目的:近年来,电子烟已成为越来越受欢迎的用于消耗尼古丁的设备。越来越多的证据表明,这些设备有自发爆炸导致烧伤和弹丸伤害的风险。这篇综述的主要目的是总结电子烟爆炸继发的口腔和颌面部区域的所有损伤。次要目的是根据文献中的发现提出一种针对此类伤害的初始管理算法。这篇评论还旨在检验以下假设:电子烟对口腔区域的爆炸伤害与插管和手术的风险增加有关,并检查任何其他伤害模式是否与插管或手术的风险增加有关。
方法:进行了一项基于文献中识别病例的队列研究,以总结口腔颌面部损伤,并检查损伤类型与位置和处理之间的关联。2022年9月,使用电子烟等术语对主要生物医学数据库进行了文献检索,爆炸,爆炸,创伤,燃烧,其中,产生了922项研究。非临床研究,评论文章,排除面部区域无损伤的研究。记录研究对象的人口统计学,器件特性,损伤机制,损伤位置,管理,和并发症。卡方分析用于确定损伤类型(烧伤或弹丸)及其相关位置(眼,面部,或口内烧伤和面部三分之一射弹)与插管和手术治疗的结果相关。然后将收集的数据用作指导,为这些伤害提出初始管理算法。
结果:28项研究,包括20例病例报告和8例病例系列符合纳入标准.共有32次电子烟爆炸给32名患者造成了105次面部受伤记录。弹丸损伤占所有面部损伤的73.3%(n=77),烧伤占26.7%(n=28)。有14例(43.8%)患者同时遭受弹丸和烧伤。烧伤主要涉及面部(64.3%,n=18),口腔(25%,n=7),和眼睛(10.7%,n=7)。大多数(81.8%,n=63)的弹丸损伤发生在下面部三分之一。有20名(62.5%)患者发生骨或牙齿骨折。62.5%(n=20)的患者受伤管理涉及手术,包括切开复位和骨折内固定,拔牙,骨和皮肤移植,和眼科手术。在随访报告的研究中观察到并发症发生率为44.4%(n=8)。口腔区域的爆炸性损伤与插管或手术管理之间没有统计学上的显着关联。任何其他损伤类型和位置与插管或手术管理之间也没有其他统计学上的显着关联。
结论:电子香烟有自燃的风险,可导致严重的口腔和颌面部损伤,特别是下面部三分之一,通常需要手术治疗。应通过增加用户教育和监管来提高这些设备的安全性。
E-cigarettes have become increasingly popular devices used to consume nicotine in recent years. There is a growing body of evidence regarding the risk of spontaneous explosion of these devices causing burn and projectile injuries. The primary purpose of this review was to summarize all injuries to the oral and maxillofacial region secondary to explosion of e-cigarettes. The secondary purpose was to propose an initial management algorithm for such injuries based on the findings in the literature. This review also aims to test the hypothesis that e-cigarette explosive injuries to the oral region were associated with an increased risk of intubation and surgery and examine whether any other injury pattern was associated with an increased risk of intubation or surgery.
A cohort study based on identifying cases in the literature was conducted to summarize injuries to the oral and maxillofacial region and examine the associations between injury types and location and management. A literature search of the major biomedical databases was conducted in September 2022 using terms such as e-cigarette, explosion, blast, trauma, and burn, among others, which yielded 922 studies. Nonclinical studies, review articles, and studies without injuries to the facial region were excluded. Study subjects were recorded for demographics, device characteristics, injury mechanism, injury location, management, and complications. Chi-squared analysis was used to determine if the predictor variables of type of injury (burn or projectile) and its associated location (ocular, facial, or intraoral for burns and facial thirds for projectile) were associated with the outcomes of intubation and surgical management. The collected data were then used as a guide to propose an initial management algorithm for these injuries.
Twenty eight studies, including 20 case reports and 8 case series met the inclusion criteria. A total of 32 explosions of e-cigarettes to 32 patients caused 105 recorded injuries to the facial region. Projectile injuries made up 73.3% (n = 77) of all facial injuries, while burn injuries made up of 26.7% (n = 28). There were 14 (43.8%) patients who suffered both projectile and burn injuries. Burn injuries mostly involved the face (64.3%, n = 18), oral cavity (25%, n = 7), and eye (10.7%, n = 7). The majority (81.8%, n = 63) of projectile injuries occurred in the lower facial third. There were 20 (62.5%) patients who suffered a bone or tooth fracture. Management of injuries involved surgery in 62.5% (n = 20) of patients, which included open reduction and internal fixation of fractures, dental extraction, bone and skin grafts, and ocular surgery. A complication rate of 44.4% (n = 8) was observed across studies that reported on follow-up. There was no statistically significant association between explosive injury to the oral region and intubation or surgical management. There was also no other statistically significant association between any other injury type and location with intubation or surgical management.
E-cigarettes are at risk for spontaneous combustion that can cause serious oral and maxillofacial injuries, particularly to the lower facial third and commonly requiring surgical management. Safety of these devices should be improved through increased user education and regulation.