The le fort system revisited: trauma velocity predicts the path of le fort i fractures through the lateral buttress

Roumeliotis, Grayson; Ahluwalia, Romy; Jenkyn, Thomas R.; Yazdani, Arjang

doi:10.4172/plastic-surgery.1000899

Cited by 6 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further, those presenting with these severe fractures were more likely to receive higher levels of neurosurgical intervention involving craniotomies, craniectomy, and burr holes compared with only EVDs or ICP monitors. This is consistent with the initial hypothesis that the high-velocity impacts required to produce the more severe type 2 and 3 Le Fort type fractures 22,26 are also more likely to lead to more severe neurologic injury. These results also support previous investigations that showed associations between midface fractures and more severe TBI.…”

Section: Discussionsupporting

confidence: 89%

“… 4 21 This is likely due to diffuse axonal injury, epidural, and subdural hematomas secondary to the high-velocity facial trauma required to produce these fractures. 4 22 Despite these findings, little is known about how fracture types predict TBI severity and which patients eventually require neurosurgical intervention. Thus, the present study is designed to develop an improved algorithm for the management of TBI in the context of known facial fractures with a hypothesis that patients with midface fractures are at increased risk for severe TBI warranting more aggressive neurosurgical intervention.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Facial Fractures: Independent Prediction of Neurosurgical Intervention

et al. 2022

View full text Add to dashboard Cite

Context Over half of patients with facial fractures have associated traumatic brain injury (TBI). Based on force dynamic cadaveric studies, Le Fort type 2 and 3 fractures are associated with severe injury. Correlation to neurosurgical intervention is not well characterized. Aims This study characterizes fracture pattern types in patients requiring neurosurgical intervention and assesses whether this is different from those not requiring intervention. Settings and Design Retrospective data was collected from the trauma registry from 2010 to 2019. Methods and Materials Patients over 18 years, with confirmed facial fracture, reported TBI, available neuroimaging, and hospital admission were included. Statistical Analysis Retrospective contingency analysis with fraction of total comparison was used with chi-square analysis for demographic and injury characteristic data. Results Note that 1,001 patients required no neurosurgical intervention and 171 required intervention. The intervention group had a significantly greater number of patients with Glasgow Coma Scale (GCS) < 8 compared with the nonintervention group. Subset analysis revealed a twofold increase in Le Fort type 2 fractures and notable increase in Le Fort type 3 and panfacial fractures in the intervention group. Patients requiring craniectomy, craniotomy, or burr holes were much more likely to have Le Fort type 2 or 3 fractures compared with those only requiring external ventricular drains or intracranial pressure monitoring. Subset analysis accounting for GCS supported these results. Conclusion Le Fort type 2 and type 3 fractures are significantly associated with requiring neurosurgical intervention. An improved algorithm for managing these patients has been proposed in the discussion. Ongoing work will focus on validating and refining the algorithm to improve patient care.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Facial Fractures: Independent Prediction of Neurosurgical Intervention

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Although the biological reality of the “pillars and buttresses” of the facial skeleton is debatable, they still serve as important concepts in discussions of fracture reduction and repair, and are accepted anchor points for plates, screws, and other implants (Manson et al, ; Gruss and Mackinnon, ; Yamamoto et al, ; Nagasao et al, ; Andrades et al, ; Rodriguez et al, ; Bluebond‐Langner and Rodriguez, ; Olynik et al, ; Roumeliotis et al, ; Hurrell et al, ; Litschel and Suárez, ). The zygomatic complex is especially important because it is the strongest and most easily accessible of the vertical facial “pillars,” the zygoma serves as an important anchor point for zygomatic implants (Fernández et al, ), and zygomatic complex fractures due to motor vehicle accidents and interpersonal violence are the most common facial fractures treated by maxillofacial surgeons.…”

