Clinical Assistant Professor of Surgery, Department of ENT and Maxillofacial Surgery, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH.
Radiology Resident, University of Rochester, Rochester, NY; and Former Medical Student, Geisel School of Medicine, Dartmouth, Hanover, NH.
J Oral Maxillofac Surg. 2021 Feb;79(2):430.e1-430.e12. doi: 10.1016/j.joms.2020.09.031. Epub 2020 Oct 14.
Penetrating facial trauma is an uncommon injury, but patients who present with these dramatic situations require special consideration. We describe the case of a young man who had been shot with an arrow that deeply penetrated his midface as well as report the results of a literature review of penetrating midface injuries. The information gathered was used to create a diagnostic protocol for patients who sustain such injuries.
A PubMed search up to October 2019 using several key phrases was performed, and 623 unique articles were evaluated. Excluding firearm injuries to the midface, there were 57 unique cases that involved penetrating midface injuries. Clinical and imaging data were compiled and evaluated with descriptive statistical analysis.
The average patient age was 27 years, with a male predilection. The most common reported etiology was accidental trauma (54%), and a knife was the most common weapon of injury (30%). The most common (32%) specific location of trauma was within the orbital region, including the canthus or the eyelid. In all cases where the patient had not died immediately, surgery was used to remove the penetrating object. We found that computed tomography was the most commonly obtained imaging study (39% of cases). Radiographs were the sole imaging in 28% of the cases, with angiography (16%) and magnetic resonance imaging (10%) used less frequently in management. In 28% of the cases, deep structures, such as the carotid artery, sphenoid sinus, or skull base, were involved in the injury. In 25% of the cases, there was injury to the central nervous system. Death occurred in 8.8% of the cases. Postoperative complications occurred in at least 21% of the cases. Statistical analysis also revealed a significant correlation between antibiotic use and full recovery. Penetration of the object posterior to the maxillary sinus was correlated with incomplete recovery or death.
Based on all case reports collected, a Dartmouth Penetrating Midface Protocol was developed to aid the practitioner who may happen to be responsible for these dramatic life-threatening injuries. The Dartmouth Penetrating Midface Protocol is based on the type of imaging available at the treating facility, the neurologic and hemodynamic stability of the patient, and the depth of penetration beyond the posterior wall of the maxillary sinus.
穿透性面部创伤并不常见，但出现这些戏剧性情况的患者需要特别考虑。我们描述了一位年轻男子被箭深深穿透中面部的病例，并报告了穿透性中面部损伤的文献回顾结果。收集的信息用于为发生此类损伤的患者创建诊断方案。
使用几个关键词在 PubMed 上进行了截至 2019 年 10 月的搜索，评估了 623 篇独特的文章。排除中面部火器伤后，有 57 例独特的穿透性中面部损伤病例。对临床和影像学数据进行编译，并使用描述性统计分析进行评估。
平均患者年龄为 27 岁，男性居多。最常见的报告病因是意外创伤（54%），最常见的受伤武器是刀（30%）。最常见（32%）的创伤特定位置是在眶区，包括内眦或眼睑。在所有没有立即死亡的患者中，均采用手术取出穿透性物体。我们发现，计算机断层扫描是最常获得的影像学研究（39%的病例）。X 线摄影在 28%的病例中是唯一的影像学检查，血管造影（16%）和磁共振成像（10%）在管理中使用较少。在 28%的病例中，深层结构，如颈动脉、蝶窦或颅底，受到损伤。在 25%的病例中，有中枢神经系统损伤。8.8%的病例死亡。至少有 21%的病例发生术后并发症。统计分析还显示，抗生素的使用与完全康复之间存在显著相关性。物体穿透上颌窦后部与不完全康复或死亡相关。
基于所有收集的病例报告，制定了达特茅斯穿透性中面部方案，以帮助可能负责这些戏剧性危及生命的损伤的医生。达特茅斯穿透性中面部方案基于治疗机构可获得的影像学类型、患者的神经和血流动力学稳定性以及穿透上颌窦后壁的深度。
