摘要
Background: The maxillofacial region is in close proximity with the cranium and its contents. Studies
exploring the relationship between injuries in the cranial versus facial regions are sparse but they appear to come to conflicting conclusions regarding what that relationship really is. Some studies suggest that the maxillofacial region may act as a protective shock-absorbing region against traumatic impacts to the cranium while some other studies have documented that the occurrence of facial fractures does not necessarily prevent head injury and might actually be an indicator of an increased likelihood of the presence of head injury. This study aims to investigate the possible impacts of the presence of maxillofacial injuries (MFI) in a population of head injured (HI) patients.
Methods: The study was a cross-sectional analysis of a prospective cohort of patients with craniofacial
trauma. It compared the severity of HI, which was assessed clinically using the Glasgow Coma Scale
(GCS); presence and duration of loss of consciousness (LOC), and findings on the brain computed
tomography (CT) scan of the head injured among patients with HI alone (Group I) and those with HI and
associated osseous MFI (Group II).
Results: Ninety-nine patients with HI were included. Mean age was 30.2 years. Motorbike crashes,
(44.4%), was the most common mechanism of injury. The frequency of severe HI, LOC and intracranial
injuries were higher in those with isolated head injury than those with associated MFI. However, these
findings were not statistically significant.
Conclusion: The findings of this study did not support a cushioning effect of maxillofacial injury on
severity of head injury.
Keywords: Head injury, maxillofacial trauma, severity.
Résumé
Contexte: La région maxillo-faciale est à procheproximitédu crâne et de son contenu. Les études
explorant la relation entre les blessures dans les régions crâniennes et faciales sont rares, mais elles
semblent arriver à des conclusions contradictoires sur ce qu’est réellement cette relation. Certaines études suggèrent que la région maxillo-faciale peut agir comme une région protectrice absorbant les chocs contre les impacts traumatiques sur le crâne tandis que d’autres études ont documenté que la survenue de fractures faciales n’empêche pas nécessairement les traumatismes crâniens et pourrait en fait être un indicateur d’une probabilité accrue de la présence d’un traumatisme crânien. Cette étude vise à étudier les impacts possibles de la présence de lésions maxillo-faciales (LMF) dans une population de patients souffrant de traumatismes crâniens (TC).
Méthodes: L’étude était une analyse transversale d’une cohorte prospective de patients souffrant d’un
traumatisme crâniofacial. Celle-ci a comparé la gravité de TC, ce qui a été évaluée cliniquement à l’aide
de l’Echelle Coma de Glasgow (ECG); présence et durée de la perte de conscience (PDC) et les résultats
de la tomodensitométrie(TDM) cérébrale de la tête blessée chez les patients atteints d’TC seule (groupe
I) et ceux atteints deTCet de LMF osseuse associée (groupe II).
Résultats : Quatre-vingt-dix-neuf patients atteints de TC ont été inclus. L’âge moyen était de 30,2
ans. Les accidents de moto (44,4%) étaient le mécanisme de blessure le plus courant. La fréquence des
lésions TC, DPC et intracrâniennes sévères était plus élevée chez les personnes souffrant d’un
traumatisme crânien isolé que chez celles ayant une LMF associée. Cependant, ces résultats n’étaient pas statistiquement significatifs.
Conclusion: Les résultats de cette étude ne soutiennent pas un effet d’amortissement des lésions maxillofaciales sur la gravité des traumatismes crâniens.
Mots-clés: traumatisme crânien, traumatisme maxillo-facial, gravité .
Correspondence: Dr. T.O. Aladelusi, Department of Oral and Maxillofacial Surgery, College of Medicine,
University of Ibadan, Ibadan Nigeria, Email: drtimmylee@gmail.com
参考
Chowdhury R, Menon PS, Chowdbury R, and Menon PS. Etiology and management of zygomaticomaxillary complex fractures in the armed forces. MJAFI 2005;61:238–240.
Zandi M and Seyed Hoseini SR. The relationship between head injury and facial trauma: A case-control study. Oral Maxillofac Surg 2013;17(3):201–207.
Lee FK, Wagner LK, Lee EY, Suh JHO and Lee SRO. The impact-absorbing effects of facial fractures in closed-head injuries. J Neurosurg 1987;66:542–547.
