Treatment-assessment of Zygoma-tripod, -quadripod, –arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (1995-2015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatment Suggestions

The ever growing population of elderly patients aged 70 years and onwards are prone to facial injuries caused by a general degrading medical and mental state. Main cause for zygoma-tripod, -quadripod, –arch and orbital floor fractures are falls, followed by traffic accidents and only to a small extent violence. Surgical reduction for these types of fractures is recommended but not correlated to the general medical and mental state of this patient-group. Aim of the study was to compare the outcomes of surgical treatment versus non-surgical observation. Between 1995 and 2014 a total of 1318 patients – hospitalized for isolated zygomaand correlated fractures – were initially screened for cause of accident, pain, hyp/anaesthesia of the corresponding infraorbital nerve, mandible mobility, facial emphysema/haematoma and diplopia and then distributed into three different groups: no functional and/or cosmetic surgery indication (X), surgery indication but denied by internist and/or anaesthesist due to high general medical risks (Y) and surgery indication and released for surgery by internist/anaesthesist (Z). Follow up for each group was performed on day 5, 7 and 1 month after date of injury. Pain assessment revealed a significant higher pain-load for group Z on the 5th and 7th day after injury. Mandible mobility, facial emphysema/haematoma and diplopia improved significantly better in group X and Y on day 5, 7 and after 1 month compared to group Z. Hyp/anaesthesia of the corresponding infraorbital nerve improved generally but not significant between all three groups. The results of this study suggest that indication for closed or even more for open-reduction surgery of isolated midface-bone fractures should be applied very restrictive and only in accordance with specialists for internal medicine and anaesthesiology for elderly patients and non-surgical observation might lead to better results both for life-quality and remaining life-time from the patients point of view. bicyclists in urban and leisure-time traffic [3], general leisure-time sports activities [4] and countries with strong increase of road-vehicle traffic [5]. Few studies were published recently investigating the incidence and causes of facial-bone-trauma and prevalence of zygoma-tripod, -quadripod, – arch and orbital floor-fractures in the growing elderly population of 70 years + in various parts of the world [6-11] but only isolated studies suggest therapy-guidelines for treatment modalities in this increasing patient-group with mostly general chronic-disease anamnesis [12,13] which should be based on a multidisciplinary Introduction Although the incidence of zygomaand related orbital-floor fractures decreased over the years towards the turn of the millennium for road-vehicle-accident related causes in the overall population of countries with mandatory passive and active safety-devices in cars and mandatory helmet-duty when motorcycling [1], still zygomatripod and/or arch-fractures and related orbital-floor-fractures represent the most common trauma of facial bones representing a quarter of all cases, followed by generic orbital-floor-fractures [2] and are now increasing again in recent years by ever higher numbers of Research Article Treatment-assessment of Zygomatripod, -quadripod, –arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (19952015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatment Suggestions Angelo Troedhan* Institute for Maxillofacial Surgery and Dentistry, General Hospital of Vienna “Hietzing”, Wolkersbergenstraße 1, Pavillon 3a, 1130 Vienna Dates: Received: 08 March, 2015; Accepted: 30 March, 2015; Published: 31 March, 2015 *Corresponding author: Troedhan Angelo, Institute for Maxillofacial Surgery and Dentistry, General Hospital of Vienna “Hietzing”, Wolkersbergenstraße 1, Pavillon 3a, 1130 Vienna, Tel: (+43 1) 801 10 – 3202; E-mail: www.peertechz.com ISSN: 2455-4634