Psychological Complications of Maxillofacial Trauma: Preliminary Findings From a Nigerian University Teaching Hospital

Psychological Impact on Maxillofacial Trauma Patients - An Observational Study

Facial disfigurement due to trauma is very common as the face is a prominent part of the body and is susceptible to injuries. A protocol for the diagnosis and intervention for psychological problems of trauma patients should be implemented in the Indian hospitals as they lack policies for assessing the mental status of such patients. This study was conducted to analyze and determine the psychological implications and need for mental health services of maxillofacial trauma patients. Fifty patients with maxillofacial trauma above 18 years of age were included in this study. The assessment was done using the Hospital Anxiety and Depression Scale (HADS) and Trauma Screening Questionnaire (TSQ), which are considered as the standard tools for assessment of psychological disorders post-trauma. We observed psychological stress in 84% of the patients at the baseline, which reduced to 24% after one month at the first follow-up visit and further reduced to 22% at the second follow-up visit. The reduction in the percentage from the first to the second follow-up visit was less significant. However, the change in HADS and TSQ scores was found to be significant, suggesting that the intensity of trauma decreases with the time-lapse. Anxiety, depression, and post-traumatic stress are prevalent in patients with maxillofacial trauma, which may lead to impaired day-to-day life. Our results suggest that there is a need for psychological care in patients with maxillofacial trauma.

Psychological Distress Before and After Surgical Resection of Benign Orofacial Tumors: A Prospective Study

PURPOSE

We evaluated the presence and level of psychological distress in patients before and after resection of benign orofacial tumors and identified the variables associated with this psychological distress.

MATERIALS AND METHODS

The present study used the Hospital Anxiety and Depression Scale and the Rosenberg Self-Esteem Scale. A questionnaire that included these 2 scales was administered to the patients before surgery and at 1, 2, and 6 weeks after surgery. The scores at the various intervals were statistically compared, and the relationships between the variables (eg, age, gender, education, marital status, occupation, lesion size) and psychological distress were also tested.

RESULTS

Of the 31 patients, 29% had abnormal levels of anxiety before surgery, and 12.9% reported abnormal depression levels before surgery. The proportion of patients with abnormal anxiety levels increased from 29% before surgery to 38.7, 38.7, and 35.5% at 1, 2, and 6 weeks after surgery, respectively. The proportion of patients with abnormal depression levels at all intervals after surgery remained the same as that before surgery (12.9%). All the patients had normal self-esteem levels both before and after surgery. Using a paired t test, the mean anxiety scores at all intervals after surgery were significantly greater than the mean anxiety score before surgery. Analyses of the relationships between the independent variables and psychological distress (anxiety and depression) found the level of education to be significantly associated with anxiety before and after surgery. In contrast, the lesion size was significantly associated with depression both before and after surgery.

CONCLUSIONS

The results of the present study suggest that abnormal anxiety and depression will be present in some patients with benign orofacial tumors both before and after surgery. The patients' education level and lesion size were strongly associated with the level of psychological distress present in patients with benign orofacial tumors.

Physical injury and depression in six low- and middle-income countries: A nationally representative study

BACKGROUND

Studies on the association between physical injury and depression in low- and middle-income countries (LMICs) are scarce. Therefore, our goal was to analyze the association between physical injury and depression using nationally representative data from six LMICs.

METHODS

Cross-sectional data from the Study on Global Ageing and Adult Health (SAGE) survey (2007-2010) were analyzed (N = 42,489). Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Any injury in our analysis referred to having experienced traffic injury or other injury in the past 12 months. Multivariable logistic regression analysis and meta-analyses were used to assess associations.

RESULTS

Overall, the prevalence of depression was higher among those who had any injury compared to those without injuries (9.0% vs. 3.7%). Compared to having no injury, any injury without disability was associated with a 1.72 (95%CI=1.18-2.50) times higher odds for depression, while the odds for injury with disability was much higher (OR =3.81; 95%CI=2.16-6.73). The pooled estimate (OR) for the association between any injury and depression based on a meta-analysis using country-wise estimates was 3.28 (95%CI = 1.71-6.31) and a moderate level of between-country heterogeneity was observed (I² = 63.1%).