Pappachan B and Alexander M. Correlating facial fractures and cranial injuries. J Oral Maxillofac Surg 2006;64(7):1023–1029.
Keenan HT, Brundage SI, Thompson DC, Maier R V and Rivara FP. Does the face protect the brain? A case-control study of traumatic brain injury and facial fractures. Arch Surg 1999;134:14–17.
Haug RH, Adams JM, Conforti PJ and Likavec MJ. Cranial fractures associated with facial fractures: a review of mechanism, type, and severity of injury. J Oral Maxillofac Surg 1994;52:729–733.
Mithani SK, St-Hilaire H, Brooke BS, et al. Predictable patterns of intracranial and cervical spine injury in craniomaxillofacial trauma: analysis of 4786 patients. Plast Reconstr Surg 2009;123:1293–1301.
Hampson D. Facial injury: A review of biomechanical studies and test procedures for facial injury assessment. J Biomech 1995;28:1–7.
Chang C, Chen Y, Noordhoff MS and Chang C. Maxillary involvement in central craniofacial fractures with associated head injuries. J Trauma 1994;37:807–811.
Rahman SA and Chandrasala S. When to suspect head injury or cervical spine injury in maxillofacial trauma/ ? Dent Res J 2014;11:336–344.
Haug RH, Savage JD, Likavec MJ and Conforti PJ. A review of 100 closed head injuries associated with facial fractures. J Oral Maxillofac Surg 1992;50:218–222.
Fasola AO, Nyako EA, Obiechina AE and Arotiba JT. Trends in the characteristics of maxillofacial fractures in Nigeria. J Oral Maxillofac Surg 2003;61:1140–1143.
Obuekwe ON and Etetafia M. Associated injuries in patients with maxillofacial trauma. Analysis of 312 consecutive cases due to road traffic accidents. J Biomed Sci 2004;3:30–36.
Agnihotri A, Galfat D and Agnihotri D. Incidence and pattern of maxillofacial trauma due to road traffic accidents: a prospective study. J Maxillofac Oral Surg 2014;13:184–188.
Dube A, Rao G and Tanwar A. Pattern of maxillofacial injury associated with head injury at a neuro surgical centre: An analysis of 250 cases. Int J Dent Med Spec 2014;1:2–6.
Aladelusi TO, Akinmoladun VI, Olusanya AA, et al. Analysis of road traffic crashes – related maxillofacial injuries severity and concomitant injuries in 201 patients seen at the UCH, Ibadan. Craniomaxillofac Trauma Reconstr 2014;7(4):284–289.
Oginni FO, Ugboko VI, Ogundipe O and Adegbehingbe BO. Motorcycle-related maxillofacial injuries among Nigerian intracity road users. J Oral Maxillofac Surg 2006;64:56–62.
Aladelusi TO, Akinmoladun VI, Olusanya AA, Akadiri OA and Fasola AO. The impact of protective devices on the severity of road traffic maxillofacial injuries in Ibadan, Nigeria. J West Afr Coll Surg 2013;3(1):25–39.
Rajandram RK, Syed Omar SN, Rashdi MFN and Abdul Jabar MN. Maxillofacial injuries and traumatic brain injury - a pilot study. Dent Traumatol 2014;30:128–132.
Kraus JF, Rice TM, Peek-Asa C and Mcarthur DL. Facial trauma and the risk of intracranial injury in motorcycle riders. Ann Emerg Med 2003;41:18–26.
Olusanya AA, Adeleye AO, Aladelusi TO and Fasola AO. Updates on the epidemiology and pattern of traumatic maxillofacial injuries in a Nigerian university teaching hospital: A 12-month prospective cohort in-hospital outcome study. Craniomaxillofac Trauma Reconstr 2015;8:50–58.
MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Eng J Med 2006;354:366–378.
Sasser S, Varghese M, Kellermann A and Loemand JD. Prehospital trauma care systems. Geneva: World Health Organization; 2005.
Beyaztas F and Alagozlu H. Evaluation of traffic accident cases admitted to the emergency department of the Cumhuriyet University Hospital in 1988. Ulus Travma Derg 2002;8:29 – 33.