title: Microstructural Change and Cognitive Alteration in Maxillofacial Trauma and Mild Traumatic Brain Injury: A Diffusion Tensor Imaging Study.
abstract: OBJECTIVE
  The aim of the present study was to establish the incidence of maxillofacial (MF) injury accompanying mild traumatic brain injury (mTBI) and the associated neurocognitive deficits and white matter changes.
  
  
  METHODS
  A prospective review of 41 patients with mTBI and maxillofacial injury (with or without intracranial lesion) due to motor vehicle accidents who had admission computed tomography (CT), neurocognitive evaluation, and quantitative diffusion tensor imaging available was performed during admission and at 6 months of follow-up. Descriptive statistics were used for the demographic data, and a paired t test and repeated measure analysis of variance were used to establish the intergroup differences and susceptibility.
  
  
  RESULTS
  The included patients were relatively young adults, with a mean age of 27.3 ± 8.8 years and 11.3 ± 2.1 years of education. Of the 41 patients, 20 (48.8%) had maxillofacial injuries involving the soft tissue and muscles, 18 (43.9%) had facial bone fractures, and 3 (7.3%) had mixed injuries. Of the 41 patients with MF injuries, 28 (68.3%) had intracranial abnormalities found on the admission CT scan. Executive function and attention were significantly altered across the time points, with patients with both MF injury and an intracranial lesion doing poorly at baseline but with improvement 6 months later. In contrast, the patients with no visible intracranial lesion but with MF injuries remained impaired, with signs of a slowed recovery. The fractional anisotropy of the genu of the corpus callosum, anterior limb of the internal capsule, and cingulum for patients with MF injuries but without an intracranial lesion showed trends of reduced integrity over time.
  
  
  CONCLUSIONS
  The presence of MF injury without any intracranial traumatic lesions in patients with mTBI increases the risk of short- and long-term neurocognitive derangement compared with patients with mTBI, MF injury, and intracranial traumatic lesions.
authors.affiliation: Fellow in Clinical Neuropsychology, Division of Neurosurgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: vicveera@gmail.com.
authors.forename: Vigneswaran
authors.initials: V
authors.lastname: Veeramuthu
authors.affiliation: Senior Lecturer in Oral and Maxillofacial Surgery, Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Firdaus
authors.initials: F
authors.lastname: Hariri
authors.affiliation: Associate Professor of Neurosurgery, Division of Neurosurgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Vairavan
authors.initials: V
authors.lastname: Narayanan
authors.affiliation: Senior Lecturer in Biomedical Imaging, University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Li Kuo
authors.initials: LK
authors.lastname: Tan
authors.affiliation: Professor of Neuroradiology, University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Norlisah
authors.initials: N
authors.lastname: Ramli
authors.affiliation: Professor of Neurosurgery, Division of Neurosurgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Ganesan
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000648:ultrastructure; D001924:Brain Concussion / Q000000981:diagnostic imaging* / Q000523:psychology; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008446:Maxillofacial Injuries / Q000000981:diagnostic imaging* / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult