title: Maxillofacial and concomitant serious injuries: An eight-year single center experience.
abstract: OBJECTIVE
  Maxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas.
  
  
  METHODS
  We retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different institutions, pediatric trauma patients and adult patients who were transferred in accordance with pre-existing agreements in case of paucity of beds were excluded. Finally we included 447 (0.2%) patients over the 8 years. Data were evaluated with emphasis on epidemiology (age, gender, mechanism of trauma), primary survey and abnormalities and pattern of trauma.
  
  
  RESULTS
  The most frequent cause of maxillofacial trauma was road accidents (319 patients, 71.4%), among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients; 443 (99.1%) patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries (χ2= 557.2, p < 0.0001). Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas (χ2= 17.13, p < 0.0001 vs minor lesions). All of the neglected lesions occurred in paucisymptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hematoma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms.
  
  
  CONCLUSIONS
  Among the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit, diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial major lesions.
authors.affiliation: Department of Human Pathology, University Hospital of Messina, 98125 Messina, Italy. Electronic address: famafausto@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Fama
authors.affiliation: Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cicciu
authors.affiliation: Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sindoni
authors.affiliation: Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Nastro-Siniscalchi
authors.affiliation: Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Falzea
authors.affiliation: Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cervino
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Polito
authors.affiliation: Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Ponte
authors.affiliation: Department of Human Pathology, University Hospital of Messina, 98125 Messina, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Gioffre-Florio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D009104:Multiple Trauma / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies
keywords: Concomitant lesions; Emergency department; Maxillofacial injuries; Multiple trauma