Fama Fausto, Cicciu Marco, Sindoni Alessandro, Nastro-Siniscalchi Enrico, Falzea Roberto, Cervino Gabriele, Polito Francesca, De Ponte Francesco, Gioffre-Florio Maria
Department of Human Pathology, University Hospital of Messina, 98125 Messina, Italy.
Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, 98125 Messina, Italy.
Chin J Traumatol. 2017 Feb;20(1):4-8. doi: 10.1016/j.cjtee.2016.11.003. Epub 2017 Jan 20.
Maxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas.
We retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different institutions, pediatric trauma patients and adult patients who were transferred in accordance with pre-existing agreements in case of paucity of beds were excluded. Finally we included 447 (0.2%) patients over the 8 years. Data were evaluated with emphasis on epidemiology (age, gender, mechanism of trauma), primary survey and abnormalities and pattern of trauma.
The most frequent cause of maxillofacial trauma was road accidents (319 patients, 71.4%), among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients; 443 (99.1%) patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries (χ = 557.2, p < 0.0001). Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas (χ = 17.13, p < 0.0001 vs minor lesions). All of the neglected lesions occurred in paucisymptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hematoma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms.
Among the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit, diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial major lesions.
颌面损伤常与多发伤相关，可导致功能和美观方面的不良后果。颌面损伤的严重程度可能相当大，会使临床医生的注意力从其他伴随损伤上转移，这些伴随损伤不太明显但可能危及生命。本研究的目的是找出因颌面创伤被转诊至意大利西西里岛东北部墨西拿大学医院急诊科的患者的伴随损伤情况。
我们回顾性评估了2008年1月至2015年12月期间因颌面损伤导致住院和手术治疗而入住墨西拿大学医院急诊科的240,833例患者的数据。排除了主要在不同机构接受治疗的患者、儿科创伤患者以及因床位不足而按照预先存在的协议转诊的成年患者。最终，我们纳入了这8年中的447例（0.2%）患者。对数据进行了评估，重点关注流行病学（年龄、性别、创伤机制）、初步检查以及创伤的异常情况和模式。
颌面创伤最常见的原因是道路交通事故（319例患者，占71.4%），其中以摩托车事故居多。出现严重损伤的颌面受伤患者有98例，轻度损伤的有349例；443例（99.1%）患者接受了颌面手术，手术时机根据伴随损伤的严重程度而定，可立即进行或延迟进行（χ = 557.2，p < 0.0001）。发现有5例被忽视的伴随损伤与严重颌面创伤相关（χ = 17.13，与轻度损伤相比，p < 0.0001）。所有被忽视的损伤均发生在症状轻微的患者中，这些患者腹部无痛、无血流动力学不稳定、无前腹壁和后腹壁血肿迹象或其他可疑的临床症状和体征。
在首先入住颌面外科以外其他外科病房的患者中，诊断较为困难，尤其是对于钝性腹部创伤，此类患者仅表现出模糊且非特异性的症状，掩盖了严重且危及生命的损伤。我们建议，当颌面损伤较为普遍时，尤其是对于受颌面严重损伤影响的患者，常规使用全身CT扫描。
