2011-2021 Yılları Arasında Acil Servise Fasiyal Kemiklerde Fraktür Sebebi ile Başvuran Hastaların Retrospektif Analizi

Yıl 2024, , 35 - 40, 17.05.2024

Nihal Akçalı Bostancı , Vahide Aslıhan Durak , Sümeyye Tuğba Sarkı Cander , Halil İbrahim Çıkrıklar , Buşra Altınkök Şentürk , Orhan Çavdar

https://doi.org/10.32708/uutfd.1428054

Öz

Bu çalışmada fasiyal yaralanma nedeniyle Acil Servise başvuran olguların klinik özellikleri ve klinik sonlanımları ile ilişkili parametrelerin belirlenmesi amaçlanmıştır. Kesitsel tipte olan bu çalışmada 2011-2021 yılları arasında Bursa Uludağ Üniversitesi Acil Servisine fasiyal yaralanma sebebi ile başvuran ve plastik ve rekonstrüktif cerrahi anabilim dalına fasiyal kemiklerde fraktür sebebi ile konsülte edilen hastaların klinik özellikleri hastane kayıtlarından retrospektif olarak taranmıştır. Olguların %80,5’i erkekti, en sık travma nedenleri %26,1 darp, %25,7 düşme ve %14,0 araç içi trafik kazasıydı. En sık başvuru yaz aylarında yapılmıştı (%34,5). En sık yaralanan fasiyal kemikler %43,6 nazal kemik, %32,4 maksilla ve %31,8 orbitaydı. Olguların %72,6’sı taburcu edilirken, %14,3’ü kliniğe, %4,8’i YBÜ’ye yatırıldı, %3,7’si sevk edildi ve %0,3’ü eksitus oldu. Kadınlarda ateşli silah yaralanması, yüksekten düşme ve trafik kazaları kaynaklı travmalara maruz kalan olgular arasında YBÜ’ye yatış/ eksitus sıklığı anlamlı düzeyde daha fazlaydı (p<0,05). Yaralanma saptanan fasiyal kemiğe göre YBÜ’ye yatış/ eksitus durumu sıklık sırasına göre şu şekildeydi: frontal (%19,0), orbita (%9,0), maksilla (%8,3), zigoma (%8,1), mandibula (%8,0) ve nazal (%3,6) kemik. Herhangi tipte fasiyal kemik fraktürü saptanması YBÜ’ye yatış/ eksitus ile ilişkili bulundu (p<0,05). Sonuç olarak fasiyal yaralanmalı olgular daha çok erkeklerden oluşmakta, yaz aylarında, darp ya da düşme kaynaklı nazal fraktürle acil servise başvuru yapmaktadır. Kadınlar, daha yüksek enerjili travmaya maruz kalanlar ve fasiyal kemik fraktürü saptananlar arasında klinik sonlanım daha olumsuz olmaktadır. Bu özelliklere sahip olguların daha sıkı takip edilmesi ve erken dönemde uygun tedavinin sağlanması sağkalım ve sekel sıklığını azaltacak müdahaleler arasında değerlendirilebilir.

Anahtar Kelimeler

acil servis, fasiyal kemik fraktürü, travma

Retrospective Analysis of Patients Presenting to the Emergency Department between 2011-2021 with Fractures in the Facial Bones

Öz

This study aimed to determine the parameters associated with the clinical characteristics and clinical outcomes of cases admitted to the Emergency Department due to facial injury. In this cross-sectional study, the clinical characteristics of the patients who applied to Bursa Uludag University Emergency Service due to facial injury between 2011 and 2021 and were consulted to the department of plastic and reconstructive surgery due to fractures in facial bones were retrospectively analyzed from hospital records. 80.5% of the cases were male, the most common causes of trauma were 26.1% assault, 25.7% fall and 14.0% in-car traffic accident. The most frequent application was made in the summer months (34.5%). The most frequently injured facial bones were the nasal bone in 43.6%, the maxilla in 32.4%, and the orbit in 31.8%. While 72.6% of the cases were discharged, 14.3% were admitted to the clinic, 4.8% were admitted to the ICU, 3.7% were referred and 0.3% died. The frequency of ICU admission/ ex was significantly higher among women who were exposed to trauma due to gunshot wounds, falling from heights, and traffic accidents (p<0.05). ICU admission/exit status according to the facial bone with injury was as follows, in order of frequency: frontal (19.0%), orbita (9.0%), maxilla (8.3%), zygoma (8.1%). mandibular (8.0%) and nasal (3.6%) bone. Detection of any type of facial bone fracture was found to be associated with ICU admission/exit (p<0.05). As a result, cases with facial injuries mostly consist of men, and they apply to the emergency department with nasal fractures caused by assault or falling in the summer months. Clinical outcome is worser among women, those exposed to higher energy trauma, and those diagnosed with facial bone fractures. Closer follow-up of cases with these characteristics and providing appropriate treatment in the early period can be considered among the interventions that will reduce survival and the frequency of sequelae.

