Oral and maxillofacial trauma in motorcyclists in an Iranian subpopulation

The pattern of maxillofacial fractures associated with rollover accidents: A 7-year retrospective study

BACKGROUND/AIM

This study aimed to assess the incidence and pattern of maxillofacial fractures and related demographic data in the victims of rollover crashes.

PATIENTS AND METHODS

This retrospective study was based on medical records of patients who sustained maxillofacial injuries following rollover accidents. Investigated data included age, gender, accident date and time, accident cause, seat belt usage, airbag deployment, road type, anatomical location of the facial fracture, and treatment approach.

RESULTS

Among the 147 patients who met the inclusion criteria, the most prevalent age groups were 20-30 (36.7%) and 30-40 (32.7%) years, with a mean age of 33.6 ± 9.7 years. The male-to-female ratio was 6:1. Most crashes occurred in March, August, and July. These accidents involved 69.4% light vehicles and 39.6% heavy vehicles. The leading causes of rollover crashes were speeding (58.5%) followed by distracted driving (21.1%) and traffic rule violations (13.6%). The most prevalent injuries were fractures of the maxillary sinus wall (40.8%), nasal bones (39.5%), zygomaticomaxillary complex (36.1%), and the mandible (32.6%). Surgical intervention was necessary for 44.2% of patients, while 12.9% of cases underwent close reduction, and 42.9% did not require any surgical intervention. The occurrence of nasal bone fractures was significantly lower in cases where seat belts were worn and zygomatic arch fractures were less frequent in incidents with airbag deployment.

CONCLUSIONS

In rollover crashes, the midface is the most vulnerable anatomical location. Utilization of seat belts and airbag deployment has the potential to prevent nasal bone and zygomatic arch fractures.

Patterns of Maxillofacial Injures Caused by Motorcycle Accidents

Introduction  Motorcycles are used as a common means of transportation, and motorcycle accidents are responsible for a major portion of trauma injuries. Objectives  The purpose of this study was to analyze the patterns of facial injuries in motorcyclists, to evaluate the types of injuries, and to investigate if the accident-related factors had any impact on the characteristics of the injuries. Methods  This retrospective observational study included 74 patients with maxillofacial injuries following motorcycle-related accidents. Investigated data were divided into four main categories: sociodemographic, accident-related, injury-related, and treatment-related. Results  All the patients were males with a mean age (±SD) of 25.03 (±9.986) years. Most accidents ( n  = 44, 59.4%) occurred in the evening. Most of the patients ( n  = 40, 54%) were traveling on motorcycle models that had maximum speed of over 120 km/h. Furthermore, 15 patients (18.9%) were under the influence of alcohol during the crashes and only one patient was wearing a helmet. Fractures of the maxillofacial bones were observed in 50 (67.5%) crash victims; 24 of them (48%) had middle third fractures, 11 (22%) had mandibular fractures, and 15 patients (30%) presented with a combination of lower, middle, and upper third fractures. Conclusion  Almost all patients were not wearing helmets at the moment of the crash. The most common fractured site was the maxilla. The majority of the patients received surgical treatment. Increased enforcement of safety measures for riders and raising awareness about the dangers of motorcycle crashes are required measures to improve traffic safety and, ultimately, population health.

The Causes and Prevalence of Maxillofacial Fractures in Iran: A Systematic Review

Background

Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes.

Methods

A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed.

Results

A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low.

Conclusion

Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.

Pattern of oral and maxillofacial trauma and associated factors: An 8-year prospective study

BACKGROUND/AIMS

Oral and maxillofacial trauma (OMFT) is a public health problem due to its high occurrence and demand for resources for its management and the financial and social impact of OMFT victims on the health system. The aim of this study was to conduct an 8-year prospective analysis of OMFT cases from an emergency service.

MATERIALS AND METHODS

A hospital-based 8-year prospective study on OMFT and associated factors was performed on data from December 2011 to December 2019. Data regarding sociodemographic (gender, age, and skin color) and socio-economic profiles (educational level, family income, and occupation), OMFT profile (etiology, OMFT type, and treatment), associated factors [alcohol consumption and personal protective equipment (PPE) use], OMFT occurrence (injury day and hour), length of hospital stay, and cost were collected. Descriptive and inferential analyses of data were performed.

RESULTS

Most OMFT cases involved men with low schooling and family income, resulting from traffic accidents. OMFT severity was associated with longer hospital stay, higher hospital costs and nonuse of PPE, midface fractures (mainly orbital-zygomatic fractures), closed reduction, and open reduction/internal fixation. Traffic accidents were the main cause of longer hospital stays for victims aged 41-60 years with better socio-economic status compared with cases that had higher hospital costs. In general, higher hospital costs were associated with victims of violence under 40 years of age, with low schooling and farmers. Alcohol consumption and non-use of PPE also contributed to increasing the length of hospital stay.

