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© The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background

Maxillofacial fractures can lead to massive oronasal bleeding; however, surgical hemostasis and packing procedures can be challenging owing to complex facial anatomy. Only a few studies investigated maxillofacial fractures with massive oronasal hemorrhage. However, thus far, no studies have reported a protocolized management approach for maxillofacial trauma from a single center. This study aimed to evaluate the effectiveness of protocolized management for maxillofacial fractures with oronasal bleeding.

Methods

Patients were identified from the National Cheng University Hospital trauma registry from 2010 to 2020. We included patients with a face Abbreviated Injury Scale (AIS) score of > 3 and active oronasal bleeding. Patients’ characteristics were compared between the angiography and non-angiography groups and between survivors and nonsurvivors.

Results

Forty-nine patients were included. Among them, 34 (69%) underwent angiography, of whom 21 received arterial embolization. Forty-seven patients (96%) successfully achieved hemostasis by adhering to the treatment protocol at our institution. Compared with the non-angiography group, the angiography group had significantly more patients requiring oral intubation (97% vs. 53%, P < 0.001), Glasgow Coma Scale < 9 (GCS; 79% vs. 27%, P < 0.001), head AIS > 3 (65% vs. 13%, P = 0.001), higher Injury Severity Score (ISS; 43 [33–50] vs. 22 [18–27], P < 0.001), higher incidence of cardiopulmonary resuscitation (CPR; 41% vs. 0%, P = 0.002), higher mortality rate (35% vs. 7%, P = 0.043), and more units of packed red blood cells (PRBC) transfused within 24 h (12 [6–20] vs. 2 [0–4], P < 0.001). The nonsurvivor group had significantly more patients with hypotension (62% vs. 8%; P < 0.001), higher need for CPR (85% vs. 8%; P < 0.001), head AIS > 3 (92% vs. 33%; P < 0.001), skull base fracture (100% vs. 64%; P = 0.011), GCS score < 9 (100% vs. 50%; P = 0.003), higher ISS (50 [43–57] vs. 29 [19–48]; P < 0.001), and more units of PRBC transfused within 24 h (18 [13–22] vs. 6 [2–12]; P = 0.001) than the survivor group. More patients underwent angiography in the nonsurvivor group than in the survivor group (92% vs. 61%; P = 0.043). Among embolized vessels, the internal maxillary artery (65%) was the most common bleeding site. Hypoxic encephalopathy accounted for 92% of deaths.

Conclusions

Protocol-guided management effectively optimizes outcomes in patients with maxillofacial bleeding.

Details

Title
Effectiveness of protocolized management for patients sustaining maxillofacial fracture with massive oronasal bleeding: a single-center experience
Author
Wu, Fang-Chi 1 ; Hung, Kuo-Shu 2 ; Lin, Yu-Wen 3 ; Sung, Kang 4 ; Yang, Tsung-Han 2 ; Wu, Chun-Hsien 1 ; Wang, Chih-Jung 2   VIAFID ORCID Logo  ; Yen, Yi-Ting 2 

 National Cheng Kung University Hospital, Division of General Surgery, Department of Surgery, Tainan, Taiwan (GRID:grid.412040.3) (ISNI:0000 0004 0639 0054) 
 National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Division of Trauma, Department of Surgery, Tainan, Taiwan (GRID:grid.64523.36) (ISNI:0000 0004 0532 3255) 
 National Cheng Kung University, School of Medicine, College of Medicine, Tainan, Taiwan (GRID:grid.64523.36) (ISNI:0000 0004 0532 3255) 
 National Cheng Kung University Hospital, Department of Medical Imaging, Tainan, Taiwan (GRID:grid.412040.3) (ISNI:0000 0004 0639 0054) 
Publication year
2022
Publication date
Dec 2022
Publisher
Springer Nature B.V.
ISSN
17577241
e-ISSN
15007480
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2738303715
Copyright
© The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.