الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Worldwide, Trauma is a leading cause of death and major disabilities and various disfigurements. Every individual in the world is at risk for traumatic injury and the etiologies of injury are as diverse as the lifestyles and socioeconomic backgrounds of its victims, ranging from interpersonal violence to motor vehicle crashes and occupational accidents.
Craniomaxillofacial trauma is an important issue in the field of trauma, as it not only hampers the function but also causes serious psychological and cosmetic deficiencies. The study of Craniomaxillofacial fractures entails many important aspects. There are many studies in the literature that have analyzed the demographic factors associated with facial trauma according to various criteria. An understanding of the incidence, epidemiology, cause, type and associated injuries in Craniomaxillofacial trauma can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries.
Our study was a cross-sectional descriptive study included all trauma patients with craniomaxillofacial fractures admitted to the emergency department of Alexandria Main University Hospital over a period of six months from March 2011 to August 2011.During the period of the study 207 patients with craniomaxillofacial fractures were included. The aim of the study was assessment of the cases of craniomaxillofacial fractures as regards: the frequency of occurrence among trauma patients, cause of trauma, common age group and affected sex, types of craniomaxillofacial fractures, associated injuries in other parts of the body and airway affection and its management.
In the clinical evaluation of studied patients in the emergency department, there were five phases of evaluation and management according to guidelines of advanced trauma life support. These phases were; primary survey which evaluated airway, breathing, circulation, disability and other injuries by exposure, resuscitation phase which began side to side with primary survey to correct life threatening conditions, secondary survey which included full clinical examination, full laboratory and radiological evaluation, then definitive care which included splinting, medications, consultation and transfer, lastly tertiary care which was done by repetition of primary and secondary surveys within 24 hours for detection of occult or missed injures.
In this study 207 patients sustained craniomaxillofacial fractures representing (2.4 %) of 8801 trauma patients admitted in the study period. Out of 207 patients, 142 were males (68.6 %) and 65 were females (31.4 %) with a male to female ratio of 2.18: 1.Their ages ranged between 2 years and 75 years with mean age of 25.05 ± 13.86. There were 82 patients (36.9 %) in the age group from 20 to 30 years which was the most common age group affected.
In our study the most common cause of trauma among studied patients was road traffic accidents (RTA) with 88 patients representing (42.5 %) from total number of patients and most of the road traffic accidents victims were pedestrians with 41 patients representing (46.6 %) of all RTA victims. Out of 207 patients, 24 patients (11.6 %) had compromised airway and needed airway management. The most common cause of airway compromise was disturbed level of consciousness in 18 patients (75 %), then aspiration with blood or vomitus in 17 patients (70.8 %). Orotracheal intubation was a procedure done to secure definitive airway in 20 patients representing (83.3 %) from total cases needed airway management.
Out of 207 patients in this study, 102 patients (49.3 %) were presented with isolated craniomaxillofacial fractures while 105 patients (50.7 %) had other associated injuries. Wounds and orthopedic fractures are the most common associated injuries.
In our study, hemodynamic status of studied patients could not be assessed accurately either by blood pressure or pulse alone, so it was defined according to shock index (SI) which is (pulse rate / systolic blood pressure), and shock is defined according to this index when the index is equal or more than one. The shock index among our studied patients ranged from 0.46 to 1.91 with a mean SI of 0.74 ± 0.20. We classified patients into to groups according to their hemodynamic status, There were 192 patients (92.8 %) with SI less than 1 (group A, hemodynamically stable), and there were 15 patients with SI equals or more than 1 (group B, hemodynamically unstable).
It is confirmed in our study that the use of CT scans is needed for proper diagnosis of craniomaxillofacial fractures in most of the cases that conventional x- ray is incapable to confirm diagnosis, especially 3D reconstruction. This needs from emergency physicians to have good knowledge about how to order and interpret CT scans concerning facial bones.
In our study the analysis of studied patients as regards types of craniomaxillofacial fractures revealed that the most common type of fractures were mandibular fractures presented in 95 patients out of 207 patients representing (45.9 %). Nasal fractures come in the second place with 59 patients representing (28.5 %), then dentoalveolar fractures with 43 patients representing (20.8 %). 56 patients were presented with multiple fractures representing (27.1 %) from total number of patients where isolated fractures had the predominance with 151 patients (72.9 %). Combinations between different types of fractures occurred in 56 patients (27.1 %). The most common combination was between mandibular and dentoalveolar fractures in 9 patients representing (16.1%) from total cases with multiple fractures followed by combination between zygomatic and maxillary fractures in 6 patients (10.7 %).
In our study the analysis of the anatomical types of mandibular fractures revealed that the most common type was parasymphyseal in 51 patients (53.7 %) followed by body in 30 patients (31.6 %) then symphyseal in 15 patients (15.8 %) then angle in 14 patients (14.7%) and condylar in 14 patients (14.7 %). Combined types of mandibular fractures occurred in 35 patients (36.8 %),the most common combination occurred between parasymphyseal and condylar in 8 patients (8.4%) followed by parasymphyseal and body in 7 patients (7.4 %) then parasymphyseal and angle in 6 patients (6.3 %).