Traumatismos maxilofaciais como marcadores de violência urbana

The profile of patients with maxillofacial trauma due to interpersonal violence treated in a hospital emergency room

AIM

This study evaluated records of patients with maxillofacial trauma due to interpersonal violence (IPV) being treated in the emergency room of a level I trauma center hospital in São Paulo, Brazil.

MATERIAL AND METHODS

Data of patients with maxillofacial trauma due to IPV recorded between January 2019 and December 2019 were retrospectively examined. Personal data, days on which they experienced IPV, and the type of maxillofacial trauma sustained were extracted and statistically analyzed (p < .050).

RESULTS

During the analysis, 1034 patients with maxillofacial trauma were identified; of these patients, 292 (28.2%) who experienced trauma due to IPV were included in this study. There was a mean age of 32.6 years and the most common type of trauma was soft tissue injuries (38.7%). Mandible and nose fractures were more prevalent in males and females, respectively. Our data, when compared with other studies on maxillofacial trauma due to IPV, showed a lower prevalence and male-to-female ratio, and a higher presence of dentoalveolar trauma. Additionally, our data when compared with studies on maxillofacial trauma due to other causes showed lower mean age and male-to-female ratios, and a higher occurrence of nose fractures differing from the predominance of mandibular fractures.

CONCLUSION

Oral and maxillofacial surgeons must be able to suspect and identify cases due to IPV among their patients with trauma. With our results, although each case has its individuality, we can suggest that cases of maxillofacial trauma in young, female, and nasal fracture patients may be suspicious for IPV.

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.

Spatial distribution of maxillofacial injuries caused by urban violence: An ecological analysis to identify high-risk areas

OBJECTIVES

To investigate the spatial and spatial-temporal distribution of oral and maxillofacial injuries caused by urban violence, as well as to identify underlying disparities at regional level through a geostatistical approach.

METHODS

This was a historical ecological cohort study of trauma cases caused by urban violence using aggregate data from victims assisted in a Brazilian medical-forensic service between January 2012 and December 2015. The longitudinal patterns of change observed in each geographic area (neighbourhoods) were evaluated using the finite mixture model (FMM). The spatial autocorrelation of events was investigated using the Getis-Ord Indicator (Gi*) to identify significant hot and cold spatial clusters. With a spatial regression model, it was also found when socioeconomic variables, residential infrastructure and neighbourhood infrastructure were associated with high incidence rates. The significance level was set at P ≤ 0.05.

RESULTS

The finite mixture model revealed three different patterns of longitudinal trajectory of the incidence of oral and maxillofacial trauma caused by urban violence (TP1 to TP3, P < 0.05). TP1 was characterized by an incidence that remained stable and high over time, comprising 17.4% of the city's neighbourhoods. In TP2, it was observed that the incidence was moderate, with a slightly increasing trend in the last year evaluated, representing around 41.8% of the sample. In contrast, in TP3, it was found that the incidence was relatively low and remained stable over time, accounting for about 40.8% of the sample. The Getis-Ord (Gi*) statistic identified significant high-risk clusters in the western (P < 0.05), southern (P < 0.05), and eastern regions (P < 0.05) and low risk in the northern region (P < 0.05). The spatial regression model indicated significant association between areas with unfavourable socioeconomic conditions and higher incidence of events (β = 0.178, SE = 0.046, P < 0.001).

CONCLUSIONS

Clusters demarcating areas with high socio-spatial vulnerability for urban violence and oral and maxillofacial injuries were identified. The findings highlight the need to improve living conditions in segregated urban areas and develop intersectoral actions to improve living conditions, employment, public safety, social support, health care and prevention.

Aggression Using a Knife or Other Sharp Instruments and Oral-Maxillofacial Trauma: Incidence, Risk Factors, and Epidemiologic Trends

PURPOSE

The aim of the present study was to characterize the profile of victims of interpersonal physical violence (IPV) caused by a knife or other sharp instrument, identify the factors associated with maxillofacial trauma, and examine the incidence of maxillofacial trauma over time.

PATIENTS AND METHODS

In a retrospective cohort study, we evaluated 569 medicolegal and social records of IPV victims by knife or other sharp instruments treated at a forensic medicine and dentistry center in Brazil during a 4-year consecutive period. The variables investigated were related to the sociodemographic characteristics of the victims, circumstances of the aggression, and trauma patterns. Descriptive and multivariate statistics through Poisson regression and trend analysis with the creation of polynomial regression models were used.

RESULTS

The cumulative incidence of oral-maxillofacial trauma was 19.3%. The mean age of the victims was 31.29 ± 13.82 years. Cases of trauma affecting more than one region of the face prevailed (45.5%). Based on the final Poisson regression model, unemployed people were more likely to exhibit maxillofacial trauma (relative risk [RR] 1.86; 95% confidence interval [CI] 1.03-3.35; P = .039). In addition, individuals were more likely to experience maxillofacial trauma on Wednesdays (RR 1.85; 95% CI 1.01-3.37; P = .045). The trend analysis revealed a significant increase in oral-maxillofacial injuries over time (P < .05).

CONCLUSIONS

The incidence of oral-maxillofacial trauma was high, and the main factors associated with trauma were the victim's employment status and day of occurrence. Future studies will focus on assessing the effect of maxillofacial trauma on the quality of life and well-being of violence victims.

Pattern of oral-maxillofacial trauma from violence against women and its associated factors

BACKGROUND/AIM

Violence against women is a global public health problem. The aim of this study was to characterize the profile of women victims of violence and identify factors associated with maxillofacial injuries.

MATERIAL AND METHODS

A cross-sectional study was performed based on an evaluation of 884 medico-legal and social records of women victims of physical aggression treated at the Center of Forensic Medicine and Dentistry in Brazil. The variables investigated were related to the sociodemographic characteristics of victims, circumstances of aggressions, and patterns of trauma. Descriptive and multivariate statistics using decision tree analysis by the Chi-squared automatic interaction detector (CHAID) algorithm, as well as univariate and multivariate Poisson regression analyses were performed.

RESULTS

The occurrence of maxillofacial trauma was 46.4%. The mean age of victims was 29.38 (SD=12.55 years). Based on decision tree, the profile of violence against women can be explained by the aggressor's gender (P<.001) and sociodemographic characteristics of victims, such as marital status (P=.001), place of residence (P=.019), and educational level (P=.014). Based on the final Poisson regression model, women living in suburban areas were more likely to suffer maxillofacial trauma (PR=1.752; CI 95%=1.153-2.662; P=.009) compared to those living in rural areas. Moreover, aggression using a weapon resulted in a lower occurrence of maxillofacial trauma (PR=0.476; CI 95%=0.284-0.799; P=.005) compared to cases of aggression using physical force.

CONCLUSIONS

The prevalence of oral-maxillofacial trauma was high, and the main associated factors were place of residence and mechanism of aggression.