Temporal bone (TB) fractures are frequently accompanied by intracranial injury. This study aimed to analyze combined intracranial injuries in relation to functional changes in the inner ear, including those of the contralateral ear, in patients with TB fractures. Ninety-four patients (mean age: 35.6 ± 18.7 years, M : F=67 : 27) diagnosed with unilateral TB fracture were included. Bone conduction (BC) threshold, word recognition score (WRS), and changes in vestibular function were compared based on intracranial injuries, focusing on the contralateral side. Various types of intracranial injuries were observed (67.9%). Among these, a significant association between traumatic brain injury (TBI) and otic capsule-violating fractures was noted. The BC threshold on the fractured side significantly deteriorated in patients with TBI. Additionally, a significantly worse BC threshold was confirmed on the contralateral side in patients with TBI, intracranial hemorrhage (ICH), and contrecoup injury. The follow-up BC threshold did not improve or differ, regardless of high-dose steroid administration. The initial WRS and canal paresis in the bithermal caloric test were not significantly different in the presence of each intracranial injury. Concurrent fluctuations in the pressure of the cerebrospinal fluid space and perilymphatic space were speculated to be the potential underlying mechanisms. A significantly worse BC threshold was confirmed on the contralateral side of patients with TBI, contrecoup injury, ICH, and on fracture sides of patients with TBI.

The human head can sometimes experience impact loads that result in skull fractures or other injuries, leading to the need for a craniectomy. Cranioplasty is a procedure that involves replacing the removed portion with either autologous bone or alloplastic material. While titanium has traditionally been the preferred material for cranial implants due to its excellent properties and biocompatibility, its limitations have prompted the search for alternative materials. This research aimed to explore alternative materials to titanium for cranial implants in order to address the limitations of titanium implants and improve the performance of the cranioplasty process. A 3D model of a defective skull was reconstructed with a cranial implant, and the implant was simulated using various stiff and soft materials (such as alumina, zirconia, hydroxyapatite, zirconia-reinforced PMMA, and PMMA) as alternatives to titanium under 2000N impact forces. Alumina and zirconia implants were found to reduce stresses and strains on the skull and brain compared to titanium implants. However, PMMA implants showed potential for causing skull damage under current loading conditions. Additionally, PMMA and hydroxyapatite implants were prone to fracture. Despite these findings, none of the implants exceeded the limits for tensile and compressive stresses and strains on the brain. Zirconia-reinforced PMMA implants were also shown to reduce stresses and strains on the skull and brain compared to PMMA implants. Alumina and zirconia show promise as alternatives to titanium for the production of cranial implants. The use of alternative implant materials to titanium has the potential to enhance the success of cranial reconstruction by overcoming the limitations associated with titanium implants.

UNASSIGNED: To determine the prevalence of maxillofacial fractures associated with persistent CSF leak, and to assess its bearing on clinical outcomes of consecutive patients managed at our centre.
UNASSIGNED: This was a retrospective cross-sectional study. The medical records of patients over 11-year period were analysed for age, gender, etiology of injuries, duration between injury and presentation to the hospital, types of facial fracture and their treatments, treatment done to control CSF leak, and complication(s). Descriptive and bivariate statistics were computed.
UNASSIGNED: Overall, 1473 patients were evaluated, 66 (4.5%) presented with craniofacial injuries associated with persistent CSF leak after 5 days of non-surgical treatment. Males (92.5%, P= 0.0000) and those in the 21 to 30 years age group (59.1 %, P=0.01) were predominant. The most common (68.2%) type of fracture combination was Le Fort I, II and III, NOE, zygomatic complex and mandible. The commonest clinical presentation of CSF leak was rhinorrhea only, in 66.7% of patients (P= 0.001).
UNASSIGNED: This study shows that the prevalence of maxillofacial fractures associated with persistent CSF leak was low, which was 4.5% of patients that presented with persistent CSF leak and 84.9% of the cases resolved after treatment of the various maxillofacial fractures.

