Luo Guan-Jie, Chou Pang-Yun, Chen Chih-Hao
From the Department of Surgery.
Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine, Taoyuan.
Ann Plast Surg. 2023 Apr 1;90(1 Suppl 1):S44-S50. doi: 10.1097/SAP.0000000000003350.
Geriatric maxillofacial trauma has become an increasingly pressing clinical issue in Taiwan because of increased life expectancy.
The purposes of this study were to investigate the anthropometric changes and the posttrauma outcomes in the aging population and to optimize the management strategies for geriatric facial fractures.
From 2015 to 2020, a total of 30 patients 65 years or older were identified to have suffered from maxillofacial fractures and presented at the emergency department of the Chang Gung Memorial Hospital (CGMH). These patients were categorized into group III, representing the elderly group. Two other groups (group I, age 18-40 years; group II, age 41-64 years) of patients were categorized based on their age. After applying propensity score matching to reduce bias caused by a large case number difference, patient demographics, anthropometric data, and management methods were compared and analyzed.
Among 30 patients 65 years or older who met the inclusion criteria, the mean age of the matched group III was 77.31 ± 14.87 years, and the mean number of retained teeth was 11.77 (range, 3-20 teeth). The elderly patients had a significantly lower number of retained teeth (group I vs group II vs group III, 27.3 vs 25.23 vs 11.77; P < 0.001). Anthropometric data showed that facial bone structure degenerated significantly with advancing age. Outcome analysis demonstrated that falls accounted for 43.3% of injury mechanisms in the elderly group, followed by motorcycle accidents (30%) and car accidents (23.3%). Nineteen elderly patients (63%) received nonsurgical management. On the other hand, 86.7% of cases in the other 2 age groups underwent surgery. The average numbers of total hospital and intensive care unit stays in group III patients were 16.9 (range, 3-49 days) and 4.57 (range, 0-47 days), which was significantly longer than the other 2 age groups.
Our results suggested that not only surgery is feasible for elderly patients with facial fractures, but an acceptable result is often obtainable. However, an eventful course, including extended hospital/intensive care unit stays and an increased risk of associated injuries and complications, may be expected.
由于预期寿命的增加，老年颌面创伤在台湾已成为一个日益紧迫的临床问题。
本研究的目的是调查老年人群的人体测量学变化和创伤后结果，并优化老年面部骨折的管理策略。
2015年至2020年，共有30名65岁及以上的患者被确定患有颌面骨折，并在长庚纪念医院急诊科就诊。这些患者被归类为III组，代表老年组。另外两组患者（I组，年龄18 - 40岁；II组，年龄41 - 64岁）根据年龄进行分类。在应用倾向得分匹配以减少因病例数差异大而导致的偏差后，对患者的人口统计学、人体测量数据和管理方法进行了比较和分析。
在符合纳入标准的30名65岁及以上患者中，匹配后的III组患者平均年龄为77.31±14.87岁，平均存留牙数为11.77颗（范围为3 - 20颗）。老年患者的存留牙数明显较少（I组 vs II组 vs III组，27.3颗 vs 25.23颗 vs 11.77颗；P < 0.001）。人体测量数据显示，面部骨骼结构随着年龄的增长而显著退化。结果分析表明，跌倒占老年组损伤机制的43.3%，其次是摩托车事故（30%）和汽车事故（23.3%）。19名老年患者（63%）接受了非手术治疗。另一方面，其他两个年龄组86.7%的病例接受了手术治疗。III组患者的平均总住院天数和重症监护病房住院天数分别为16.9天（范围为3 - 49天）和4.57天（范围为0 - 47天），明显长于其他两个年龄组。
我们的结果表明，老年面部骨折患者不仅手术可行，而且通常可获得可接受的结果。然而，可以预期病程复杂，包括延长住院/重症监护病房住院时间以及相关损伤和并发症风险增加。
