{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:19:58Z","timestamp":1789057198102,"version":"build-2803163510"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T00:00:00Z","timestamp":1668988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T00:00:00Z","timestamp":1668988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Scand J Trauma Resusc Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Maxillofacial fractures can lead to massive oronasal bleeding; however, surgical hemostasis and packing procedures can be challenging owing to complex facial anatomy. Only a few studies investigated maxillofacial fractures with massive oronasal hemorrhage. However, thus far, no studies have reported a protocolized management approach for maxillofacial trauma from a single center. This study aimed to evaluate the effectiveness of protocolized management for maxillofacial fractures with oronasal bleeding.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients were identified from the National Cheng University Hospital trauma registry from 2010 to 2020. We included patients with a face Abbreviated Injury Scale (AIS) score of\u2009&gt;\u20093 and active oronasal bleeding. Patients\u2019 characteristics were compared between the angiography and non-angiography groups and between survivors and nonsurvivors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Forty-nine patients were included. Among them, 34 (69%) underwent angiography, of whom 21 received arterial embolization. Forty-seven patients (96%) successfully achieved hemostasis by adhering to the treatment protocol at our institution. Compared with the non-angiography group, the angiography group had significantly more patients requiring oral intubation (97% vs. 53%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), Glasgow Coma Scale\u2009&lt;\u20099 (GCS; 79% vs. 27%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), head AIS\u2009&gt;\u20093 (65% vs. 13%, <jats:italic>P<\/jats:italic>\u2009=\u20090.001), higher Injury Severity Score (ISS; 43 [33\u201350] vs. 22 [18\u201327], <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), higher incidence of cardiopulmonary resuscitation (CPR; 41% vs. 0%, <jats:italic>P<\/jats:italic>\u2009=\u20090.002), higher mortality rate (35% vs. 7%, <jats:italic>P<\/jats:italic>\u2009=\u20090.043), and more units of packed red blood cells (PRBC) transfused within 24\u00a0h (12 [6\u201320] vs. 2 [0\u20134], <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The nonsurvivor group had significantly more patients with hypotension (62% vs. 8%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), higher need for CPR (85% vs. 8%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), head AIS\u2009&gt;\u20093 (92% vs. 33%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), skull base fracture (100% vs. 64%; <jats:italic>P<\/jats:italic>\u2009=\u20090.011), GCS score\u2009&lt;\u20099 (100% vs. 50%; <jats:italic>P<\/jats:italic>\u2009=\u20090.003), higher ISS (50 [43\u201357] vs. 29 [19\u201348]; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and more units of PRBC transfused within 24\u00a0h (18 [13\u201322] vs. 6 [2\u201312]; <jats:italic>P<\/jats:italic>\u2009=\u20090.001) than the survivor group. More patients underwent angiography in the nonsurvivor group than in the survivor group (92% vs. 61%; <jats:italic>P<\/jats:italic>\u2009=\u20090.043). Among embolized vessels, the internal maxillary artery (65%) was the most common bleeding site. Hypoxic encephalopathy accounted for 92% of deaths.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Protocol-guided management effectively optimizes outcomes in patients with maxillofacial bleeding.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13049-022-01047-9","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T05:02:40Z","timestamp":1669006960000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effectiveness of protocolized management for patients sustaining maxillofacial fracture with massive oronasal bleeding: a single-center experience"],"prefix":"10.1186","volume":"30","author":[{"given":"Fang-Chi","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Shu","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Wen","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang","family":"Sung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung-Han","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Hsien","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7625-2891","authenticated-orcid":false,"given":"Chih-Jung","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ting","family":"Yen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,21]]},"reference":[{"key":"1047_CR1","first-page":"831","volume":"63","author":"KE Follmar","year":"2007","unstructured":"Follmar KE, Debruijn M, Baccarani A, Bruno AD, Mukundan S, Erdmann D, et al. 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