Risk factors for maxillofacial injuries in a Brazilian emergency hospital sample

Covid lockdowns and hospitalisations for oro-facial trauma among children in Australia and the United Kingdom

BACKGROUND/AIM

This retrospective study investigated the effect of lockdowns for Covid-19 on the rates of oro-facial trauma hospitalisations in children in Australia and the United Kingdom (UK).

MATERIALS AND METHODS

Hospitalisation data for children up to 19 years old for oro-facial trauma injuries (according to ICD-10-AM principal diagnosis codes) over 5 years were collected for Australian and UK children. The age-standard rate (ASR) for each age group was calculated per 100,000 population.

RESULTS

In the younger Australian children, there was no statistically significant change in the ASR of oro-facial trauma hospitalisations during the 'Covid year', compared to the average rate over the 3 years preceding. However, there was a significant decrease in the ASR of oro-facial trauma hospitalisations during the 'Covid year' in older Australian children (aged 10-19), and for all UK children, except for infants under one-year-old.

CONCLUSIONS

Reduction of the ASR of hospitalisations due to oro-facial trauma during the 'Covid year', and the implementation of lockdown measures in the two countries provides further evidence of the impact of physical activities and travel as contributing factors to oro-facial injuries in children. In addition to its role in reducing the spread of virus infections during the pandemic, the lockdown measures also resulted in a simultaneous decrease in trauma injuries.

Epidemiology of maxillofacial fractures in northwest China: an 11-year retrospective study of 2240 patients

BACKGROUND

The aim of this study was to determine the epidemiological pattern of maxillofacial fractures in northwestern China by retrospectively analysing the demographics, aetiologies, concomitant injuries, fracture sites, and management.

METHODS

A 10-year retrospective analysis of 2240 patients with maxillofacial fractures admitted to the General Hospital of Ningxia Medical University was conducted. The extracted data included sex, age, aetiology, fracture site, concomitant injuries, time of treatment, therapeutic approaches and complications. Statistical analyses were performed, including descriptive analysis and the chi-square test. Logistic regression was used to determine the impact factors of maxillofacial fractures and concomitant injuries. P values < 0.05 were considered statistically significant.

RESULTS

The age of the included patients ranged from 1 to 85 years, and the mean age was 35.88 ± 15.69 years. The male-to-female ratio was 3.9:1. The most frequent aetiology of maxillofacial fractures was road traffic accidents (RTAs) (56.3%), and the most common fracture sites were the anterior wall of the maxillary sinus, arcus zygomaticus and mandibular body. A total of 1147 patients (51.2%) were affected by concomitant injuries, with craniocerebral injury being the most common. Logistic regression analyses revealed increased risks of mid-facial fractures in elderly individuals (odds ratio (OR) = 1.029, P < 0.001) and females (OR = 0.719, P = 0.005). Younger patients had a higher risk of mandibular fractures (OR = 0.973, P < 0.001). RTAs increased the risk for mid-facial fractures and high falls increased the risk for mandibular fractures.

CONCLUSIONS

The maxillofacial fracture pattern is correlated with sex, age and aetiology. Patients were mainly young and middle-aged males, and the main cause of injury was RTAs, mostly causing compound fractures. Medical staff must be systematically educated to comprehensively examine patients with injuries resulting from RTAs. The management of patients with fractures requires thorough consideration of the patient's age, aetiology, fracture site, and concomitant injuries.

Characteristics and management of teeth in the line of mandibular fractures treated with internal fixation

BACKGROUND/AIMS

The ideal management of teeth in the line of mandibular fractures is unclear and controversial. The aim of this study was to analyze the characteristics and management of teeth in the line of mandibular fractures treated with open reduction and internal fixation.

MATERIAL AND METHODS

Medical records of patients with mandibular fractures in the symphysis, body and angle regions seen between July 2019 and January 2021 were evaluated. Personal data, etiology, location of fractures, characteristics of the teeth involved in the fracture lines and management were collected. The relationship between the fracture lines and the periodontium was classified according to Kamboozia & Punnia-Moorthy. Fractures were divided into two groups according to the management of the tooth in the fracture line: removal and retention. The likelihood ratio test was used (p < .050).

RESULTS

During the study period, 52 patients with mandibular fractures were seen, of which 42 patients (83.3% men) with a mean age of 29.6 years and 54 fractures were included. The most frequent location was the angle of the mandible (41.3%) (p < .001). The removal group represented 35.2% of the fractures, and the retention group represented 64.8%. The most frequently removed tooth was the third molar (p < .001), and the most frequent classification of dental involvement in the fracture line was type II (p = .047). There was no correlation between age, gender, or etiology and the management of the teeth involved.

CONCLUSION

The retention of teeth in the fracture line predominated, and the third molar in angle fractures was the most often removed tooth when the fracture line followed the root surface but did not cross the apical region, probably due to the greater frequency of this type of relationship between the fractures and the periodontium.

Mapping Evidence on the Epidemiology and Cost Associated with Maxillofacial Injury among Adults in Sub-Saharan Africa: A Scoping Review Protocol

(1) Background: Maxillofacial injury (MI) occurs universally, for it disregards preference for age, gender, and geographical region. The global incidence and prevalence of facial fractures rose by 39.45% and 54.39%, respectively, between the years 1990 to 2017. Projections indicate that the burden of injuries will persist in sub-Saharan Africa (SSA) in the next twenty years. This scoping review aims to map the literature on MI epidemiology and the economic burden on society in SSA. (2) Methods: The methodology presented by Arksey and O'Malley and extended by Levac and colleagues will be employed in the scoping review. The researcher will report the proposed review through the Preferred Reporting Items for Systematic Review, and Meta-Analysis extension for scoping reviews (PRISMA-ScR). The review will include studies encompassing MI in sub-Saharan African adults 18 years and above. (3) Results: This will be presented as a thematic analysis of the data extracted from the included studies, and the Nvivo version 12 will be employed. (4) Discussion: We anticipate searching for related literature on the prevalence, incidence, risk factors, mortality, and cost associated with MI in the adult population of SSA. The conclusion from the review will assist in ascertaining research gaps, informing policy, planning, authorizing upcoming research, and prioritizing funding for injury prevention and management.