LIMITATIONS

Causality or temporal associations cannot be established due to the cross-sectional nature of the study.

CONCLUSIONS

Personalized mental health care to victims of physical injury may reduce risk for depression. Treating disability as the result of injuries may also be effective in the prevention of depressive disorders.

Self-esteem following maxillofacial and orthopedic injuries: preliminary observations in sub-Saharan Africans

BACKGROUND

The face is a vital component of one's personality and body image while extremities are important in function (mobility, routine daily activities). Recovery and rehabilitation from acquired maxillofacial and orthopedic traumas are psychological in nature.

METHODS

This was a prospective study of recruited subjects in a Nigerian University teaching hospital. A total of 160 participants (80 with maxillofacial injuries and 80 with orthopedic injuries) had repeated review assessments within 1 week of arrival in the hospital (time 1), 4-8 weeks after initial contact (time 2), and 10-12 weeks thereafter (time 3), using Rosenberg's Self-Esteem Questionnaire.

RESULTS

Thirty-three (41.3%) participants in the maxillofacial injured and 12 (15.0%) in the orthopedic injured subjects scored between 0 and 14 at time 1. At time 2, 39 (51.3%) subjects in the maxillofacial fracture group and 20 (29.0%) in the orthopedic injured group scored between 0 and 14, while at time 3, 7 (9.2%) in the maxillofacial fracture group and 1 (1.5%) in the orthopedic injured group scored between 0 and 14. There was a statistical significant difference between the two groups when compared at times 1, 2, and 3 with p < 0.001, p = 0.006, and p = 0.041 respectively. Subjects with maxillofacial fracture consistently had lower self-esteem compared to subjects with orthopedic injured for times 1, 2, and 3.

CONCLUSIONS

Self-esteem may be reduced following maxillofacial injuries; therefore, measures should be taken by surgeons to minimize the risk of facial scarring by careful handling of tissues. Also, management of these injuries should integrate multidisciplinary care that will address psychological needs of patients.

TRIAL REGISTRATION

Not applicable.

The association of affective disorders and facial scarring: Systematic review and meta-analysis

BACKGROUND

Facial scarring can have a dramatic effect on a patient's psychological health and wellbeing and present unique management challenges. This patient population remains poorly characterised in the contemporary literature.

AIMS

To evaluate the prevalence of, and risk factors associated with affective disorders in adult patients with facial scars.

METHODS

A systematic review was conducted using a protocol registered with PROSPERO and in line with the PRISMA statement. A comprehensive search of the literature was conducted using PubMed, MEDLINE, EMBASE, PSYCHInfo and The Cochrane Library.

RESULTS

Twenty one studies were included, with a total of 2,394 participants. Using a random effects model, the weighted pooled prevalence of anxiety was 26.1% (95% CI 17.9%-36.3%) and the weighted pooled prevalence of depression was 21.4% (95% CI 15.4%-29.0%). Studies identified female gender, past psychiatric history and violent causation as factors associated with anxiety and depression.

LIMITATIONS

Included studies were limited to those published in peer reviewed journals. Longitudinal trends in both anxiety and depression were limited by a short duration of follow up.

CONCLUSIONS

There is a high and persistent burden of affective disorders in patients with facial scars. Additional research is required to further characterise this population and develop effective management strategies.

Comparative study of anxiety and depression following maxillofacial and orthopedic injuries. Study from a Nigerian University Teaching Hospital

This study hopes to compare levels of anxiety and depression in the maxillofacial and orthopedic injured patients over a period of 12 weeks. This was a prospective, repeated measure design. A total of 160 participants (80 with maxillofacial and 80 with long bone fractures) had repeated review follow-ups within 1 week of arrival in the hospital (Time 1), 4-8 weeks after initial contact (Time 2) and 10-12 weeks thereafter (Time 3), using hospital anxiety and depression scale questionnaire. Road traffic accident remained the main cause of injury in both groups of subjects. The Hospital anxiety and Depression scale detected 42 (52.5%) cases of depression at baseline, 36 (47.4%) cases at Time 2, and 14 (18.4%) cases at Time 3 in the maxillofacial injured group. In the long bone fracture subjects, 47 (58.8%) cases were depressed at baseline, 23(33.3%) cases at Time 2, and only 5 (7.2%) cases at Time 3. Both groups showed reduction in depression levels with time. Fifty-six (70.0%) had anxiety at baseline, 32 (42.1%) at Time 2, and only 9 (11.8%) had anxiety at Time 3 in the maxillofacial fracture group, whereas in the long bone fracture group, 69 (86.3%) subjects were anxious at baseline, 32 (46.4%) at Time 2, and 22 (31.9%) at Time 3. There were significant differences in depression and anxiety level in both the maxillofacial and the long bone fracture subjects at baseline (Time 1), Time 2(4-8 weeks) and Time 3(10-12 weeks).

