Oral Abstract Track 2

References:

1. Shanti RM, Ziccardi VB: Use of Decellularized Nerve Allograft for

Inferior Alveolar Nerve Reconstruction: A Case Report. JOMS 69:550-

553, 2011

2. Brooks DV, Weber RV, Chao JJ, et al: Processed Nerve Allografts for

Peripheral Nerve Reconstruction: A Multicenter Study of Utilization and

Outcomes in Sensory, Mixed, and Motor Nerve Reconstructions. Micro-

surgery 1-14, 2011

BDNF Gene Transfer PromotesRegeneration After Rat Facial NerveCrush Injury

B. E. Yang: Hallym University School of Medicine

Although facial nerve injury is seldom a complication

of dentoalveolar surgery, transient Bell’s palsy may follow

an inadvertent injection of local anesthetic into the

parotid gland and its superficial location make it liable

to be injured during dental treatment. A variety of

methods are used in the treatment of facial palsy.

However, there is no simple and effective treatment for

this problem up to now.Objectives:Damage to the facial nerve produces weak

muscles of facial expression. Facial nerve crush model

was designed and nerve recovery was evaluated using

BDNF gene transfer.

Materials and Methods: A crushed injury was made

with hemostat to create axonotmesis on the right facial

nerve main trunk in rats. Adenoviral BDNF (BDNF-Ad)

was injected into the experimental group andsaline was injected for the control group. Regeneration

was evaluated with functional test (vibrissae and

ocular movement), electrophysiologic (threshold volt-

age, peak voltage, conduction velocity) and histomorpho-

metric study.

AAOMS � 2013

The t-test was used to compare the mean score of the

electrophysiology test and axon density results in thesame day. The Mann-Whitney U test was used to compare

the mean score of functional test in the same day. For

analysis of experiments involving time, one-way ANOVA

was used to determine the mean score of the electrophys-

iology test results and the axon density measurements.

The Kruskal-Wallis test was used to compare the mean

score of the functional test results on the same day be-

tween the control and experimental groups. A value ofp < 0 .05 was considered significant.

Results: Functional test score, threshold and conduc-

tion velocity improved with time in both groups. How-

ever, axon density increased significantly only in the

experimental group. Functional tests at 10 and 20 days

showed no difference. Vibrissae movement, threshold,

conduction velocity and axon density at 30 days revealed

that the degree of regeneration in the experimental groupwas significantly superior. The degree of nerve regenera-

tion in the BDNF-Ad group was significantly higher dur-

ing the 30 days of analysis, and functional recovery

after facial nerve crush was obtained 30 days.

Conclusion: Despite the lack of long-term effective-

ness, the present study demonstrates that the administra-

tion of BDNF using an adenoviral vector accelerates

nerve regeneration for a period of 30 days followingcrush injury.

References:

1. Zhang JY, Luo XG, Xian CJ, Liu ZH, Zhou, XF: (2000): Endogenous

BDNF is required for myelination and regeneration of injured sciatic

nerve in rodents. Eur J Neurosci 12, 4171-4180

2. Hadlock TA, Heaton J, Cheney M, Mackinnon SE: (2005): Func-

tional recovery after facial and sciatic nerve crush injury in the rat.

Arch Facial Plast Surg 7, 17-20.

Oral Abstract Track 2

TRAUMA, ORTHOGNATHIC, COSMETIC, OSA

October 10, 2013 7:00 AM-9:00 AM

Facial Fractures: Demographics andInjury Patterns in a Level 1 Trauma Center

R. Garza III: Allentown, PA, J. M. Adkinson, J. N. Gilstrap,

N. F. Miller, S. M. Eid, R. X. Murphy Jr

Purpose:With increasing age, an individual’s potential

for exposure to various mechanisms of trauma may

change. This may impact the types of facial fractures sus-

tained and the likelihood for surgical intervention. The

objective of this study is to examine the impact of patient

demographics on facial fractures at our Level 1Trauma Center.

Method: An IRB-approved review of the Network

Trauma Registry from 2006-2010 was performed: age,

sex, mechanism, Injury Severity Score (ISS), Glasgow

Coma Score (GCS), blood alcohol level (BAL), length of

stay (LOS), type of facial fracture (nasal, maxillary/malar,

orbital, mandible), and operative intervention were docu-mented. A logistic regression was performed using SPSS

15.0 (SPSS Inc, Chicago, IL).