Section: How Useful Is the Pillar‐buttress Concept Clinically And Canmentioning

confidence: 99%

Review of In Vivo Bone Strain Studies and Finite Element Models of the Zygomatic Complex in Humans and Nonhuman Primates: Implications for Clinical Research and Practice

Prado

Freire

Rossi

et al. 2016

The Anatomical Record

View full text Add to dashboard Cite

The craniofacial skeleton is often described in the clinical literature as being comprised of vertical bony pillars, which transmit forces from the toothrow to the neurocranium as axial compressive stresses, reinforced transversely by buttresses. Here, we review the literature on bony microarchitecture, in vivo bone strain, and finite-element modeling of the facial skeleton of humans and nonhuman primates to address questions regarding the structural and functional existence of facial pillars and buttresses. Available bone material properties data do not support the existence of pillars and buttresses in humans or Sapajus apella. Deformation regimes in the zygomatic complex emphasize bending and shear, therefore conceptualizing the zygomatic complex of humans or nonhuman primates as a pillar obscures its patterns of stress, strain, and deformation. Human fossil relatives and chimpanzees exhibit strain regimes corroborating the existence of a canine-frontal pillar, but the notion of a zygomatic pillar has no support. The emerging consensus on patterns of strain and deformation in finite element models (FEMs) of the human facial skeleton corroborates hypotheses in the clinical literature regarding zygomatic complex function, and provide new insights into patterns of failure of titanium and resorbable plates in experimental studies. It is suggested that the "pillar and buttress" model of human craniofacial skeleton function be replaced with FEMs that more accurately and precisely represent in vivo function, and which can serve as the basis for future This article includes AR WOW Videos. Video 1 can be viewed at http://bcove.me/2mla49wp, Video 2 can be viewed at

show abstract

“…This classification is in use even nowadays because it is practical in nature and enables a common language between the trauma specialists. Often fracture lines are not complete bilaterally but still enable correct assessment of middle vault head trauma [11].…”

Section: Classification Of Midfacial Fractures According To Lefortmentioning

confidence: 99%

Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics during COVID-19 Pandemic Conditions

Vrînceanu¹,

Bănică²,

Dumitru³

2021

Trauma and Emergency Surgery - The Role of Damage Control Surgery

View full text Add to dashboard Cite

Midfacial trauma is never an immediate therapeutic emergency excepting cases with nasal bleeding and risk of aspiration or requiring a permeable airway that will allow intubation when appropriate. The patient with polytraumas and midfacial fractures who needs ear, nose, and throat (ENT) or oral and maxillofacial (OMF) surgery should be reassessed at 24 and 48 hours to determine the optimal operating time. The surgical indication should be established according to esthetic and functional deficits. We consider that the optimal operative moment for the lesions of the midface is at 4-5 days after the trauma, under the conditions of a stable hemodynamic, respiratory, and afebrile patient. We propose the schematic presentation of the principles of diagnosis and treatment for midface trauma. We will discuss also some aspects of midfacial trauma during coronavirus disease-2019 (COVID-19) pandemic conditions. We must assume every patient with polytrauma as a COVID-19-positive patient. So, it is necessary to have a special circuit for a suspect COVID-19 polytrauma patient between emergency room (ER) department, operating room, and intensive care unit (ICU). All medical team must wear high-level personal protective equipment (PPE) during emergency treatment of a craniofacial trauma in the context of polytrauma until we get the result of RT-PCR testing.

show abstract

The le fort system revisited: trauma velocity predicts the path of le fort i fractures through the lateral buttress

Cited by 6 publications

References 17 publications

Facial Fractures: Independent Prediction of Neurosurgical Intervention

Facial Fractures: Independent Prediction of Neurosurgical Intervention

Review of In Vivo Bone Strain Studies and Finite Element Models of the Zygomatic Complex in Humans and Nonhuman Primates: Implications for Clinical Research and Practice

Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics during COVID-19 Pandemic Conditions

Contact Info

Product

Resources

About