Cases of Maxillofacial Trauma Treated at Hospitals in a Large City in Northeastern Brazil: Cross-Sectional Study

Maxillofacial trauma is associated with facial deformation, loss of function, emotional and social impacts, and high financial costs. This study investigated cases of maxillofacial trauma in a large Brazilian city through a cross-sectional study conducted at two public and two private hospitals. Primary data of 400 patients were collected through a questionnaire, clinical examination, and tomography. Statistical analysis at the 5% significance level was performed. Motorcycle accident was the major cause of trauma (41%); the most frequent trauma and treatment were mandibular fracture (24.3%) and surgery (71%), respectively. The female sex was more affected only regarding domestic accidents (p = 0.041) and falls (p < 0.001). Motorcycle accidents were more prevalent among 20 to 29 year-olds (p < 0.001), followed by physical aggression (p < 0.001) and sports accidents (p = 0.004). Falls were more frequent among 40 to 59 year-olds (p < 0.001). Mandibular fracture affected males and 20 to 29 year-olds more and was mainly associated with motorcycle accidents (48.2%) and physical aggression (22.7%) (p = 0.008). Nose fracture was more frequent in falls (29.6%), physical aggression (22.5%), and sports accidents (21.1%) (p < 0.001). Compound fracture was associated with motorcycle accidents (84.2%; p = 0.028). Maxillofacial trauma (mandibular, nasal, and zygomatic fractures) was associated with motorcycle accidents, physical aggression, and falls. Surgical treatment, hospital care, and public services were the most frequent.

The effects of treatment timing on the management of patients with multiple facial fractures and on the self-perception of TMD recovery

OBJECTIVE

To investigate the effects of time on the orofacial functions and on the self-perception of temporomandibular disorders (TMD) recovery in a population of patients with multiple facial fractures.

METHODS

Orofacial functions and self-perception of TMD recovery was verified in patients with midface and/or lower face fractures. Patients were divided according to the time between fracture reduction and the clinical assessments: 0-1 month (Group 1), 1-3 months (Group 2), and 15 >3 months (Group 3).

RESULTS

Patients in Group 1 presented a greater compromise of swallowing and mastication when compared to patients with older fractures (p = 0.015), whereas patients in Group 3 presented a poorer TMD recovery (TMJ pain: p = 0.010 and tinnitus: p = 0.004).

CONCLUSION

Delays in functional treatments involving the myofunctional orofacial system have a negative impact on the recovery of essential orofacial functions and on TMD symptoms..

Factors Associated With Violence Against Women and Facial Trauma of a Representative Sample of the Brazilian Population: Results of a Retrospective Study

Study Design

Violence against women is a challenge in public health. It involves women of all ages, socioeconomic statuses, cultures, and religions.

Objective

The objective of this study was to perform an epidemiological survey of facial trauma among women who experienced physical aggression by an intimate partner.

Methods

Electronic medical records from a public tertiary referral hospital for trauma in the Brazilian state of Espírito Santo were analyzed between 2013 and 2018.

Results

Patients were most commonly between 20 and 29 years of age (33.9%), and 50% of the patients were of mixed race. When separated by days of the week, facial trauma was most commonly inflicted on Sundays (24.2%) and on Saturdays (22.6%). Of the 62 women included in the study, 47 had facial fractures, and 7 had more than 1 concomitant fracture. Forty of the total fractures (72.7%) were on the middle and upper thirds of the face, while 15 fractures (27.3%) were on the lower third of the face. The most commonly observed signs and symptoms of these injuries were edema (56.5%), periorbital ecchymosis (35.5%), deviated nasal dorsum (22.6%), and hematoma (16.1%).

Conclusions

Facial trauma may be considered an important marker of attempted femicide. Health care professionals must be aware of and attentive to this correlation, since many cases of attempted femicide go unnoticed or are attributed to another etiology.

Oral and maxillofacial injuries in children: a retrospective study

Objectives

The purpose of this retrospective epidemiological study was to determine the etiology and pattern of maxillofacial injuries in a pediatric population.

Materials and Methods

Data for pediatric maxillofacial trauma patients aged 12 years and younger who were registered at the Department of Pediatric and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, India, were reviewed and examined. Patients who were treated between October 2016 and September 2018 were analyzed according to age, sex, cause of injury, frequency and site of facial fractures, and soft tissue injuries. The chi-square tests were carried out for statistical analyses with a significance level of 5%.

Results

Of 232 patients with a mean age of 6.77±3.25 years, there were 134 males (57.8%) and 98 females (42.2%). The overall male to female ratio was 1.39:1. The most common causes of injuries were falls (56.5%) and motor vehicle accidents (16.8%). Incidence of falls decreased significantly with age (P<0.001). Dentoalveolar injuries (61.6%) and soft tissue injuries (57.3%) were more common than facial fractures (42.7%). Mandibular fractures (82.8%) were the most common facial fractures, and perioral or lip injuries were the most prevalent injuries in our patient population. There was a positive association between facial fractures and soft tissue injury (P<0.01) (odds ratio 0.26; confidence interval 0.15-0.46).

Conclusion

Falls were the leading cause of maxillofacial trauma in our sample of children, and the most common site of fractures was the mandible.

The Epidemiology of Traumatic Brain Injury Due to Traffic Accidents in Latin America: A Narrative Review

Objective  Traumatic brain injuries (TBIs) are devastating injuries and represent a major cause of morbidity and mortality worldwide. Traffic accidents are one of the main causes, especially in low- and middle-income countries. The epidemiology of TBI due to road traffic in Latin America is not clearly documented.

Methods  A narrative review was conducted using PubMed, SCOPUS, and Google Scholar, looking for TBI studies in Latin America published between 2000 and 2018. Seventeen studies were found that met the inclusion and exclusion criteria.

Results   It was found that TBI due to road traffic accidents (RTAs) is more frequent in males between the ages of 15 and 35 years, and patients in motor vehicles accounted for most cases, followed by pedestrians, motorcyclists, and cyclists.

Conclusion  Road traffic accidents is a common cause of TBI in Latin America. More studies and registries are needed to properly document the epidemiological profiles of TBI related to RTAs.

Substance Use and Maxillofacial Trauma: A Comprehensive Patient Profile

PURPOSE

Maxillofacial trauma confers an increased risk of long-term clinical sequelae with a substantial economic burden on the health care system. Substance use has long been correlated with an increased risk of trauma, yet to date, a comprehensive profile of substance users incurring facial fractures has not been established. We aimed to establish patterns and trends of substance use and specific substances in the setting of maxillofacial trauma.

PATIENTS AND METHODS

A retrospective chart review was conducted at our institution examining patients with maxillofacial fractures from 2016 to 2017. Information on age, gender, race, urine drug screen status, setting of presentation, mechanism of injury, trauma history, and injury severity was collected and examined for associations with particular substances.

