[Maxillofacial trauma by defenestration: 64 cases]

There has been little work reported in the literature concerning trauma resulting from high level falls and almost none devoted to maxillofacial trauma following defenestration. The purpose of this work was to report the first series of defenestration victims who incurred maxillofacial trauma.

This retrospective series included all patients treated at the Pitié-Salpêtrière hospital between July 1994 and July 1999, all units included: surgery intensive care, neurosurgical emergency, orthopedic surgery or maxillofacial surgery.

Female gender predominated in comparison with studies concerning high level falls (SR=0.5) with no difference concerning age (mu=31.5, sigma2=9.1). Fifty percent of the patients had a maxillofacial involvement. Death ensued in 17.2% (11/64 patients). The height of the fall among survivors ranged from one floor to eight floors; third-floor falls accounted for 31%. Defenestration was intentional in 70.3% of the cases, accidental in 17.1% and undetermined in 12.6%. The suicide attempts involved 13 patients with maniac depressive psychosis, 11 with depression, 6 with schizophrenia, 2 with undetermined familial problems, and 12 with no specific history. Four patients were drug abusers and 3 were alcoholics. Fifty percent of the victims were living in precarious social and economical conditions. The maxillofacial injuries included: 20 mandibular fractures, 15 Lefort fractures (I, II, III or combined), 2 blow out fractures, 7 fractures of the orbital roof, 15 fractures of the malar bone, 7 fractures of the nose bones, and 11 fractures of the naso-ethmoïdo-maxillo-fronto-orbital complex. On the average, patients lost 6 dental elements. The mean Glasgow index was 7.9. Extrafacial injuries included limb fractures (89%), chest trauma (73.4%), brain lesions (67%), spinal injury (40.6%), and abdominal injury (26.5%).

The psychic and social vulnerability of the defenestration patient aggravated by the trauma is a fundamental dimension which must be taken into consideration during the initial management of these patients.