FACIAL FRACTURES

The capacity for self-regeneration and healing in bone declines with advancing age. There may be associated endocrinopathy with disturbed calcium metabolism, suboptimal nutritional status, and a reduced blood supply. Much of the blood supply to facial bones depends on vessels in the subperiosteal plexus and adjacent soft tissues; therefore, periosteal elevation should be kept at a minimum during the management of geriatric facial fractures.

With advancing age, the upper and lower alveolar ridges undergo resorption. This occurs even if the teeth are still present, but in the absence of teeth, the resorption is often marked, with loss of more than 50% of total mandibular height. Resorption markedly weakens the strength of the mandible and predisposes it to fracture with the impact of much less force. A major problem in trauma management, resorption makes it more difficult to achieve solid bone healing in good position (because of the markedly reduced contact area between bone fragments).

As a general policy, the management of facial fractures in the elderly focuses on techniques that are minimally invasive, require less dissection, and introduce less hardware into the wound. Healing requires about 50% longer than in young adults. Nutritional management (both support and supplementation) is critical in older patients.

As Fee (13) emphasized, age alone should not be used as a determinant for surgery. Sound medical judgment and individual patient evaluation should guide our treatment decisions.

HIGHLIGHTS

The process of "aging” is the sum of many phenomena: disease, environmental insult, injuries, nutrition, and genetic programming.

The etiology of the aging process is not fully understood. Theories explaining aging include finite limits on the number of cell replications, the somatic mutation theory, the error theory, and the program theory.

The United States is experiencing unparalleled growth in the number of older people.

There are 9.2 million noninstitutionalized older people and 1.5 million hearing-impaired elderly in nursing homes in the United States.

Ataxia of the elderly (presbyastasis) causes many damaging falls annually among the elderly, results in numerous femoral fractures, and contributes to significant morbidity, mortality, and high health care costs.

Swallowing disorders and aspiration (presbyphagia) are serious problems in the elderly and may cause cough, fever, pneumonia, atelectasis, empyema, or death.

The immune system becomes less effective in the elderly in terms of protecting against infections and neoplastic disease. Malignant neoplasms are especially problematic in the elderly because of more aggressive clinical behavior and delays in seeking medical attention.

Facial plastic surgery to counteract the skin changes of aging (blepharoplasty and rhytidectomy) has become much more popular during the past decade.

Management of the geriatric airway may be complicated by associated general disease, specific pulmonary pathology, or medications. Prolonged intubation (longer than 2 weeks) is a major issue in managing respiratory problems in the elderly.

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  • Category: Surgical treatment