UNASSIGNED: Trauma remains the leading cause of death for children over a year old. Motorized recreational conveyances (RCs) adds another potential cause of pediatric trauma. This study aims to determine the impact of adding electric motors to RCs on the severity and frequency of pediatric injuries and craniofacial fractures.
UNASSIGNED: Pediatric trauma information was obtained from the National Electronic Injury Surveillance System (NEISS) database between 2012 and 2021. Demographics, injury cause, diagnoses, and incident narrative were collected. Bivariate and multivariate regression analyses were used to determine injury factors associated with serious injuries.
UNASSIGNED: One million five hundred ninety-six thousand five hundred fifty-nine encounters were examined; 113,905 (7.1%) were related to pediatric RCs and 5354 (5.4%) of those involved RCs with electric motors. 14.3% of injuries were related to scooters, 18.6% to skateboards, 54.2% to bicycles, and 12.9% to other RCs. There were significant differences in age, sex, race, helmet use, serious injuries, and craniofacial fractures between RC modalities. RC users were more likely to develop facial fractures (OR 2.12; 95%CI 2.01, 2.23; p < .001) and be involved in serious injuries (OR 1.42; 95%CI 1.38, 1.46; p < .001). Compared to their self-propelled counterparts, motorized scooters (OR 2.24; 95%CI 1.86, 2.69; p < .001) but not motorized skateboards (OR 1.01; 95%CI 0.88, 1.17; p = 0.88) were more likely to cause serious injuries. Helmet use was associated with fewer serious injuries (OR 0.5; 95%CI 0.46, 0.54; p < .001), facial fractures (OR 0.48; 95%CI 0.41, 0.55; p < .001), and skull fractures (OR 0.13; 95%CI 0.09, 0.17; p < .001).
UNASSIGNED: The addition of electric motors to RCs significantly increases the risk of pediatric craniofacial fractures and serious injuries.
UNASSIGNED: 3.

OBJECTIVE: To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications.
METHODS: A retrospective study was carried out in King Saud Medical City, Riyadh, Saudi Arabia. The study analyzed the records of patients who were diagnosed and treated with FSF from 2011-2021. Files with missing documents or incomplete treatment were excluded. The retrieved data includes: patients age, gender, types, locations, treatment, and complications of FSF. Data was analyzed by the statistical Package for the Social Sciences Statistics, version 23.0 using descriptive statistics and Chi-square test.
RESULTS: A total of 72 cases were included, 94.4% males and 5.6% females. Road traffic accidents were the common cause of trauma (91%). Frontal sinus fractures were unilateral in 59.7% and associated other injuries in 80.6% of cases. Anterior table fractures were the largest proportion (58.3%), followed by anterior and posterior table (37.5%). The carried out surgical procedures were obliteration (23.9%), cranialization and obliteration (23.9%), and fixation only (52.2%). The post-operative complications were categorized into; neurological (22.2%), ophthalmic (15.3%), infection (2.8%), and deformity (16.7%). Anterior and posterior table had the highest percentage among these categories.
CONCLUSIONS: Frontal sinus fractures were mostly required surgical treatment (63.9%) and post-operative complications occurred especially the neurological and ophthalmic. We recommend studies on the association of complications and different types of obliteration materials.

BACKGROUND: This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs).
METHODS: PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed.
RESULTS: Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients\' satisfaction with the anesthesia procedure, and patients\' satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = - 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = - 0.00, p = 0.9974).
CONCLUSIONS: Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures.

The report describes a patient who presented with traumatic right temporoparietal calvarial fracture with chronic right subdural haematoma who underwent right middle meningeal artery embolisation with n-BCA during which direct filling of an anterior temporal branch of the middle cerebral artery was observed.