RESULTS

We included 388 patients for analysis. Patients with positive urine drug screen results were significantly more likely to be men, present in an urban setting, incur poly-facial trauma, and have a history of facial trauma. In addition, alcohol use correlated significantly with injury severity in the context of polytrauma. Living in an urban setting and using phencyclidine were both significantly associated with a history of maxillofacial trauma.

CONCLUSIONS

Patients with comorbid maxillofacial trauma and substance use exhibit particular patterns in presentation and history. Establishing a profile for these patients allows for the development of prevention and rehabilitation programs.

[Characterization of oral maxillofacial lesions resulting from physical aggression: differences between genders]

In developed countries, violence is the main cause of oral maxillofacial (OMF) injuries. In Brazil, there are scant records of such lesions. The scope of this study was to detail the OMF injuries resulting from physical aggression in a capital of the Brazilian northeast and analyze gender differences. The Forensic Medicine Institute of São Luís, state of Maranhão, featured 15,847 reports, which occurred in 2012, and they were investigated. Socioeconomic, demographic data and OMF characteristics were analyzed. The Chi-square and Fisher's Exact tests were applied to assess gender differences. Of the cases examined, 1977 were OMF. Female victims, aged 20-59, dark-skinned, without a partner and maids were the most affected. Ecchymosis-type lesions, in the mouth and lip regions arising from the use of blunt instruments, causing permanent functional impairment, were the most prevalent in women (P < 0.05), whereas dental fracture and contusion arising from sharp instruments causing permanent deformity, occupational disability, and threat to life were detected in men (P < 0.05). The conclusion drawn is that the incidence of OMF due to physical aggression is high in São Luís, state of Maranhão, and although women are the most affected, the OMF in men are more severe.

The Patterns and Etiology of Maxillofacial Trauma in South India

Background

Maxillofacial trauma is any physical trauma to the facial region, commonly encountered by maxillofacial surgeons, and is often associated with high morbidity. Maxillofacial injuries can occur as an isolated injury or may be associated with multiple injuries in other parts of the body.

Aim

This study aims to assess the patterns, etiology, and management outcomes of maxillofacial trauma in a teaching hospital in Chennai, South India, over an 8-year period.

Methods

Patients with maxillofacial injury were identified using the department database and clinical records. Nine hundred and forty-four patients were identified with maxillofacial trauma in the Department of Oral and Maxillofacial Surgery between January 2009 and December 2017.

Results

The mean age of the patients was 30 ± 12 years. Of the 944 patients with maxillofacial injuries, 64% had isolated lower face (mandibular) fractures, followed by isolated midface fractures (19%). Road traffic accidents were the most common form of etiology for trauma.

Conclusion

The etiology and pattern of maxillofacial injuries reflect the trauma patterns within the community and can thus provide a guide to help design programs toward prevention and treatment.

Associated Injuries in Maxillofacial Trauma: A Study in a Tertiary Hospital in South India

Aim

Maxillofacial trauma when associated with concomitant injuries has a significant potential for increased morbidity. This study aims to identify the causes of trauma, evaluate the types of associated injuries and to highlight the significance of multi professional collaboration in sequencing of treatment.

Patients and Methods

A total of 300 patients who reported to the casualty of a tertiary Hospital in Karnataka with facial fractures were enrolled.

Results

Associated injuries were sustained by 162 patients. The predominant aetiology was the Road Traffic Accident with maximum number of patients in the age group of 20-29 and a male to female ratio of 10.1:1. The mandible was the most frequently fractured bone. Head injury was the most common associated injury. The mortality rate was 0.66%. The mean ISS and GCS values among the patients who sustained associated injuries along with maxillofacial trauma were higher and lower respectively, as compared to those without associated injuries with a statistically significant difference (p < 0.001).

Conclusion

Implementation of strict road safety measures in the rural and interior regions of South India, to prevent morbidity and mortality due to road traffic accidents is essential. Injuries to the facial skeleton must be approached with the knowledge of probable associated injuries that could have been incurred.

Emergency department visits for dental problems associated with trauma in Alberta: A report between the years 2011 and 2017

BACKGROUND/AIMS

Dental trauma represents a significant cause for concern in emergency department (ED). The aim of this study was to report on the prevalence of ED visits for dental problems associated with trauma (DPAT) in Alberta, Canada. The specific objectives were to provide up-to-date information regarding ED utilization for dental trauma concerning the demographics of users and distribution of ED visits across the Province of Alberta, allowing for an assessment of possible trends over the period of time observed.

METHODS

Data for ED visits in Alberta between January 1, 2011, and December 31, 2017, were extracted from the National Ambulatory Care Reporting System (NACRS). Data elements pertinent to this analysis include patient demographics, administrative information, and diagnosis. Only the main or primary diagnosis of each ED visit was included in this analysis using the International Statistical Classification of Diseases (ICD-10-CA).

RESULTS

There were 71 118 total ED visits for DPAT in this time period, with an average of 10 159 visits per year across Alberta. Children aged 1-4 years old represented the age-group in both genders with the largest number of ED visits, 22.1% of the total number of visits. The number of ED visits for DPAT by males 21 years or younger (22 384) was higher than the total number of ED visits among females in all age-groups (21 099). The ICD-10-CA code S01.5 referring to open wound of lip and oral cavity was by far the most prevalent diagnosis, representing 57.6% of the total visits during the period investigated.

CONCLUSIONS

This population-based report quantifies the rates and frequency of ED utilization for DPAT in the province of Alberta, Canada. The information gathered is important to support injury prevention initiatives using a population-based approach targeting the high-risk groups of the population identified by this study.

Prevalence of mandibular fracture in patients visiting a tertiary dental care hospital in North India

Background:

Injuries of the maxillofacial complex represent one of the most important health problems worldwide. At present, in developing India, due to poor traffic sense, maxillofacial trauma and fractures are most epidemiologic diseases. Mandible is the largest and strongest facial bone and it is the second most commonly fractured bone. Mandibular fractures can involve only one site or can often involve multiple anatomic sites simultaneously.

Aims:

The present study is aimed to know the age- and sex-related prevalence of parasymphyseal fracture, fracture of angle, condylar fracture, symphyseal fracture, and coronoid fracture of mandible in North Indian population. It also evaluates the correlation of prevalence of parasymphyseal fracture, angle of mandible, condylar fracture of mandible, symphyseal fracture of mandible, and coronoid fracture of mandible.

