Comparison of Maxillofacial Trauma Patterns in the Urban Versus Suburban Environment: A Pilot Study

Epidemiology of Craniomaxillofacial Fractures Over a 5-year Period at a Midwestern Level 1 Trauma Center Serving a Large Rural Population

BACKGROUND

Though the epidemiology of craniomaxillofacial (CMF) fractures has been well documented at urban hospitals, the characteristics of these fractures in rural hospitals have not been well studied.

PURPOSE

The purpose of this study is to report on the epidemiology of CMF fractures at a regional Level 1 trauma center serving a large rural population in central Illinois.

STUDY DESIGN, SETTING, SAMPLE

This is a retrospective cohort study at a community-based regional tertiary referral center that serves a predominantly rural population. Inclusion criteria comprised patients with radiologically confirmed CMF fractures between 2015 and 2019. Patients with incomplete medical records were excluded.

PREDICTOR VARIABLE

Predictor variables included demographics (age, admission source, race, and sex) and etiology of CMF fracture (assault/domestic violence, all-terrain vehicle/off-road, falls, farm-related, motor vehicle collisions, gunshot wound, and others).

MAIN OUTCOME VARIABLE

The primary outcome variable was the CMF anatomic location including nasal bone, orbit, mandible, malar/maxillary, and other CMF fractures.

COVARIATES

The covariates are not applicable.

ANALYSES

Descriptive statistics were used to summarize a sample of the population characteristics. Wilcoxon ranked sign tests and χ2 tests of independence were used to assess for statistically significant associations between select variables of interest. Statistical significance was defined as P < .05.

RESULTS

Between 2015 and 2019, a total of 2,334 patients presented to the emergency department with a CMF fracture. After applying the inclusion/exclusion criteria, the final sample was composed of 1,844 patients for the management of 2,405 CMF fractures. The majority of patients were male(62.0%) and young adults (aged 18-39) had the highest number of CMF fractures (819) relative to all other age groups. The most common fracture etiology was fall(37.3%), and nasal bone fractures represented the most common fracture location(41.6%). χ2 analyses revealed statistically significant associations between the anatomic location of CMF fracture incurred, and differing categories of age, admission source, race, sex, and etiology.

CONCLUSION AND RELEVANCE

Our study shows that patients seen at our Midwestern Level 1 trauma center are more likely to present with nasal bone and malar/maxillary fractures due to falls. In studies based in urban centers, patients are likely to present with orbital and mandibular fractures due to falls and assault.

Risk Factors for Pediatric Facial Trauma in an Appalachian Region: An Epidemiological Review at a Single Institution

BACKGROUND

Rural and low-income pediatric populations are at higher risk for trauma. Craniomaxillofacial (CMF) trauma in this population has not been studied.

PURPOSE

This study's purpose was to determine if rural populations or low-income populations are at higher risk for pediatric CMF trauma than urban or high-income populations, respectively, and to determine differences in mechanism of injury (MOI).

STUDY DESIGN, SETTING, SAMPLE

A retrospective cohort study of CMF trauma patients younger than 17 years-old, living in the region served by one institution in Tennessee, and requiring oral and maxillofacial surgery consultation between January 2011 and December 2022 was performed. Exclusion criteria were incomplete medical records.

PREDICTOR VARIABLE

The primary predictor variable was geographic residence of the patient grouped into two categories: rural or urban defined by the state of Tennessee. Secondary variables were postal code (PC) average median household income (MHI) and PC population density.

MAIN OUTCOME VARIABLE(S)

The main outcome variable was pediatric CMF injury rate per 100,000 people. MOI is a secondary outcome variable.

COVARIATE(S)

Covariates included sex, age, and race.

ANALYSES

Frequencies and percentages, Fisher's exact test, and Poisson regression models were utilized. Statistical significance was assumed at P-value <.05.