BACKGROUND: Children aged 0-4 years have the highest rate of emergency department (ED) visits for traumatic brain injury (TBI); falls are the leading cause. Infants younger than 2 years are more likely to sustain a fractured skull after a fall.
OBJECTIVE: This study examined caregiver actions and products associated with ED visits for fall-related fractured skulls in infants aged 0-4 months.
METHODS: Data were analyzed from the 2001-2017 National Electronic Injury Surveillance System-All Injury Program. Case narratives of infants aged 0-4 months who visited an ED for a fall-related skull fracture were examined to code caregiver actions preceding the fall. Product codes determined fall location and product type involved (e.g., flooring, bed, or stairs). All national estimates were weighted.
RESULTS: There were more than 27,000 ED visits (weighted estimate) of infants aged 0-4 months for a nonfatal fall-related fractured skull between 2001 and 2017. Most were younger than 2 months (46.7%) and male (54.4%). Falls occurred primarily in the home (69.9%) and required hospitalization (76.4%). Primary caregiver actions coded involved placing (58.6%), dropping (22.7%), and carrying an infant (16.6%). Floor surfaces were the most common product (mentioned in 24.0% of the cases).
CONCLUSIONS: Fall-related fractured skulls are a health and developmental concern for infants, highlighting the importance of a comprehensive assessment at the time of the injury to better understand adult actions. Findings indicated the need to develop prevention messages that include safe carrying and placement of infants.

OBJECTIVE: Research on reasons for malpractice claims in oral and maxillofacial surgery is scarce. The aim of this study was to investigate the causes and prevalence of permanent harm among craniofacial fracture related malpractice claims.
METHODS: A retrospective register study was designed and implemented. All patients with a complaint and a diagnosis of facial or cranial fracture were included. The main outcome was the presence of permanent harm, and the predictor variable was the cause of complaint. Chi-square test was used for estimation of statistical significance.
RESULTS: Delay in correct diagnosis was the leading cause of malpractice claims (63.2%), and permanent harm was found in 23.1% of the population. 82.4% of injuries were facial fractures in total population. 65.3% (n = 98) of facial trauma were related with delayed diagnostics (p < 0.001). Permanent harm was more frequent in patients with delayed diagnosis (71.4%) than those without (60.7%, p = 0.299).
CONCLUSIONS: Claims of craniofacial trauma are related with under-diagnostics, and un-diagnosed facial fracture can lead to a high rate of permanent harm. Systematic clinical evaluation and facial trauma specialist consultation is recommended to set early correct diagnosis for and improve treatment of craniofacial trauma patients.

OBJECTIVE: The purpose of this study was to analyze the prevalence of and complications resulting from temporal bone fractures in adult and pediatric patients evaluated for cranio-facial trauma in an emergency setting.
METHODS: A retrospective blinded analysis of CT scans of a series of 294 consecutive adult and pediatric patients with cranio-facial trauma investigated in the emergency setting was conducted. Findings were compared between the two populations. Preliminary reports made by on-call residents were compared with the retrospective analysis, which was performed in consensus by two experienced readers and served as reference standard.
RESULTS: CT revealed 126 fractures in 116/294 (39.5%) patients, although fractures were clinically suspected only in 70/294 (23.8%); p < 0.05. Fractures were longitudinal, transverse and mixed in 69.5%, 10.3% and 19.8% of cases, respectively. Most fractures were otic-sparing fractures (95.2%). Involvement of the external auditory canal, ossicular chain and the osseous structures surrounding the facial nerve was present in 72.2%, 8.7% and 6.3% of cases, respectively. Temporal bone fractures extended into the venous sinuses/jugular foramen and carotid canal in 18.3% and 17.5% of cases, respectively. Vascular injuries (carotid dissection and venous thrombosis) were more common in children than in adults (13.6% versus 5.3%); however, the observed difference did not reach statistical significance. 79.5% of patients with temporal bone fractures had both brain injuries and fractures of the facial bones and cranial vault. Brain injuries were more common in adults (90.4%) than in children (63.6%), p = 0.001. Although on-call residents reliably detected temporal bone fractures (sensitivity = 92.8%), they often missed trauma-associated ossicular dislocation (sensitivity = 27.3%).
CONCLUSIONS: Temporal bone fractures and related complications are common in patients with cranio-facial trauma and need to be thoroughly looked for; the pattern of associated injuries is slightly different in children and in adults.