Materials and Methods:

All patients fulfilling the selection criteria and having mandible fracture were selected for the study. The data about mandibular fracture was collected by means of a structured questionnaire including age, sex, and anatomic site of fracture. Qualitative variables were compared using Chi-square test/Fisher's exact test as appropriate.

Results:

The study population consists of 1015 individuals aged between 7 and 68 years with the mean age of 33.49 ± 11.79 years. The most common anatomic site for mandibular fracture was parasymphyseal region (40.3%) followed by angle (28.8%), condyle (27.6%), and symphysis (12.5%) of mandible. The coronoid process of mandible (44, 4.3%) was least involved in mandibular fracture. Males (30.8%) are more predilected for condylar fracture than females (15.7%). The mandibular symphyseal fracture is more common in male (14.9%) than female (3.7%).

Conclusion:

Mandibular fractures occur in people of all ages and races, in a wide range of social settings. Their causes often reflect shifts in trauma patterns over time. The present assessments of mandibular fracture will be valuable to government agencies and health-care professionals involved in planning future programs of prevention and treatment.

3D assessment of damaged bicycle helmets and corresponding craniomaxillo-mandibular skull injuries: A feasibility study

OBJECTIVES

In the Netherlands, cyclists continue to outnumber other road users in injuries and deaths. The wearing of bicycle helmets is not mandatory in the Netherlands even though research has shown that wearing bicycle helmets can reduce head and brain injuries by up to 88%. Therefore, the aim of this study was to assess the feasibility of using 3D technology to evaluate bicycle-related head injuries and helmet protection.

METHODS

Three patients who had been involved in a bicycle accident while wearing a helmet were subjected to multi-detector row computed tomography (MDCT) imaging after trauma. The helmets were separately scanned using the same MDCT scanner with tube voltages ranging from 80kVp to 140kVp and tube currents ranging from 10mAs to 300mAs in order to determine the best image acquisition parameters for helmets. The acquired helmet images were converted into virtual 3D surface hence Standard Tessellation Language (STL) models and merged with MDCT-derived STL models of the patients' skulls. Finally, all skull fractures and corresponding helmet damage were visualized and related.

RESULTS

Imaging bicycle helmets on an MDCT scanner proved to be feasible using a tube voltage of 120kVp and a tube current of 120mAs. Merging the resulting STL models of the patients' skull and helmet allowed the overall damage sustained by both skull and helmet to be related.

CONCLUSION

Our proposed 3D method of assessing bicycle helmet damage and corresponding head injuries could offer valuable information for the development and design of safer bicycle helmets.

MAXILLOFACIAL TRAUMA, ETIOLOGY AND PROFILE OF PATIENTS: AN EXPLORATORY STUDY

Objective:

To describe the profile of patients with facial trauma admitted in a hospital located in a metropolitan area of Northeast Brazil.

Methods:

A cross-sectional and exploratory study was performed. A total of 244 cases were in agreement with the eligibility criteria. The variables include the sociodemographic characteristics of patients, etiology, type of trauma, treatment modalities, length of stay in a hospital and quarter of care. Descriptive statistics and Cluster Analysis were performed.

Results:

The average age of patients was 31.16 years (SD = 15.17 years) and average hospitalization was 6.32 days (SD = 7.75 days). It was verified the automatic formation of four clusters with different profiles of patients. The variables which most contributed to the external differentiation between clusters were: length of stay in a hospital (p <0.001), etiology (p <0.001), type of facial trauma (p <0.001), presence of associated trauma (p <0.001), treatment modalities (p <0.001) and quarter of care (p <0.001).

Conclusion:

The most of patients were men, victims of traffic accidents, which suffered fracture of zygomatic complex and underwent surgery. Level of Evidence III, Retrospective Study.

Maxillofacial prostheses challenges in resource constrained regions

BACKGROUND

This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations.

METHOD

A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries.

RESULTS

Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach.

CONCLUSIONS

In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

Two years retrospective study of maxillofacial trauma at a tertiary center in North West Ethiopia

BACKGROUND

Maxillofacial injury poses a challenge to oral and maxillofacial surgeons working in developing countries with limited resource and human power. The present study aimed to determine the etiology, pattern, and management of maxillofacial trauma in Gondar university of Gondar hospital.

METHODS

A retrospective descriptive study design was used. Medical registration retrieving of patients with maxillofacial trauma visited dental center of University of Gondar Hospital from September 2013 to August 2015 was done. During data collection, etiology of trauma, pattern of fracture, treatment modality and complications were recorded using predesigned data collection template and analyzed using SPSS computer software version 20. Statistical analysis was done to show the sex distribution of maxillofacial trauma and the effect of alcohol intake on the incidence of trauma.

RESULTS

During 2-year period, September 2013-August 2015, 326 patients of maxillofacial trauma were treated in the dental center of university of Gondar hospital. The mean age was 29.12 (± 8.62) with age range of 11-75 years. Majority of the study participants (47.2%) were within the age group of 21-30 years. Eighty percent of the participants were male with a male to female ratio of 4.02:1. Interpersonal violence (75.8%) and Road traffic accident (21.5%) were the leading causes. Males are at high risk of maxillofacial trauma relative to females (P < 0.0001). There was high incidence of trauma in the weekend, rural residents, December to February, mandibular fractures and soft tissue injuries were the most common injuries. There was an associated injury in 79 (24.2%) patients in head and neck area, thoracic, abdominal and extremities. Half of the patients were managed conservatively (49.7%) with debridement and suture, while 45.7% of the patients were closed reduction and 4.6% were surgical open reduction. There were 25 post procedure complications especially in mandibular fractures.

CONCLUSION

Interpersonal violence was the major cause of maxillofacial trauma, while mandible and soft tissue were the most affected maxillofacial areas. The federal ministry of health, Ethiopia should have well-organized maxillofacial center in tertiary hospitals for emergency management to avoid morbidity and mortality.

Orofacial trauma in rural India: A clinical study

PURPOSE

Orofacial trauma is becoming a leading medical problem worldwide. Most of the studies pertaining to orofacial trauma have been done in urban areas but very little scientific literature is available for rural areas.

METHODS

A prospective medical institute-based study of orofacial injury patients was carried out from May 2013 to April 2016 (36 Months). Data regarding incidence, age and sex distribution, causes, types and site of injury, treatment modalities and trauma associated complications were collected and analysed.

