Statistical analyses included χ² tests, risk evaluation with 2 × 2 tables, and logistic regression analysis.
AIs outside the face, and particularly brain injuries, were significantly more frequent in the geriatric group than in the control group (P < .001). The significant predictors of AIs outside the face were fall from a height (66.7%), motor vehicle accidents (66.7%), and absence of ZMO dislocation (59.5%; P < .001). The adjusted risk of brain injury was 2.5-fold in the absence of dislocation. The geriatric group had a more than 5-fold higher risk of brain injuries compared with the younger control group (P = .003).
AIs in general, and particularly brain injuries, are frequent in geriatric ZMO fractures. Intracranial injuries should be ruled out, particularly in geriatric patients diagnosed with a non-dislocated ZMO fracture.
Management of atrophic mandibular fractures: An Italian multicentric retrospective study
2018, Journal of Cranio-Maxillofacial Surgery
The aim of this multicentric study was to retrospectively evaluate the surgical outcome of atrophic mandible fractures treated with open reduction and rigid fixation (ORIF), using load-bearing plates.
55 patients from three trauma centers were retrieved for the study. Inclusion criteria were: edentulous patients with mandibular body fractures; mandibular body thickness <20 mm. Collected data included: cause of fracture; degree of atrophy (according to Luhr's classification); characteristics of the fracture; adequacy of reduction; postoperative complications. All patients were treated with ORIF, using 2.0 mm, large-profile, locking bone plates and 2.4 mm locking bone plates. No bone graft was used in any case.
12 patients were classified as class I atrophy, 18 patients as class II, and 25 patients as class III. Mean mandibular height at the site of fracture was 12.8 mm (ranging from 5.4 mm to 20 mm). 22 were unilateral fractures and 23 were bilateral. Mild displacement was observed in 11 fractures, moderate in 34, severe in 16, and comminution was present in seven fractures. Adequacy of reduction was judged good in 62 fractures and poor in six fractures. Transient weakness of the marginal branch of the facial nerve was recorded in 11 patients and permanent weakness in two patients. All patients achieved a complete fracture healing.
External open reduction and rigid fixation (ORIF) with locking, load-bearing plates is a reliable and predictable treatment for atrophic edentulous mandible fracture. Immediate bone grafting should not be considered mandatory unless there is consistent bone loss.
Interpersonal Violence Is Associated with Increased Severity of Geriatric Facial Trauma
2016, Journal of Oral and Maxillofacial Surgery
The geriatric population is rapidly increasing in number with increased demand on health care resources including those spent on the treatment of maxillofacial trauma. The purpose of this analysis was to investigate the independent and cumulative associations between potential risk factors (age, gender, mechanism of injury, drug use, and alcohol use) for and the severity of geriatric facial trauma.
This was a cross-sectional analysis of secondary data of geriatric (individuals aged ≥65 years) facial trauma using the Allegheny General Hospital Trauma Registry database. Data were collected for diagnosis codes that reflected facial trauma (International Classification of Diseases, Ninth Revision codes 802.0 to 802.9, 800.1 to 801.9, and 803.0 to 804.9) and specific mechanisms of injury (E810 to E819, motor vehicle traffic accidents; E880 to E888, accidental falls; and E960 to E969, injury purposely inflicted by other persons). The Facial Injury Severity Scale (FISS) is a validated measurement that was used to determine the severity of the facial trauma and calculated through analysis of the abstracted data obtained from the trauma registry and patient records. Pearson correlations, 2-way independent t test, 1-way analysis of variance, and multiple linear regression were used to test hypotheses for independent and cumulative associations between the risk factors for and the severity of geriatric facial trauma. Statistical significance was set at the P < .05 level.
The sample was composed of 229 patients with a mean age of 72.3 ± 4.5 years. A statistically significant association between mechanism of injury and the severity of geriatric facial trauma (P = .019) was found. Specifically, interpersonal violence (assault) was associated with the greatest facial trauma severity (FISS score, 4.2) when compared with motor vehicle collisions (FISS score, 2.2; P = .011) and falls (FISS score, 2.4; P = .016).
Interpersonal violence (assault) is associated with increased severity of geriatric facial trauma compared with other risk factors.

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^☆: Received from the Division of Maxillofacial Surgery, University of Turin, Italy.

^∗: Assistant Professor.

^†: Resident.

^§: Head Professor.

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Clinical articleMaxillofacial trauma in the elderly☆

Abstract

J Oral Maxillofac Surg

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Clinical article
Maxillofacial trauma in the elderly☆