Incidence of Concussion in Patients With Isolated Mandible Fractures
Original Investigation Research
Invited Commentary
Mandibular Fractures—Are We Asking the Right Questions? Robert Chun, MD
“How is your occlusion?” “Where is your jaw pain?” These are the common questions we ask when evaluating a patient with mandibular trauma. But maybe what we should also be asking is “Do you have a headache?” “Have you been dizzy?” “How is your mentation?” In this issue of JAMA Facial Plastic Surgery, Sobin et al1 raise the importance of concussion in isolated mandible fractures. In their prospective study of 16 adults with isolated mandibular fractures, 75% met the criteria for high risk for concussion, based on the Military Acute Concussion Evaluation (MACE). Sobin et al raise Related article page 15 the concern that without associated life-threatening injuries, the possibility of concussion may be overlooked in cases of isolated mandible fractures. In their search of the Nationwide Inpatient Sample database, they found that only 5.6% of mandible fractures had a concurrent diagnosis of concussion. However, their prospective study shows that 75% of patients with isolated mandible fractures are at high risk of concussion. But what are the sequelae of having a concussion? Sobin et al1 remind us that minor traumatic brain injury is associated with chronic pain syndromes, migraine headaches, posttraumatic stress disorder, and mood disorders. And concussion with facial trauma is not unique to adults. In a retrospective chart review of pediatric patients ARTICLE INFORMATION
with facial fracture, Afrooz et al2 demonstrated a concurrent International Classification of Diseases diagnosis of concussion in 31% of pediatric facial fracture cases. In pediatric concussion, the complications can range from a persistence of symptoms to other complications. Headache in children is the most common postconcussive symptom (65%-93%), followed by fatigue, dizziness, and slowed mentation.3 And these symptoms persist as well. In a prospective study of patients aged 11 to 22 years who presented emergently with an acute concussion, irritability and sleep disturbances lasted a median of 16 days, and frustration and poor concentration lasted 14 days.4 Children with a concussion may experience excessive sleep, daytime drowsiness, difficulty falling asleep, or frequent nighttime waking.3 Posttraumatic seizures are another serious complication from concussion and occur at a 2-fold increased rate in children following concussion.5 In the management of mandibular fractures at my institution, we are always concerned about the complications of fracture treatment such as infection, nonunion, or malunion. But what else could we be missing? Sobin et al1 demonstrate that the incidence of concussion in isolated mandibular trauma may be high, and the data suggest that the sequelae of concussion in both children and adults are long-term and significant. So when evaluating these cases, remember that the deleterious effects of trauma go beyond the healing of the bone; we must make sure that we ask our patients the right questions.
Author Affiliation: Department of Otolaryngology, Medical College of Wisconsin, Milwaukee.
mandible fractures [published online October 8, 2015]. JAMA Facial Plast Surg. doi:10.1001 /jamafacial.2015.1339.
Corresponding Author: Robert Chun, MD, Department of Otolaryngology, Medical College of Wisconsin, 9000 W Wisconsin Ave, Ste 540/ENT offices, Milwaukee, WI 53226 ([email protected]).
2. Afrooz PN, Grunwaldt LJ, Zanoun RR, et al. Pediatric facial fractures: occurrence of concussion and relation to fracture patterns. J Craniofac Surg. 2012;23(5):1270-1273.
Published Online: October 8, 2015. doi:10.1001/jamafacial.2015.1549.
3. Rose SC, Weber KD, Collen JB, Heyer GL. The diagnosis and management of concussion in children and adolescents. Pediatr Neurol. 2015;53 (2):108-118.
Conflict of Interest Disclosures: None reported. REFERENCES 1. Sobin L, Kopp R, Walsh R, Kellman RM, Harris T. Incidence of concussion in patients with isolated
jamafacialplasticsurgery.com
5. Christensen J, Pedersen MG, Pedersen CB, Sidenius P, Olsen J, Vestergaard M. Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet. 2009;373(9669):1105-1110.