RESULTS

A total of 784 patients were studied. Males outnumbered females by a ratio of 2.9:1. Age range was 9 months-75 years with the peak incidence in the age-group of 18-34 years. Most injuries were caused by road-side accidents (72.7%), followed by assault and falls in 11.6% and 8% respectively. Soft tissue injuries and mandibular fractures were the most common type of injuries. Head/neck (50.29%) and limb injuries (27.2%) were the most prevalent associated injuries. Surgical debridement and soft tissue suturing was the most common emergency procedure. Closed reduction was performed in 61% of patients and open reduction and internal fixation in 30% of cases and 9% were managed conservatively. Complications occurred in 6.88% of patients, mainly due to infection and malocclusion. The mean duration of hospital stay was (10.12 ± 6.24) days.

CONCLUSION

This study highlights the importance of department of dental surgery along with other disciplinaries in the management of orofacial injuries. Road-side accident remains the major etiological factor of orofacial injuries in our setting.

Determinants of Oral Diseases in the African and Middle East Region

Oral health policies must be developed that emphasize the role of social determinants in health and oral diseases. The aim of this report is to review literature on determinants of oral diseases and apply the concepts to promoting oral health in the African countries in the African and Middle East region (AMER). Structural and proximal determinants of oral diseases are common to those affected by other noncommunicable diseases (NCDs). Oral diseases are also heavily affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy. Wide-scale poverty exists in populations in the AMER. Oral health promotion and preventive oral health programs should therefore be integrated with those for general health and use the common risk factor approach (CRFA). Attempts should be made to improve the daily living conditions and reduce the incline of the social gradient. Oral health practitioners should use the CRFA when dealing with determinants of oral diseases and in the design of preventive oral health programs. The detrimental effects of the social determinants of health may be ameliorated by involving both the individual and community. Interventions in health promotion programs in the AMER need more research on the epidemiology of oral diseases and the role played by the social determinants of oral diseases, especially with regard to poverty. The high levels of poverty and low gross domestic product in most countries in the African region make it difficult to fund high-quality, affordable, accessible oral health services.

Assessment of Oro-Maxillofacial Trauma According to Gender, Age, Cause and Type of the Injury

OBJECTIVES

The occurrence and causes of maxillofacial trauma varies in different regions of the world. The aim of this study was to identify the occurrence, types and causes of maxillofacial injuries according to the age and gender differences in patients treated at the Department of Maxillofacial Surgery, University Hospital Center Osijek, between January 2011 and December 2013.

MATERIALS AND METHODS

A total of 64 patients, 41 males (64.1%) and 23 females (35.9%), aged from 18 to 86 years (mean age 42) participated in the study. Data collected and analyzed included gender, age, cause of injury and the type of maxillofacial injuries.

RESULTS

The most common cause of injuries in both gender groups was falling down (39% males; 65% females). The second leading cause of injuries in males was interpersonal violence (29%) and in females traffic accident (26%) (p<0.05). The most common type of injury in both gender groups was bone injury (50%; in males zygomatic bones 55%, in females mandible 40%) (p>0.05). The most common causes of injuries in the youngest patients was violence (43%), and in others fall (50-70%; p<0.05). The most common reported type of injury in all age groups was bone injury (more than 50%; p>0.05). The majority of the falls and violence caused bone tissue injuries, and soft tissue and dentalveolar injuries were detected in traffic and sports accidents (p>0.05).

CONCLUSION

Falling down was the most common cause of oro-maxillofacial injuries in both men and women and in all three age groups. The leading type of injury was bone injury. The data obtained from this study provide important information for future prevention from injuries.

Facial trauma among victims of terrestrial transport accidents

Introduction

In developing countries, terrestrial transport accidents – TTA, especially those involving automobiles and motorcycles – are a major cause of facial trauma, surpassing urban violence.

Objective

This cross-sectional census study attempted to determine facial trauma occurrence with terrestrial transport accidents etiology, involving cars, motorcycles, or accidents with pedestrians in the northeastern region of Brazil, and examine victims’ socio-demographic characteristics.

Methods

Morbidity data from forensic service reports of victims who sought care from January to December 2012 were analyzed.

Results

Altogether, 2379 reports were evaluated, of which 673 were related to terrestrial transport accidents and 103 involved facial trauma. Three previously trained and calibrated researchers collected data using a specific form. Facial trauma occurrence rate was 15.3% (n = 103). The most affected age group was 20–29 years (48.3%), and more men than women were affected (2.81:1). Motorcycles were involved in the majority of accidents resulting in facial trauma (66.3%).

Conclusion

The occurrence of facial trauma in terrestrial transport accident victims tends to affect a greater proportion of young and male subjects, and the most prevalent accidents involve motorcycles.

Retrospective study maxillofacial fractures epidemiology and treatment plans in Southeast of Iran

Background

The epidemiology of facial injuries varies in different countries and geographic zones. Population concentration, lifestyle, cultural background, and socioeconomic status can affect the prevalence of maxillofacial injuries. Therefore, in this study, we evaluated the maxillofacial fractures epidemiology and treatment plans in hospitalized patients (2012-2014) which would be useful for better policy making strategies.

Material and Methods

In this retrospective study, the medical records of 386 hospitalized patients were evaluated from the department of maxillofacial surgery at Bahonar Hospital of Kerman, Iran. The type and cause of fractures and treatment plans were recorded in a checklist. For data analysis, ANOVA, t-test, Chi-square, and Fisher’s exact test were performed, using SPSS version 21.

Results

The majority of patients were male (76.5%). Most subjects were within the age range of 20-30 years. Fractures were mostly caused by accidents, particularly motorcycle accidents (MCAs), and the most common site of involvement was the mandible (parasymphysis). There was a significant association between the type of treatment and age. In fact, the age group of 16-59 years under went open reduction internal fixation (ORIF) more than other age groups (P=0.02). Also, a significant association was observed between gender and the occurrence of fractures (P=0.01).

Conclusions

Considering the geographic and cultural indices of the evaluated population, it can be concluded that patients age and gender and trauma causes significantly affect the prevalence of maxillofacial traumas and fracture kinds and treatment plans.

Key words:Epidemiology, treatment, facial injuries, face fractures, maxillofacial trauma, trauma.

Prevalence of Oral and Maxillofacial Trauma in Elders Admitted to a Reference Hospital in Northeastern Brazil

OBJECTIVE

To know the prevalence and etiology of oral and maxillofacial trauma in elders.

METHODS

Analytical quantitative cross-sectional study conducted at a public trauma hospital located in Fortaleza-Ceará, Brazil. The study population comprised patients with trauma who were hospitalized from April to August 2014. Of these patients, patients with oral and maxillofacial trauma were chosen to be included in the research. A questionnaire was administered in order to obtain information on socio-demographics, systemic comorbidities, use of medication, deleterious habits (smoking and alcohol consumption), etiology of oral and maxillofacial trauma and type of pre-hospital care.

