The effect of the new 24h alcohol Licensing law on the incidence of facial trauma in London
Oral & Maxillofacial Surgery Unit, Division of Oral & Maxillofacial Medical, Surgical & Diagnostic Services, UCL Eastman Dental Institute for Oral Health Care Sciences, United Kingdom.British Journal of Oral and Maxillofacial Surgery (Impact Factor: 1.08). 05/2008; 46(6):460-3. DOI: 10.1016/j.bjoms.2008.01.018
On 24 November 2005 the new 2003 Licensing Act was implemented. It permits licensed premises to close at different times under English and Welsh law, rather than at 2300h as under the previous law. The aim of this study was to assess whether head and neck trauma secondary to alcohol-associated assaults had increased, decreased, or stayed the same since the introduction of the act. Data were collected from the Accident and Emergency Department, University College Hospital, attendance databases for two six-month periods: 24 November 2004 to 30 April 2005, and 24 November 2005 to 30 April 2006. There were 1102 attendances for head and neck trauma secondary to alcohol-associated assaults during the six months before the introduction of the 2003 Licensing Act and 730 such attendances during the similar period after the introduction of the law, with fewer cases in each corresponding month during the later period. There were more cases at weekends than on weekdays during both periods. There were fewer cases but more at weekends in 2005-6 than in 2004-5 (423, 58% compared with 584, 53%, respectively). Neither rainfall nor temperature had any influence on the results. The 2003 licensing Act seems to have reduced the number of attendances at the A&E department for head and neck trauma secondary to alcohol associated assaults.
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- "This could be one explanation for the gradual decline in the overall rate of penetrating injury between 2006 and 2008. This was also experienced in a recent study done at University College London Hospital where rates of maxillofacial injuries secondary to alcohol use have fallen by 34% since the Licensing Act were introduced. Their study did, however, show an increased number of attendances over the weekend in 2005/6. "
ABSTRACT: To study the incidence, pattern and outcome of stab injuries attending a North London Teaching Hospital over a 3-year (2006-2008) period. A retrospective review of collected data from the Hospital database was conducted. The database contains comprehensive medical records for all patients attended by the trauma team for deliberate stab injuries. It is updated by the surgical team after each admission. All patients with deliberate penetrating injury who were attended by the service between 1 January 2006 and 31 December 2008 were identified. Patients who died in the prehospital phase, those managed exclusively by the emergency department and limb injuries without vascular compromise were excluded from the study. Six hundred and nineteen patients with stab injuries (following knife crime) from North London attended the Hospital in the above period. One hundred and thirty-seven paients required surgical admission. Two were cases of self-inflicted knife injuries. Over the 3-year period the percentage of victims below 20 years of age is increasing. Ninety-three percent of knife crime occured between 6 pm and 6 am; recently moving toward week days from weekend period. The overall rate of penetrating injuries (stab injuries) is slowly declining. Timely cardiothoracic support facility is vital in saving lives with major cardiac stab injuries. Although alcohol drinking restriction has been lifted, most cases of stabbings are still occurring out-of-hours when surgical personnel are limited.
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ABSTRACT: The zygoma is the principal buttress between the cranium and maxilla. The zygomatic fractures can lead to significant cosmetic and functional disorders such as enophthalmos, depression of malar eminence and parathesia due to injury of infraorbital nerve. Computed tomography (CT) was the first technology capable of allowing visualization of both hard and soft tissues of the face by image processing enhancement. It was reported that CT can achieve more accurate values in diagnosis of midface fractures. Another alternative technique is ultrasonographic examination. Ultrasonography is easy and quick to be performed; it is noninvasive and free of any risks. The possibility of ultrasonographic fracture visualization in the midface has already been described by many researchers. Objectives: the aim of this study was to compare between the ultrasonographic and the computed tomographic findings, in the diagnosis and repair of the zygomatic complex fractures. Patients and methods: Between November 2008 and December 2009, 10 consecutive patients (5 males and 5 females) who were referred to Oral and Maxillofacial Department of AL-Azhar University (Girls branch), for treatment of zygomatic complex fractures, were included in this prospective study. The mean age was 34.5 (range 16-60years). The clinical criteria for patient selection included; the presence of periorbital ecchymosis, scleral hematoma, infraorbital nerve parathesia, diplopia and/or limitation of ocular movements, as well as enophthalmos and flattening of the face. Patients who had diplopia or ocular abnormalities were examined by an ophthalmologist. With each patient an axial and coronal thin-layer CT with 3D reconstruction was done (Multislice CT). Subsequently each patient was sonographically evaluated by an experienced examiner with a linear transducer. All patients were treated under general anaesthesia via closed or open reduction according to the planned surgery. Immediately after patients' recovery, CT and ultrasound images were taken for all patients to evaluate accuracy of the reduction. Results: The ultrasonographic findings showed clear differences in the ability to obtain a correct estimation of the selected anatomic landmarks. The zygomatic arch, the lateral wall of the orbit and the infraorbital margin can be visualized by ultrasonography very easily. The assessment of the orbital floor and the medial wall proved to be rather difficult. The ultrasound images were always concordant with the CT findings. Open reduction through extraoral and transoral accesses, was performed in 8 patients, and 2 patients were treated conservatively. The alignment of the fractured segments could be easily identified by ultrasonography in all patients. All fractured segments were adequately reduced into their normal anatomical position. The postoperative CT confirmed these results. Conclusion: CT has been recommended for preoperative evaluation of zygomatic trauma as a standard diagnostic method, especially in complicated cases with intracranial injuries or when there is a need for optic nerve evaluation, because they cannot be adequately seen by ultrasonography. While ultrasonography has proved to be a valuable tool in detecting uncomplicated fractures at the zygomaticofrontal process, the zygomatic arch and the infra orbital margin but its results for orbital floor and medial wall remain unsatisfactory. Also, ultrasound is more reliable in postoperative follow up, resulting in decreased cost and radiation exposure. [Journal of American Science 2010; 6(9):524-533]. (ISSN: 1545-1003).