CONCLUSION

Oral and maxillofacial trauma severity was associated with longer hospital stay and higher hospital costs. Associated factors such as alcohol consumption and non-use of PPE contributed to increase the length of hospital stay and OMFT severity.

Maxillofacial trauma due to traffic accidents and falls: an exploratory study of associated factors

Background

This study aimed to determine the pattern of Maxillofacial trauma (MFT) due to traffic accidents and falls in a reference hospital in a rural region of northeastern Brazil between December 2011 and December 2018 and to identify associated factors.

Material and Methods

This was a cross-sectional study using 585 medical records of patients with MFT. The data were subjected to a Poisson-Tweedie multiple regression analysis to estimate the Prevalence ratio (PR), with a 95% confidence interval (95% CI) and a significance level of p<0.05.

Results

MFT due to traffic accidents was more prevalent among patients 21 to 40 years old (PR=2.30; 95% CI=1.20-4.41; p<0.001) diagnosed with zygomatic-orbital complex fractures (PR=1.80; 95% CI=1.08-2.98; p=0.023). Falls were more frequent among older groups of 41 to 60 years (PR=1.83; 95% CI=1.09-3.06; p=0.022) and over 61 years (PR=2.23; 95% CI=1.09-3.06; p=0.022). In traffic accidents, alcohol consumption increased the length of stay (PR=2.081; 95% CI=1.553-2.787; p<0.001), and patients who did not use personal protective equipment (PPE) had higher hospital costs (PR=179.964; 95% CI=1.485-1.994; p<0.001) for this etiology. Traffic accidents and falls are two of the main etiologies of MFT, especially for males in the young adult age group (traffic accidents) and those above 41 years (falls). Alcohol consumption and the nonuse of PPE influenced the length of the hospital stay and hospital costs.

Conclusions

Strategies to confront this problem, such as road and highway improvements, effective enforcement of laws and intersectoral coordination involving the entire community to implement policies and prevention programs targeted at these populations, can be implemented.

Key words:Maxillofacial Injuries, public policy, hospital cost.

Do Helmet Use and Type Influence Facial Trauma Occurrence and Severity in Motorcyclists? A Systematic Review and Meta-analysis

PURPOSE

This article consists of a systematic review of the literature, which verified whether the use and types of helmets reduce the occurrence and severity of facial fractures in hospitalized motorcyclists after traffic accidents.

MATERIALS AND METHODS

Prevalence studies and cohort studies, published in Latin American languages with no restrictions on publication dates, were considered. Two authors independently screened reference lists for eligible articles, assessed them for inclusion criteria, and extracted the data using a specific form. Twenty-six articles were selected, all prevalence studies.

RESULTS

The patients who used a helmet had a lower prevalence and severity of facial fractures, compared to patients who did not wear a helmet. There were no differences in the occurrence of lower third fractures between patients who used or did not wear a helmet at the time of the trauma; as well as in meta-analysis of occurrence and severity of facial trauma between helmet types (open or closed).

CONCLUSIONS

It can be concluded that the use of helmet leads to a lower number of fractures and severity of trauma when compared to nonuse. Regarding the type of helmet, there was no difference in the occurrence and severity of facial fracture in individuals who used closed or opened helmets.

Injury Prevention, Safety Education and Violence in Relation to the Risk of Tooth Fracture among Korean Adolescents

This study aimed to determine the injury prevention-, safety education-, and violence-related factors pertaining to tooth fracture experience (TFE) in Korean adolescents. We used data from the 14th Korea Youth Risk Behavior Survey (KYRBS) in 2018. The 60,040 participants were selected using a complex sampling design from middle and high schools. The participants completed a self-administered questionnaire. The explanatory variables, including school safety education and violence, were assessed in relation to prevention of traumatic injuries. Complex-samples multivariable logistic regression models were applied to explain the factors related to TFE over the past 12 months. The overall prevalence of TFE was 11.4%. Risk factors related to tooth fractures were not wearing a seatbelt on an express bus, not wearing helmets while riding motorcycles and bicycles, clinical treatment due to injuries at school, injuries associated with earphone/smartphones use, and lack of school safety education such as danger evacuation training. The top risk factor was injuries associated with earphone/smartphone usage, followed by lack of familiarity with school safety education. Thus, to prevent tooth fractures among adolescents, schools should strengthen their safety education, including education regarding mobile device usage, and wearing a seatbelt and wearing a helmet. Care should be taken to manage facilities around the school and to prevent injury related to tooth fracture. Further studies on various risk factors related to tooth fractures are warranted.

Pattern of Maxillofacial Trauma and Associated Factors in Traffic Accident Victims

INTRODUCTION

Maxillofacial trauma (MFT) due to road traffic accidents are responsible for part of care provided at trauma centers.