RESULTS

Of the 280 elderly hospitalized with trauma, 47 had oral and maxillofacial trauma, with a prevalence of 16.8%. In this group, the age ranged from 60 to 88 years, with a mean age of 72.4 years (SD± 8.38). The elderly were mostly women (55.3%), self-declared pardos (53.2%), who presented with cardiovascular disorders (48.9%), and who received formal pre-hospital care (70.2%). Elderly who were in the 60-69 years age group, spent 6-9 years at school and drank alcohol were 2.64, 3.75, and 1.97, respectively, more likely to suffer oral and maxillofacial trauma. The main causes of trauma were physical aggression, traffic accidents, falls and domestic accidents. All of the physical aggressions resulted in oral and maxillofacial traumas, and the elderly who suffered traffic accidents were four times more likely to have oral and maxillofacial trauma.

CONCLUSION

The prevalence of 16.8% and the lack of research on oral and maxillofacial traumas in the elderly is worrisome and should be included in the oral health indicators for the elderly population to support the importance of oral health.

Etiology and injury patterns of maxillofacial fractures from the years 2010 to 2013 in Mecklenburg-Western Pomerania, Germany: A retrospective study of 409 patients

OBJECTIVE

The aim of the present study was to illustrate the injury patterns and the etiology of accident victims with maxillofacial fractures in the state of Mecklenburg-Western Pomerania (M-P), Germany.

MATERIAL AND METHODS

Between 2010 and 2013, patients with maxillofacial fractures from the Department of Oral and Maxillofacial Surgery at the Helios Kliniken Schwerin, were evaluated with a specially constructed data set in a retrospective analysis. After review of the patient records, a case-related data collection was performed with the pre-set characteristics: age, gender, age group, maxillofacial fracture, and cause of injury.

RESULTS

Of 409 patients, 79% (n = 323) were male and 21% (n = 86) were female. A fracture of the zygomaticomaxillary complex was most frequently observed (31%; n = 240). Midface fractures with orbital floor involvement were the most common fracture types (48.4%; n = 137). A significant percentage of the fractures (45.2%; n = 185) were caused by interpersonal violence; 70.8% (n = 131), and thus the majority of the patients who were treated due to a brutal offense, had consumed alcohol. Within this group, men in the age group of 20-29 years were most prevalent (38.7%; n = 125). Etiologically, 25.2% (n = 103) of fractures were caused by a fall.

CONCLUSION

The regionalization of data on the distribution, emergence, and localization of maxillofacial fractures in M-P allows not only a national comparison but also an international comparison with areas that are in a similar strong socio-demographic change, as it applies to the East German population. This provides the opportunity to develop the global preventive measures and to apply suitable quality management.

Incidence, etiology, and patterns of maxillofacial fractures in ain-shams university, cairo, egypt: a 4-year retrospective study

Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients' data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community.

A 7-year study of 1,278 patients with maxillofacial trauma and cerebrospinal fluid leak

BACKGROUND

A number of patients with facial fractures have cerebrospinal fluid (CSF) leak that may result in meningitis and other central nervous system complications. Commonly, CSF leak occurs following trauma, but the etiology and pattern of this disorder are different from region to region. This study aims to evaluate the distribution of CSF leak in patients with maxillofacial fractures in Isfahan province, Iran.

PATIENTS AND METHODS

In this retrospective cross-sectional study, 1,287 medical files of patients admitted to a medical center with head and face injuries were evaluated during a 7-year period (2004-2010). Data was obtained using descriptive analysis.

RESULTS

Of the 1,278 patients with head and maxillofacial fractures, 16 (1.25 %) males and one (0.07 %) female had CSF leak; all these cases had skull base fracture. Of these, 52.9 % had maxillary fracture, 23.5 % nasal fracture, 41.1 % orbital fracture, 11.7 % mandibular fracture, 23.5 % frontal fracture, and 41.1 % had more than one site of fracture. 58.8 % had rhinorrhea and 41.2 % otorrhea. Of all these patients with CSF leak, 8 (47 %), 2 (11.8 %), and 7 (41.2 %) cases were treated spontaneously, using lumbar drain placement, and by surgical intervention, respectively.

CONCLUSIONS

Cerebrospinal fluid leak was observed most frequently in patients with fracture in the zygomatic and maxillary bone, and mostly exhibited itself as rhinorrhea and/or otorrhea. All cases with CSF leak had skull base fracture as well. However, post-traumatic CSF leaks are uncommon and are generally treated without surgical intervention (59 %). Distribution of CSF leak varies from one region to another and knowing this fact helps to manage the injury and prevent the complications.

An assessment of etiological spectrum and injury characteristics among maxillofacial trauma patients of Government dental college and Research Institute, Bangalore

BACKGROUND

Maxillofacial injuries pose a therapeutic challenge to trauma, maxillofacial and plastic surgeons practicing in developing countries. This was a retrospective study carried out to determine the incidence, etiology, injury characteristics of maxillofacial injuries reported at our centre.

PATIENTS AND METHODS

The data for this study were obtained from the medical records of 689 cases reported to our centre during the period from 2006-2009. Records of patients who were either treated in the emergency room as outpatients or the Department of Oral and Maxillofacial Surgery as inpatients were analyzed and were subjected to statistical analysis using statistical package for social sciences (SPSS) for Windows version 17.0. Data was summarized in form of proportions and frequency tables for categorical variables and was subjected to Chi-Square test.

RESULTS

Out of 689 patients, 75.9% were male and 24.1% were female. 42.5% of the patients were in the age group of 21 to 30 years. Road traffic accidents accounted for the majority (74.3%) of cases of maxillofacial trauma. Mandible was seen as the most commonly fractured bone (50.3%) and 53.8% head and neck injuries were most common among the associated injuries.

CONCLUSION

Road traffic accidents were clearly the most prevalent etiological factor for maxillofacial trauma. Measures on prevention of road traffic crashes should be strongly emphasized in order to reduce the occurrence of these injuries.

Burden of maxillofacial trauma at level 1 trauma center

There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the major etiologic factor of maxillofacial injuries in our setting and the young adult males were the main victims. Henceforth, establishment of regionalized, efficient, and focused trauma centers in various parts of the country particularly for acute trauma should be emphasized. Also, the laws regarding the precautions such as seat belts, speed limits, and traffic rules must be observed strictly to reduce the incidence of RTA.