Result: The database identified 23,318 patients; 1,686

patients with facial fractures with 910 patients sustaining

2,094 fractures by MVC, fall, or assault. This cohort in-

cluded 866 nasal, 504 malar/maxillary, 434 orbital, and

290 mandible fractures sustained in 509 MVC, 229 falls,

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Table 1Facial Fracture Rate By Age Group

Fracture Type

Age Group (years) Nasal (n=866)** Malar/Maxillary (n=504)* Orbital (n=434)*** Mandible (n=290)*

<18 82 (48.8%) 37 (22.0%) 54 (32.1%) 47 (28.0%)18-44 370 (53.6%) 237 (34.4%) 190 (27.5%) 195 (28.3%)45-64 227 (60.9%) 159 (42.6%) 99 (26.5%) 53 (14.2%)65-79 132 (61.4%) 75 (34.9%) 72 (33.5%) 21 (9.8%)80-89 109 (58.0%) 60 (31.9%) 66 (35.1%) 14 (7.4%)90+ 37 (71.2%) 11 (21.2%) 11 (21.2%) 4 (7.7%)Total 957 (56.8%) 579 (34.3%) 492 (29.2%) 334 (19.8%)

*p<0.0001 **p=0.007 ***p=0.087

Oral Abstract Track 2

and 172 assaults. Nasal fractures were the most common

injuries sustained by all age groups (56.8% of all patients).

Mandible fractures were the least frequently sustained fa-

cial fracture in patients older than 45yo, and decreased

dramatically in the subset older than 80yo (p<0.0001).

There was no age-related statistically significant differ-

ence in the likelihood of sustaining an orbital fracture(p=0.087) (Table 1). Patients in the 18-44yo age group

had a statistically significantly higher ISS, BAL, and LOS

(p<0.001). 23.8% of patients underwent surgical

intervention and this peaked in the 18-44yo age group

(p<0.001) (Table 2). With increasing age, facial

fractures from MVC decreased, while fractures

Table 2Facial Fracture Surgical Intervention By Age Group (p<0.001)

Age Group(years)

SurgicalIntervention

No SurgicalIntervention Total

<18 45 (26.8%) 123 (73.2%) 168 (100.0%)18-44 223 (32.3%) 467 (67.7%) 690 (100.0%)45-64 88 (23.6%) 285 (76.4%) 373 (100.0%)65-79 33 (15.3%) 182 (84.7%) 215 (100.0%)80-89 12 (6.4%) 176 (93.6%) 188 (100.0%)90+ 1 (1.9%) 51 (98.1%) 52 (100.0%)Total 402 (23.8%) 1284 (76.2%) 1686 (100.0%)

Figure 1 Mechanism of Facial Fracture By Age Group (p<0.0001)

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sustained in falls increased. Assaults peaked in the 18-

44yo age group (p<0.0001) (Figure 1).

Conclusion: Age is associated with differences in the

type of facial fractures sustained, mechanism of injury,

and the likelihood for surgical intervention. These data

emphasize the need to customize prevention strategies

and appropriately allocate healthcare resources for pa-tients within different age stratifications.

A Numerical Model to Simulate CombatNeck Injury From Perforating ExplosiveFragments

J. Breeze: Royal Centre for Defence Medicine

Statement of Problem: Neck injuries from explo-

sively propelled fragments are present in 11% of injured

UK soldiers and result in significant mortality and long-

term morbidity. US forces in contrast only sustain neck

wounds in 3-4% of those injured, which is believed to bedue to their greater acceptance in the wearing of issued

neck protection. A numerical simulation of the neck is de-

sired to simulate suchwounds so that potential methods of

injury mitigationmay be objectively compared. The aim of

this research is to develop an accurate numerical simula-

tion of neck anatomy that can provide accurate predic-

tions of tissue damage from these fragments, which will

enable objective comparisons between the potential miti-gative effects of different body armour systems to bemade.

Method: A high definition numerical model has been

developed based on an anatomically accurate, anthropo-

metrically representative, three-dimensional mathemati-

cal mesh of cervical neurovascular structures. An

explicit Eulerian approach has been chosen, in conjunc-

tion with an LS-DYNA finite element code, to simulate

the effect of a metal fragment simulating projectile(FSP) passing through cervical neurovascular structures.

Currently all structures are modelled using material prop-

erties based on 20% ballistic gelatin, a tissue simulant that

has been demonstrated to accurately simulate the retarda-

tion of such projectiles in tissue [2]. The predicted depth

of penetration (DoP) into muscle of 20 test shots of a sim-

ulated 1.10g FSP in the simulation were compared to that

AAOMS � 2013