Anahtar Kelimeler

emergency department, facial bone fracture, trauma

Kaynakça

• 1. Glynn SM, Shetty V, Elliot-Brown K, et al. Chronic posttraumatic stress disorder after facial injury: a 1-year prospective cohort study. J Trauma. 2007;62(2):410-8.
• 2. Allareddy V, Allareddy V, Nalliah RP. Epidemiology of facial fracture injuries. J Oral Maxillofac Surg 2011;69:2613-8.
• 3. Marinheiro BH, de Medeiros EH, Sverzut CE, et al. Frontal bone fractures. J Craniofac Surg 2014;25(6):2139–43.
• 4. Schultz K, Braun TL, Truong TA. Frontal sinus fractures. Semin Plast Surg 2017; 31(2):80–4.
• 5. Erdmann D, Follmar KE, Debruijn M, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. 2008;60(4):398-403.
• 6. Brady SM, McMann MA, Mazzoli RA, et al. The diagnosis and management of orbital blowout fractures: update 2001. Am J Emerg Med 2001;19(2):147–54.
• 7. Go JL, Vu VN, Lee KJ, et al. Orbital trauma. Neuroimaging Clin N Am 2002;12(2): 311–24.
• 8. Higuera S, Lee EI, Cole P, et al. Nasal trauma and the deviated nose. Plast Reconstr Surg 2007;120(7 Suppl 2):64–75.
• 9. Murray JA, Maran AG, Busuttil A, et al. A pathological classification of nasal fractures. Injury 1986;17(5):338–44.
• 10. Stewart MG. Head, face, and neck trauma: comprehensive management. New York: Thieme; 2005
• 11. Viozzi CF. Maxillofacial and mandibular fractures in sports. Clin Sports Med 2017; 36(2):355–68.
• 12. Louis M, Agrawal N, Truong TA. Midface fractures II. Semin Plast Surg 2017; 31(2):94–9.
• 13. Kaura S, Kaur P, Bahi R, et al. Retrospective study of facial fractures. Annals of maxillofacial surgery. 2018;8(1):78.
• 14. Khan SR, Khan ZA, Hanif S, et al. Patterns of facial fractures in children. British Journal of Oral and Maxillofacial Surgery. 2019;57(10):1009-13.
• 15. Zambani RA, Wagner JCB, Volkweis MR, et al. Epidemiological study of facial fractures at the Oral and Maxillofacial Surgery Service, Santa Casa de Misericordia Hospital Complex. Revista do Colégio Brasileiro de Cirurgiões. 2017;44: 491-7.
• 16. Rampa S, Wilson FA, Tak HJ, et al. Patient characteristics and causes of facial fractures in the state of California. Journal of Oral and Maxillofacial Surgery. 2019;77(9):1855-66.
• 17. Arpalahti A, Haapanen A, Puolakkainen T, et al. Assault-related facial fractures: does the injury mechanism matter?. International journal of oral and maxillofacial surgery. 2022;51(1):91-7.
• 18. Moshy JR, Msemakweli BS, Owibingire SS, et al. Pattern of mandibular fractures and helmet use among motorcycle crash victims in Tanzania. African health sciences. 2020;20(2):789-97.
• 19. Burkhard JPM, Pitteloud C, Klukowska-Rötzler J, et al. Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population. Gerodontology. 2019;36(4):358-64.
• 20. Bocchialini, Gabriele, and Andrea Castellani. "Facial trauma: A retrospective study of 1262 patients." Annals of maxillofacial surgery 9.1 (2019): 135.
• 21. Shumynskyi I, Gurianov V, Kanjura O, Kopchak A. Prediction of mortality in severely injured patients with facial bone fractures. Oral and Maxillofacial Surgery. 2022;26(1):161-70.
• 22. Al-Ali MA, Alao DO, Abu-Zidan FM. Factors affecting mortality of hospitalized facial trauma patients in Al-Ain City, United Arab Emirates. PLoS one, 2022;17(11):e0278381.
• 23. Oggini FO, Oladejo T, Alake DP, et al. Facial Bone Fractures in Ile-Ife, Nigeria: An Update on Pattern of Presentation and Care. Journal of Maxillofacial and Oral Surgery. 2016;15:184–90.
• 24. Conforte JJ, Alves CP, Sanches MPR, Ponzoni D. Impact of trauma and surgical treatment on the quality of life of patients with facial fractures. International journal of oral and maxillofacial surgery. 2016;45(5):575-81.
• 25. Choudhry M, Bland K, Chaudry I. Trauma and immune response—effect of gender differences. Injury. 2007;38(12):1382–91.
• 26. Pape M, Giannakopoulos GF, Zuidema WP, et al. Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. Scand J Trauma Resusc Emerg Med. 2019;27:16.
• 27. Liu T, Xie J, Yang F, et al. The influence of sex on outcomes in trauma patients: a meta-analysis. Am J Surg. 2015;210(5):911–21.
• 28. Kubat GO, Şahin C, Özen Ö. Association of frontal and maxillary bone fractures and concomitant craniocerebral injuries in patients presenting with head trauma. Nigerian Journal of Clinical Practice. 2022;25(3):342-8.
• 29. Srinivasa R, Furtado SV, Sansgiri T, Vala K. Management of Frontal Bone Fracture in a Tertiary Neurosurgical Care Center—A Retrospective Study. J Neurosci Rural Pract. 2022;13(1):60–6.
• 30. Jeyaraj P. Frontal Bone Fractures and Frontal Sinus Injuries: Treatment Paradigms. Ann Maxillofac Surg. 2019;9(2):261–82.