RESULTS

Rural or urban county designation was not associated with differing trauma rates (incident risk ratio (IRR) = 0.91; 95% confidence interval (CI) 0.78 to 1.05; P = .18) by itself. One standard deviation increase in MHI decreased CMF trauma rates in rural designation counties by 24% (IRR: 0.76, 95% CI: 0.66, 0.88) and 6% in urban designation counties (IRR: 0.94, 95% CI: 0.87, 1.02). Lower rates of CMF trauma were associated with residence in higher income PCs (IRR = 0.91; 95% (CI) 0.86 to 0.97; P = .004), and higher population density (IRR = 0.87; 95% CI 0.79 to 0.94; P < .001). Dog bites and falls were more common in infancy and early childhood. Interpersonal violence was more common in older patients.

CONCLUSIONS AND RELEVANCE

Patients in PCs with lower population density or incomes were at highest risk for CMF injuries. MOI differences by age were similar to findings in other studies. Tennessee's urban/rural county designation has complex interactions with MHI and pediatric CMF trauma rates.

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.

Trends in Operative Complex Middle and Upper Maxillofacial Trauma: A 17-Year Study

OBJECTIVES/HYPOTHESIS

Over 3 million incidents of facial trauma occur each year in the United States. This study aims to determine trends in operative middle and upper maxillofacial trauma in one of the largest US cities.

STUDY DESIGN

Retrospective case-control study.

METHODS

Retrospective chart review of all operative middle and upper maxillofacial trauma from July 1993 to July 2010 presenting to Los Angeles County Hospital, a Level I Trauma Center. Data included demographics, mechanism of injury, and fracture characteristics.

RESULTS

Analysis was performed for a total of 4,299 patients and 5,549 facial fractures. Mean patient age was 34.6, and most patients were male (88%). Between the two time periods (1993-2001 and 2002-2010), there was a 42% reduction in operative maxillofacial trauma (3,510 to 2,039). Orbital floor and zygomaticomaxillary complex fractures were the most prevalent types of fractures. Panfacial fractures demonstrated the largest reduction in number of fractures (325 to 5, P<0.01). Assault and motor vehicle accidents (MVA) were the two most common mechanisms of injury. Operative fractures due to MVAs decreased (390 to 214, P = .74), whereas fractures due to assault increased (749 to 800, P<0.01). Compared to adults, pediatric facial trauma (age < 18) were caused by a higher percentage of MVAs (27% vs. 13%), auto versus pedestrian (9% vs. 5%), and gunshot wounds (8% vs. 4%) (P<0.01).

CONCLUSIONS

Operative middle and upper maxillofacial trauma decreased over a 17-year period. Assault was the most significant mechanism of trauma overall. These trends suggest that focusing future prevention strategies on curtailing interpersonal violence may more effectively address the burden of facial trauma.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:1985-1989, 2021.

Patterns of Facial Fractures in a Major Metropolitan Level 1 Trauma Center: A 10-year Experience

OBJECTIVE/HYPOTHESIS

To report characteristics and management of facial fractures in a major metropolitan center within the United States.

STUDY DESIGN

Retrospective chart review.

METHODS

Retrospective review at a level 1 trauma academic medical center of 3,946 facial fractures in 1,914 patients who presented from 2008 to 2017. Demographics, injury mechanism, associated injuries, and treatment information were collected. Logistic regression analyses were performed to determine factors associated with management.

RESULTS

There were 1,280 males and 630 females with a median age of 42 years. Orbital fractures were the most common (41.4%) followed by maxilla fractures (21.9%). The most common mechanism was fall (43.6%). Surgical management was recommended for 38% of patients. The odds of surgical management were less for females (OR 0.59, 95% CI 0.48-0.73). Patients over 70 years were significantly less likely to undergo surgery compared to other age groups (OR 0.15-0.36, P < .001). The odds of surgical management were 1.69 times greater for patients with more than three fractures than for a single fracture (95% CI 1.18-2.42) and 2.23 times greater for traffic injuries compared to injuries from activities of daily living (95% CI 1.42-3.5).

CONCLUSIONS

This represents one of the largest comprehensive databases of facial fractures. Our patients were most frequently injured during activities of daily living, most commonly from falls. The majority of patients were managed conservatively. Gender, age, fracture number, and mechanism of injury were independently associated with the decision to treat surgically. Our data are in stark contrast to that from other populations in which assault or motor vehicle accidents predominate.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E2176-E2180, 2021.