4. Eisenberg MA, Meehan WP III, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133(6):999-1006.
(Reprinted) JAMA Facial Plastic Surgery January/February 2016 Volume 18, Number 1
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: http://archfaci.jamanetwork.com/ by a GAZI UNIVERSITESI User on 01/22/2016
19
Original Investigation Research
Invited Commentary
Mandibular Fractures—Are We Asking the Right Questions? Robert Chun, MD
“How is your occlusion?” “Where is your jaw pain?” These are the common questions we ask when evaluating a patient with mandibular trauma. But maybe what we should also be asking is “Do you have a headache?” “Have you been dizzy?” “How is your mentation?” In this issue of JAMA Facial Plastic Surgery, Sobin et al1 raise the importance of concussion in isolated mandible fractures. In their prospective study of 16 adults with isolated mandibular fractures, 75% met the criteria for high risk for concussion, based on the Military Acute Concussion Evaluation (MACE). Sobin et al raise Related article page 15 the concern that without associated life-threatening injuries, the possibility of concussion may be overlooked in cases of isolated mandible fractures. In their search of the Nationwide Inpatient Sample database, they found that only 5.6% of mandible fractures had a concurrent diagnosis of concussion. However, their prospective study shows that 75% of patients with isolated mandible fractures are at high risk of concussion. But what are the sequelae of having a concussion? Sobin et al1 remind us that minor traumatic brain injury is associated with chronic pain syndromes, migraine headaches, posttraumatic stress disorder, and mood disorders. And concussion with facial trauma is not unique to adults. In a retrospective chart review of pediatric patients ARTICLE INFORMATION
with facial fracture, Afrooz et al2 demonstrated a concurrent International Classification of Diseases diagnosis of concussion in 31% of pediatric facial fracture cases. In pediatric concussion, the complications can range from a persistence of symptoms to other complications. Headache in children is the most common postconcussive symptom (65%-93%), followed by fatigue, dizziness, and slowed mentation.3 And these symptoms persist as well. In a prospective study of patients aged 11 to 22 years who presented emergently with an acute concussion, irritability and sleep disturbances lasted a median of 16 days, and frustration and poor concentration lasted 14 days.4 Children with a concussion may experience excessive sleep, daytime drowsiness, difficulty falling asleep, or frequent nighttime waking.3 Posttraumatic seizures are another serious complication from concussion and occur at a 2-fold increased rate in children following concussion.5 In the management of mandibular fractures at my institution, we are always concerned about the complications of fracture treatment such as infection, nonunion, or malunion. But what else could we be missing? Sobin et al1 demonstrate that the incidence of concussion in isolated mandibular trauma may be high, and the data suggest that the sequelae of concussion in both children and adults are long-term and significant. So when evaluating these cases, remember that the deleterious effects of trauma go beyond the healing of the bone; we must make sure that we ask our patients the right questions.
Author Affiliation: Department of Otolaryngology, Medical College of Wisconsin, Milwaukee.
mandible fractures [published online October 8, 2015]. JAMA Facial Plast Surg. doi:10.1001 /jamafacial.2015.1339.
Corresponding Author: Robert Chun, MD, Department of Otolaryngology, Medical College of Wisconsin, 9000 W Wisconsin Ave, Ste 540/ENT offices, Milwaukee, WI 53226 ([email protected]).
2. Afrooz PN, Grunwaldt LJ, Zanoun RR, et al. Pediatric facial fractures: occurrence of concussion and relation to fracture patterns. J Craniofac Surg. 2012;23(5):1270-1273.
Published Online: October 8, 2015. doi:10.1001/jamafacial.2015.1549.
3. Rose SC, Weber KD, Collen JB, Heyer GL. The diagnosis and management of concussion in children and adolescents. Pediatr Neurol. 2015;53 (2):108-118.
Conflict of Interest Disclosures: None reported. REFERENCES 1. Sobin L, Kopp R, Walsh R, Kellman RM, Harris T. Incidence of concussion in patients with isolated
jamafacialplasticsurgery.com
5. Christensen J, Pedersen MG, Pedersen CB, Sidenius P, Olsen J, Vestergaard M. Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet. 2009;373(9669):1105-1110.
4. Eisenberg MA, Meehan WP III, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133(6):999-1006.
(Reprinted) JAMA Facial Plastic Surgery January/February 2016 Volume 18, Number 1
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: http://archfaci.jamanetwork.com/ by a GAZI UNIVERSITESI User on 01/22/2016
19