Depression and anxiety disorders in a sample of facial trauma: A study from Iran

Background

Various studies have shown that such patients are susceptible to psychological problems and poor quality of life. The aim of the present study was to evaluate and compare the prevalence of depression and anxiety disorders and quality of life in a group of facial trauma.

Material and Methods

In the present cross-sectional study Hospital Anxiety and Depression Scale (HADS) and Oral Health Impact (OHIP-14) questionnaires were used. In this study, fifty subjects were selected from the patients with maxillofacial traumas based on the judgment of the physicians, referring to hospitals in Kerman and Rafsanjan during 2012-2013. In addition, 50 patients referring to the Dental School for tooth extraction, with no maxillofacial traumas, were included. SPSS 13.5 was used for statistical analysis with two-sample t-test, Mantel-Haenszel technique, Pearson’s correlation coefficient and chi-squared test.

Results

Seven patients with maxillofacial traumas were depressed based on HADS depression scale, with 5 other borderline cases. However, patients referring for surgery or tooth extraction only 2 were depressed and 1 patient was a borderline case. The results showed that patients with maxillofacial traumas had higher rates of depression and anxiety, with significant differences between this group and the other group (P=0.01). The results of the present study showed a significant prelateship between depression severity and confounding factors. The mean of OHIP-14 parameters were 35.51 ±5.2 and 22.3±2.4 in facial trauma and dental surgery groups, respectively, with statistically significant differences (P=0.01).

Conclusions

The results of the present study showed depression and anxiety disorders in patients with maxillofacial trauma. The results showed a higher rate of anxiety and anxiety in patients with maxillofacial traumas compared to the control group.

Key words:Depression, facial trauma, HADS, OHIP-14, questionnaire.

Perioperative findings and complications of non-vascularised iliac crest graft harvest: The experience of a Nigerian tertiary hospital

Background:

The reconstruction of a mandibular defect remains a significant challenge to the reconstructive surgeon. In developing countries like Nigeria, the required facilities and expertise for vascularised graft surgery are not readily available, thus mandibular defects are commonly reconstructed with non-vascularised bone grafts. The aim of this study is to describe the experience with the reconstruction of mandibular defects using non-vascularised iliac crest bone grafts (NVICBG) at a Nigerian tertiary hospital.

Patients and Methods:

This was a descriptive longitudinal study in which data was prospectively collected from patients who had mandibular reconstruction secondary to benign lesions using NVICBG at the University College Hospital, Ibadan, over a 24-month period. Information recorded included demography, cause of mandibular defect, type of mandibular resection, span of defect, peri-operative data, recipient site complications and donor site complications. Patient satisfaction with facial aesthetic outcome was assessed with the use of visual analogue scale score.

Results:

Twenty patients had mandibular resection and immediate reconstruction with NVICBG. The mean age was 31.61 (+/−11.05) years. Mean span of the defects was 10.65 (+/−2.88) cm. At the recipient site, two patients had extra-oral wound dehiscence and two patients had intra-oral wound dehiscence of which one patient had loss of the graft. Donor site complications noted were seromas and wound dehiscence. Eighteen patients had paraesthesia of the lateral femoral cutaneous nerve. All patients had temporary abnormal gait. The mean duration of abnormal gait was 2.11 weeks (SD +/−0.74). Majority of the patients were satisfied with the aesthetic outcome.

Conclusion:

NVICBG, though limited in its versatility has satisfactory aesthetic outcome with relatively few complications. It appears that this method of reconstruction can be used even for large mandibular defects contrary to perceptions of many reconstructive surgeons.