Maxillofacial fractures in the province of pescara, Italy: a retrospective study

The aim of the present study was to assess the etiology and pattern of maxillofacial fractures in the Province of Pescara, Abruzzo, Central Italy. Was performed a retrospective review of patients treated at the Department of Maxillofacial Surgery of Spirito Santo Hospital from January 2010 to December 2012. Data collected and analyzed included sex, age, cause of injury, site of fracture, monthly distribution, and alcohol misuse. A total of 306 patients sustaining 401 maxillofacial fractures were treated. There were 173 males (56.5%) and 133 females (43.5%). Most of the patients (36.9%) were in the age group of 18–44 years. The most common causes of injuries were road traffic accidents (26.4%); the second leading cause was interpersonal violence (23.2%), followed by injuries associated with falls (19.2%). Fractures of the mandible (31%) and zygoma (23%) were the most common maxillofacial fractures in our study. The monthly distribution peaked in the summer (July and August, 30.4%) and in October (13.1%). In conclusion, this study confirms the close correlation between the incidence and etiology of facial fractures and the geographical, cultural, and socioeconomic features of a population. The data obtained provide important information for the design of future plans for injury prevention and for education of citizens.

A lei seca cumpriu sua meta em reduzir acidentes relacionados à ingestão excessiva de álcool?

OBJETIVO: avaliar se a Lei Seca cumpriu sua meta após três anos da promulgação. MÉTODOS: estudo retrospectivo dos pacientes com fraturas craniofaciais submetidos a tratamento cirúrgico em um hospital universitário, em dois períodos: antes (2005 a 2008) e após a implantação da lei (2008 a 2011). RESULTADOS:foram operados 265 pacientes (220 homens e 45 mulheres) nesse período sendo, 149 (56%) antes da lei e 116 (44%) após a lei, indicando redução no número de traumatismos (p=0,04). Houve predomínio da faixa etária entre 19 e 40 anos, em ambos os períodos. As principais causas dos traumas foram os acidentes automobilísticos, as agressões físicas e as quedas. O abuso de álcool foi identificado em 15,4% dos pacientes antes e 19% após a lei. A mandíbula e o complexo maxilozigomático foram os ossos mais acometidos. CONCLUSÃO:a redução no número de politraumatizados operados ficou aquém do esperado e almejado.

Pattern of oral-maxillofacial trauma stemming from interpersonal physical violence and determinant factors

BACKGROUND/AIM

Facial trauma is among the most common types of injury. The aim of the present study was to assess the prevalence and pattern of oral-maxillofacial trauma stemming from interpersonal physical violence (IPV) and determine whether IPV is factor associated with oral-maxillofacial trauma.

MATERIALS AND METHODS

A retrospective analysis was conducted of 790 complete patient charts for data on the type of IPV for the gender, area of residence (urban or rural), age and type of trauma. Statistical analysis involved the chi-squared test (P < 0.05), univariate/multivariate Poisson, and logistic regression (P < 0.20). Type of oral-maxillofacial trauma was the dependent variable. Socio-demographic status and type of IPV were the independent variables.

RESULTS

One hundred forty (17.7%) individuals had oral-maxillofacial injuries stemming from IPV [80 (10.1%) due to urban violence (UV) and 42 (5.3%) due to domestic violence (DV)]. DV was more prevalent among females (69%), and UV was more prevalent among males (67.5%). The most common types of trauma were facial contusion and laceration, dental concussion, and mandibular fracture. Age and UV were explanatory factors for mandibular fracture. Females from rural areas and who suffered DV were more likely to exhibit facial contusion and dental concussion.

CONCLUSIONS

Interpersonal physical violence was identified as a factor associated with oral-maxillofacial trauma, specifically mandibular fracture, facial contusion, and dental concussion.

Clinical indicators of midface fracture in patients with trauma

BACKGROUND/AIM

Midface fractures are commonly present and difficult to diagnose in trauma patients. The objective of this study was to determine clinically accessible indicators of midface fracture.

MATERIAL AND METHODS

A case-control study design was used to determine clinical indicators of midface fracture. Population source was a level I trauma center registry for years 2007-2009. Cases had a documented midface fracture. Patient and trauma characteristics were compared between cases and controls. Multivariate logistic regression analysis determined significant indicators of midface fracture.

RESULTS

Study sample included 83 cases and 83 frequency-matched controls. Cases had a total of 211 fractures with a median of two midface fractures per person. Common fractures were orbital (41%), malar and maxillary (28%), and nasal bones (19%). Patients with midface fracture were significantly different than patients without midface fracture in severity of injury and were more likely to have a traumatic brain injury. Significant clinical indicators of fracture were maxillary sinus opacification, ethmoid sinus opacification, forehead laceration, periorbital contusion, epistaxis, and injury mechanism (P < 0.05). Patients with midface fracture had a 63 times greater odds for maxillary sinus opacification. The multivariable model correctly classified the presence and absence of midface fracture in 95% of study sample.

CONCLUSIONS

Determined indicators of midface fracture provided a high level of discrimination in fracture status. Indicators can be used by clinicians to help detect possible midface fractures. Future prospective research on midface fracture indicators can assist in establishing their generalizability and impact on fracture detection, care, and outcomes.

[Severe injury within the splanchnocranium and neck with penetration of foreign bodies in wood processing]

INTRODUCTION

The aim of this work was to describe the patient with severe injury within the splanchnocranium and neck connected with the penetration of large foreign bodies in his wood processing activity, and their impaction in soft tissues and life-threatening localisation.

MATERIAL AND METHODS

The authors describe the case of a 37-year-old male patient whose splanchnocranium and neck were injured while he was processing the wood with a mechanical saw. Two enormous wooden strips staved in his face while one was boring towards the nose and paranasal sinuses and the other was penetrating through the soft tissues of the cheek and neck from side of the oral cavity, with a visible prominent ending at the nape.

RESULTS

On diagnostic tests, the patient underwent tracheotomy media under neuroleptoanalgesia and infiltration anaesthesia, then, under intratracheal anaesthesia, he was intubated through tracheostomy. The two foreign bodies (enormous wooden strips) were removed by a multispecialty team of surgeons. Further, repositioning and osteosynthesis of the fractured ramus of the mandible on the left side were performed. The minititanium plate, 5 holes, 8 holes and 3 holes, was used. The wound within the nasal passages, maxillary sinuses and anterior surface of the maxilla was cleaned from fragments and chips of wood. The reconstruction of the tissues and repositioning of the bony fragments were conducted. The Redon drainage tube was implemented in the postoperative cavity, anterior and posterior nasal tamponade (Bellocq type) was required, the wounds in the left cheek and neck were debrided. The patient was discharged in general good condition 7 days on surgery.

