Introduction: Craniomaxillofacial fractures (CMF) are common in low-income countries (LIC). Due to limited resources, treatment of these fractures usually consists of interdental wiring or immobilization with a Barton bandage to maintain the reduction by permanent occlusion. These non-surgical treatment methods often lead to unsatisfactory results, such as a disturbed dental occlusion and lockjaw. The aim of this study is to present an off-label treatment option for CMF by applying a hand fixator as external face fixator (EFF) and to demonstrate the surgical method in detail. Materials and Methods: The feasibility and postoperative outcomes of this new off-label operation technique were evaluated by analyzing patients with CMF (n = 13) treated at an NGO hospital in Sierra Leone between 2015 and 2019. Results: The application of the EFF was feasible. The biggest advantage compared to the conventional non-operative methods was, that a dynamic occlusion was still possible during the 6 weeks healing period. Hence, patients could eat and drink almost normally and perform dental hygiene with the EFF in place. We did not discover pintrack infections or other complications. Three patients developed an oronasal fistula due to traumatic a palatal bone loss of about 7–8 mm which was treated by a palatal mucoperiosteal flap 15–20 days after the first operation. Discussion and Conclusions: In LIC, where plate osteosynthesis for CMF cannot be performed due to limited resources the application of an EFF is a promising alternative for a better outcome and an improved quality of life for the patients.

ObjectiveThis systematic review aims to explore and synthesise existing literature on the direct and indirect costs from road traffic injuries (RTIs) in sub-Saharan Africa (SSA), the quality of existing evidence, methods used to estimate and report these costs, and the factors that drive the costs.MethodologyMEDLINE, SCOPUS, ProQuest Central, Web of Science, Global Index Medicus, Embase, World Bank Group e-Library, Econlit, Google Scholar and WHO webpages were searched for relevant literature. References of selected papers were also examined for related articles. Screening was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were included in this review if they were published by March 2019, written in English, conducted in SSA and reported original findings on the cost of illness or economic burden of RTIs. The results were systematically examined, and the quality assessed by two reviewers using a modified Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsEleven studies met the inclusion criteria. RTIs can cost between INT$119 and 178 634 per injury and INT$486 and 12 845 per hospitalisation. Findings show variability in costing methods and inadequacies in the quality of existing evidence. Prolonged hospital stays, surgical sundries and severity of injury were the most common factors associated with cost.ConclusionWhile available data are limited, evidence shows that the economic burden of RTIs in SSA is high. Poor quality of existing evidence and heterogeneity in costing methods limit the generalisability of costs reported.

Background The lack of resources limits the treatment of craniomaxillofacial fractures in low-income countries (LIC). Therefore, Barton bandage and/or interdental wiring are considered being gold standard in these regions. The fracture reduction is maintained by permanent occlusion for 6 weeks, which often leads to limited compliance and dissatisfying results. Furthermore, in these conditions the healing of nasopharyngeal fistula is difficult. During humanitarian missions CMF need to be treated by trauma surgeons. The aim of this cadaver-based study is to evaluate the feasibility of the use of an external face fixator (EFF) for the treatment of CMF, its biomechanical values and to define the optimal pin insertion points and angles. Material and methods A commercially available AO hand fixator was used. Craniomaxillofacial fractures type Le Fort 1-3 with split fracture of the hard palate were treated with EFF on 13 anatomical specimens. The fractures were created using a chisel. The pins were placed in specific anatomical regions. The maximal pull-out force [N] of the pins was analysed by a tensile force gauge. As a reference, Fmax of the mandibular pins was evaluated. Computer tomography (CT) scans were performed on the healthy, fractured and EFF-treated skulls. After reduction and EFF placement an adequate reposition was shown in the CT scans. Results The pull-out forces for the single pins were as follows: mandibular pins (n=15, median 488N), supraorbital pins (n=15, median 455.0N), zygomatic pins (n=14, median 269.1N), medial hard palate pins (n=12, median 208.4N) and lateral hard palate pins (n=8, median 49.6N). Conclusions The results of the presented study on the cadaver show, that the operation technique is feasible, and the stability of the EFF is sufficient for maintaining the reduction. In addition, the required pins can be safely inserted into the described areas and a good reduction result can be achieved. The technique of the EFF offers a feasible alternative to the non-surgical treatment of CMF in LIC. Thus, the gap between the open reduction and internal fixation techniques (mini-plates) used in High-income countries and the Barton bandage used in LIC can be closed. Trial registration: A vote of the local ethics committee was obtained (13.01.2022, Ethikkommission Land Salzburg, Austria). EK Nr: 1198/2021 Level of evidence: Level 2

Background The lack of resources limits the treatment of craniomaxillofacial fractures in low-income countries (LIC). Therefore, Barton bandage and/or interdental wiring are considered being gold standard in these regions. The fracture reduction is maintained by permanent occlusion for 6 weeks, which often leads to limited compliance and dissatisfying results. Furthermore, in these conditions the healing of nasopharyngeal fistula is difficult. During humanitarian missions CMF need to be treated by trauma surgeons. The aim of this cadaver-based study is to evaluate the feasibility of the use of an external face fixator (EFF) for the treatment of CMF, its biomechanical values and to define the optimal pin insertion points and angles. Material and methods A commercially available AO hand fixator was used. Craniomaxillofacial fractures type Le Fort 1-3 with split fracture of the hard palate were treated with EFF on 13 anatomical specimens. The fractures were created using a chisel. The pins were placed in specific anatomical regions. The maximal pull-out force [N] of the pins was analysed by a tensile force gauge. As a reference, Fmax of the mandibular pins was evaluated. Computer tomography (CT) scans were performed on the healthy, fractured and EFF-treated skulls. After reduction and EFF placement an adequate reposition was shown in the CT scans. Results The pull-out forces for the single pins were as follows: mandibular pins (n=15, median 488N), supraorbital pins (n=15, median 455.0N), zygomatic pins (n=14, median 269.1N), medial hard palate pins (n=12, median 208.4N) and lateral hard palate pins (n=8, median 49.6N). Conclusions The results of the presented study on the cadaver show, that the operation technique is feasible, and the stability of the EFF is sufficient for maintaining the reduction. In addition, the required pins can be safely inserted into the described areas and a good reduction result can be achieved. The technique of the EFF offers a feasible alternative to the non-surgical treatment of CMF in LIC. Thus, the gap between the open reduction and internal fixation techniques (mini-plates) used in High-income countries and the Barton bandage used in LIC can be closed. Trial registration: A vote of the local ethics committee was obtained (13.01.2022, Ethikkommission Land Salzburg, Austria). EK Nr: 1198/2021 Level of evidence: Level 2