PURPOSE

This research aimed to analyze the pattern of MFTs and associated factors in victims of road traffic accidents.

METHODS

A total of 873 medical records of patients with MFTs in 2 reference hospitals for trauma in Northeastern Brazil during the period from January 2011 to December 2018 were analyzed. Data were included in the Tweedie multiple regression analysis to estimate the prevalence ratio (PR), with 95% confidence interval (95%CI) and P < 0.05.

RESULTS

Motorcycle accidents were the most prevalent (76.4%). Higher hospital costs were the result of patients victims of motorcycle accidents (PR = 1.56; 95%CI = 1.29-1.88; P < 0.001), diagnosed with mandible fracture (PR = 1.41; 95%CI = 1.07-1.86; P = 0.001) who had consumed alcoholic beverages (PR = 1.12; 95%CI = 1.00-1.25; P = 0.04) and did not use personal protective equipment (PPE) (PR = 1.29; 95%CI = 1.10-1.50; P = 0.001). Patients victims of motorcycle accidents remained in hospital longer than other etiologies (PR = 1.47; 95%CI = 1.23-1.76; P < 0.001). The consumption of alcoholic beverages resulted in more severe MFTs (PR = 2.05; 95%CI = 1.34-3.14; P = 0.001).

CONCLUSION

Victims of motorcycle accidents remained hospitalized longer and resulted in higher hospital costs compared to other etiologies. Alcohol consumption increases hospital costs and the severity of MFTs. Higher hospital costs were also observed in patients who did not use PPE. Strategies need to be adopted to understand associated factors in MFTs such as the reallocation of resources to fund, implement and improve services and the surveillance in roads and highways, as well as prevention programs aimed at this health problem.

Oral and cranio-maxillofacial trauma in children and adolescents in an emergency setting at a Brazilian hospital

BACKGROUND/AIMS

Very few studies have been performed to evaluate cranio-maxillofacial trauma diagnosed in hospitals in children and adolescents. The aim of this study was to perform an analysis of oral and cranio-maxillofacial trauma in the aforementioned population.

MATERIALS AND METHODS

A hospital-based retrospective study, which reviewed 1438 patient records, was conducted at the "Teresina Emergency Hospital", Brazil. Data regarding demographics, day of the week on which trauma occurred, type of injury, etiology, anatomic trauma site, time of hospital admission, and associated comorbidities (or injuries) were collected.

RESULTS

There were 1092 (75.9%) males and 346 (24.1%) females. The largest group was adolescents aged between 13 and 18 years (956, 66.5%). The majority lived in urban areas (69%). Trauma occurred most frequently during the week. The most prevalent etiology was road traffic accidents involving motorcycles (771, 53.6%) causing facial and skull fractures (598, 41%). The most prevalent soft tissue lesions were facial abrasions (49%), followed by injuries to the cheek (16.7%). Comorbidities associated with craniofacial trauma were present in 82%, with complications from traumatic brain injuries being the most prevalent (65.6%) Dental trauma was recorded in only 81 cases (5.6%).

CONCLUSION

Male adolescents living in urban areas were most affected by craniofacial trauma. The most common cause was road traffic accidents involving motorcycles, resulting in facial and skull fractures. Complications from traumatic brain injuries were the most common associated injuries.

Profile and costs associated with the use of osteosynthesis materials in victims of traffic accidents

BACKGROUND/AIMS

Facial trauma arising from traffic accidents is one of the most prevalent injuries in urban trauma centers. The aim of this study was to evaluate the frequency, types, and costs associated with osteosynthesis material used in facial fractures of traffic accident victims seen at the Hospital da Restauração, Recife/PE, Brazil, from January to December 2014.

MATERIALS AND METHODS

Data were collected from the medical records of hospitalized patients submitted to surgery under general anesthesia for the treatment of facial fractures during the period. The data were analyzed descriptively by calculating absolute frequencies, percentages, and means. Statistical analysis was performed using SPSS v.21.0.

RESULTS

Among the patients, 73.1% were victims of motorcycle accidents that led to higher costs as they were the most prevalent injuries. Mandibular fractures were the most prevalent injury (53.5%). A total of 477 osteosynthesis materials were used, of which 76.51% were a 2.0-mm plate system, 15.51% were a 1.5-mm plate system, 3.14% were a 2.4-mm plate system, 3.77% titanium meshes, 0.83% lag screws, and 0.2% steel wires. The use of these materials for the treatment of facial fractures resulted in a cost of US $51.285,00 for the Brazilian public health system.

CONCLUSION

The increase in the number of traffic accidents implies significant numbers of victims with facial fractures, as well as considerable costs associated with the use of osteosynthesis materials for public health services.