CONCLUSIONS

The patients with severe injuries within the splanchnocranium and the neck, connected with the penetration of foreign bodies huge in size, should be treated in specialist centres by a multispecialty team of surgeons according to therapeutic standards.

A review of emergency room studies on alcohol and injuries conducted in Latin America and the Caribbean region

ISSUES

Alcohol-attributable burden of injury is one of the most serious public health problems in Latin America and the Caribbean region (LAC). Although knowledge on alcohol's involvement in injuries has progressed along with the implementation of evidenced-based alcohol policies in developed countries, this was not true for the most part of LAC countries for which reducing alcohol-related injuries is an urgent necessity.

APPROACH

A systematic review was performed in order to identify the most up-to-date information on alcohol and injuries derived from emergency room (ER) studies conducted in LAC.

KEY FINDINGS

Findings corroborate that alcohol has a high prevalence among injured patients in the ER setting in LAC, with violence-related injuries showing an increased association with alcohol use compared to unintentional injuries. However, a large number of studies did not include all types of injury and the measurement of injury risk associated with alcohol consumption. The amount of alcohol consumed in the event and hazardous drinking patterns seem to be strongly associated with injury occurrence, as well as drinking in public spaces, but a paucity of data relating to social-contextual factors limits the interpretation of the heterogeneity in the magnitude of the association of alcohol and injuries found across studies.

CONCLUSIONS

There is a lack of ER studies able to support strategies to reduce alcohol-related injuries in a region where effective alcohol policies are scant. Future research should focus on understanding how drinking influenced by local contexts and drinking behaviours may affect the risk of injury within each LAC country.

Risk factors associated with facial fractures

The aim of the present study was to identify risk factors for facial fractures in patients treated in the emergency department of a hospital. The medical charts of 1121 patients treated in an emergency ward over a three-year period were analyzed. The independent variables were gender, age, place of residence (urban or rural area) and type of accident. The dependent variables were fractured mandible, zygoma, maxilla, nasal bone and more than one fractured facial bone. Statistical analysis was performed using the chi-square test (a < 0.05), univariate and multivariate Poisson distributions and the logistic regression analysis (p < 0.20). Maxillofacial trauma was recorded in 790 charts (70.5%), with 393 (35.1%) charts reporting facial fractures. Motorcycle accidents were found to be the main risk factor for mandibular fractures (PR = 1.576, CI = 1.402-1.772) and simultaneous fractures of more than one facial bone (OR = 4.625, CI = 1.888-11.329) as well as the only risk factor for maxillary bone fractures (OR = 11.032, CI = 5.294-22.989). Fractures of the zygomatic and nasal bones were mainly associated with accidents involving animals (PR = 1.206, CI = 1.104-1.317) and sports (OR = 8.710, CI = 4.006-18.936), respectively. The determinant for the majority of facial fractures was motorcycle accidents, followed by accidents involving animals and sports.

Mandibular angle fractures during third molar removal: a report of two cases

Although fracture of the tooth during surgical removal is common, mandibular fracture during lower third molar removal is an unusual and major complication. Possible aetiologies are age, gender, the position of the tooth, uncontrolled excessive force applied, insufficient surgical experience and improper instrumentation. Symptoms can vary widely and treatment options range from prescription of a soft diet to surgical treatment by open reduction and internal fixation. We present two cases of the treatment and follow-up of fracture of the angle region of the mandible during removal.

Distribution assessment of maxillofacial fractures in trauma admitted patients in Yazd hospitals: An epidemiologic study

BACKGROUND

Fracture, is discontinuity of anatomical bone relations. Commonly, a maxillofacial fracture occurs after trauma but the etiology and pattern of this entity is different amongst countries. The aim of this study was to clarify the main causes of this entity in Yazd to increase public and professional awareness to prevent more injuries and subsequent consequences.

MATERIALS AND METHODS

This retrospective cross-sectional study consisted of 194 patients admitted in public hospitals in Yazd, Iran. Variables such as age, gender, cause of accidents, site of fracture and treatment method were noted and recorded in a questionnaire filled during hospitalization of these patients. Causes of accident were classified by 6 reasons such as accident by car and motorcycle, fighting and violence, falls, sports and occupational injuries. The site of fractures, including mandible, maxilla, nasal, frontal and orbital were considered. The data were analyzed using descriptive analysis.

RESULTS

The results showed that maxillofacial fractures are more prevalent in male than females (69% versus 31%). The Most sites of fractures were nasal bone (79%). The majority of people with maxillofacial fractures were in the age ranged between 20-29 years and the main reason of maxillofacial fractures was motorcycle accident.

CONCLUSION

According to our result, most sites of fractures were in nasal bone. The main cause of maxillofacial fractures was motorcycle accident. However, in each age range the most common cause of accident was different.

Etiological spectrum, injury characteristics and treatment outcome of maxillofacial injuries in a Tanzanian teaching hospital

BACKGROUND

Maxillofacial injuries pose a therapeutic challenges to trauma, maxillofacial and plastic surgeons practicing in developing countries. This study was carried out to determine the etiology, injury characteristics and management outcome of maxillofacial injuries at our teaching hospital.

PATIENTS AND METHODS

A prospective hospital based study of maxillofacial injury patients was carried out at Bugando Medical Centre from November 2008 to October 2009. Data was collected using a structured questionnaire and analyzed using SPPS computer software version 11.5.

RESULTS

A total of 154 patients were studied. Males outnumbered females by a ratio of 2.7:1. Their mean age was 28.32 ± 16.48 years and the modal age group was 21-30 years. Most injuries were caused by road traffic crushes (57.1%), followed by assault and falls in 16.2% and 14.3% respectively. Soft tissue injuries and mandibular fractures were the most common type of injuries. Head/neck (53.1%) and limb injuries (28.1%) were the most prevalent associated injuries. Surgical debridement (95.1%) was the most common surgical procedures. Closed reduction of maxillofacial fractures was employed in 81.5% of patients. Open reduction and internal fixation was performed in 6.8% of cases. Complications occurred in 24% of patients, mainly due to infection and malocclusion. The mean duration of hospital stay was 18.12 ± 12.24 days. Mortality rate was 11.7%.

CONCLUSION

Road traffic crashes remain the major etiological factor of maxillofacial injuries in our setting. Measures on prevention of road traffic crashes should be strongly emphasized in order to reduce the occurrence of these injuries.