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Is your face worth it? The cost of transfer for isolated facial fractures: A commentary on “Isolated facial fractures transferred for higher level of care”

Published:October 18, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.039
      Some facial fractures require immediate consultation and necessitate transfer due to specialist unavailability. Up to 90% of mid-face fractures have associated ocular injuries.
      • Chukwulebe S.
      • Hogrefe C.
      The diagnosis and management of facial bone fractures.
      Fracture of one or more of the seven orbital bones constitute nearly 25% of IFF and warrant immediate ophthalmologist consultation, especially in the setting of ruptured globe, visual changes, or impaired ocular motion. If cleared by ophthalmology, the vast majority of these isolated facial fractures can safely follow up with a maxillofacial surgeon within one week and only 15% of these patients will ultimately require operative intervention in an elective setting.
      • Chukwulebe S.
      • Hogrefe C.
      The diagnosis and management of facial bone fractures.
      Other indications to consider urgent specialist consultation include penetrating IFF, abnormal neurologic exam, and some displaced Lefort fractures.
      • Gelesko S.
      • Markiewicz M.
      • Bell R.
      Responsible and prudent imaging in the diagnosis and management of facial fractures.
      CT angiogram should be considered for complex facial fractures as up to 10% are found to have concomitant cervical spine injury and/or vessel injury requiring intervention.
      • Jose Anson
      • Ahmed Nagori Shakil
      • Agarwal Bhaskar
      • Bhutia Ongkila
      • Roychoudhury Ajoy
      Management of maxillofacial trauma in emergency: an update of challenges and controversies.
      Although clear guidelines are not yet solidified, it has been demonstrated that trauma surgeons are capable of safely triaging CMF trauma with equivalent in-hospital mortality and 30-day readmission regardless of the decision for CMF consultation.
      • Melmer P.
      • Taylor R.
      • Muertos K.
      • Sciarretta J.D.
      Managing craniomaxillofacial injury without inpatient consult: outcomes and patient cost savings.
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        Am J Surg. 2022; https://doi.org/10.1016/j.amjsurg.2022.10.039