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PATTERN OF MAXILLOFACIAL INJURIES - A STUDY.

Byline: SHAHEEN AHMED, ABDUL HAFEEZ SHAIKH, SUNEEL KUMAR PUNJABI and SUFYAN AHMED

Abstract

This descriptive study assessed the pattern of maxillofacial injuries seen at the Emergency Department of Abbasi Shaheed Hospital, Karachi, Pakistan from January 2014 to December 2015. A total of 464 patients with maxillofacial trauma were included in the study, of whom 329 (70.25%) were males and 135 (29.28%) female. The most common cause was road traffic accidents (220) and fall was second most common cause (86). The mandible was the most common bone fractured (243), followed by Zygomatic Bone Complex fracture (118). Majority of patients were treated with closed methods of treatment (189) and (256) patients with open reduction and internal fixation.

Maxillofacial trauma was more prevalent in males and in young age groups. The common management modality was open reduction and internal fixation.

Key Words: Demographic, Analysis, Maxillofacial Injuries, ORIF.

INTRODUCTION

Maxillofacial trauma is frequent and requires diagnosis of fractures, soft-tissue injuries and sometimes emergency intervention, and appropriate treatment required immediately.1 The patterns of maxillofacial fracture presentation are consistently influenced by geographic area, socioeconomic status of the cohort, and the period of investigation.2,3

According to reports of developing nations, traffic accidents are the main cause of maxillofacial fractures,4,7,8 while data from developed countries pointed to assaults being considered the most frequent etiology of such fractures.9-11 With regard to the anatomical sites, mandibular and zygomatic complex fractures account for the majority of all facial fractures and their occurrence varies according to the mechanism of injury and demographic factors, particularly, gender and age.7-13 The large variability in reported prevalence is due to a variety of contributing factors, such as the environment, sex, age, and socioeconomic status of the patient, as well as the mechanism of injury.

Consequently, an understanding of the cause, severity, and temporal distribution of maxillofacial trauma permits clinical and research priorities to be established for effective treatment and prevention of those injuries.12,13 Treatment of maxillofacial fracture include fixation with mini plates, wire fixation, intermaxillary fixation, graft and proplast application for reconstruction of bone defects and elevation by Gillies temporal method in the case of zygoma fracture are the most common treatment options used in the world and also in our hospital. Nevertheless the treatment protocol of the patient with Maxillofacial fracture may change according to the type, location of the fracture as well as the surgeon experience and preference.

The aim was this study was to rule out current etiological factor associated with maxillofacial trauma in our step up and to best possible treatment modality done for managing maxillofacial trauma.

METHODOLOGY

This study was conducted at Emergency Department / Out Patients Department of Abbasi Shaheed Hospital, Karachi, Sindh, Pakistan which provides emergency and elective care facilities to patients free of cost. Patients were received after initial assessment by general trauma specialist. Records of 464 patients from January 2013 to December 2015 presented with maxillofacial trauma were analyzed and data regarding age, gender, cause of trauma, diagnosis and treatment were collected on pre-design Proformas, before enrolling the patient informed written consent was taken from subjects or their attendants.

The cause of injury was divided into RTA, assaults, falls, and sport injuries. The diagnosis was classified as skeletal maxillofacial trauma which includes mandible fractures, dento-alveolar, Lefort I, Lefort II, Lefort III, Zygoma, Orbital fracture, Naso-ethmoid fracture and frontal bone fracture. The mandibular fractures further classified as Symphysis, Parasymphysis, body, angle, Condylar, coronoid and ramus.

Inclusion Criteria: Patients with any gender and from any age group and patients with signs and symptoms (Clinically and Radiological) evident of maxillofacial trauma presenting in the time period of 2013 to 2015.

Exclusion Criteria: Previously maltreated cases, 15 days old fracture, malunited fractures and patients with associated skeletal injuries.

DATA ANALYSIS PROCEDURE

Data were analyzed in statistical program for social sciences (SPSS) version 21.0. The frequency and percentage was computed for qualitative variables, like gender, etiologies. Mean standard deviation was computed for qualitative variables, like age. No inferential test applied due to descriptive statistics.

RESULTS

Out of 464 patients 329 were males (70.72%) and 135 females (29.28%). Age distribution is shown in Tables 1 and 2. The most common cause of the maxillofacial injuries was road traffic accident (Table 3). further details see Tables 4 to 8.

TABLE 1: AGE DISTRUBUTION OF STUDY SAMPLE (N=464)

Age group###No. of patients###Percentage

(years)

0-10###101###21.58

11-20###109###23.29

21-30###127###27.13

31-40###66###14.1

41-50###28###5.98

51-60###25###5.5

61-70###8###1.5

TABLE 2: FREQUENCY OF MAXILLOFACIAL INJURIES ACCORDING TO GENDER

Gender###Frequency###Percentage

Male###329###70.72

Female###135###29.28

Total###464###100.0

TABLE 3: CAUSES OF MAXILLOFACIAL FRACTURES

Cause###No. of patients###Percentage

RTA###220###47%

Assault###86###18.5%

Fall###144###30%

Sports injury###3###0.64%

Gun shot###11###2.35%

Total###464###100

TABLE 4: SITE OF MAXILLOFACIAL FRACTURES

Site###No. of cases###Percentage

Mandible###243###52.37%

Maxilla###73###15.73%

Zygomatic###118###25.43%

Naso-ethmoid###11###2.37%

Pan-facial###19###4.09%

Total###464###100

TABLE 5: ANATOMICAL LOCATION OF MANDIBULAR FRACTURES

Location###No. of cases###Percentage

Symphysis###79###21.23%

Parasymphysis###81###21.77%

Body###37###9.94%

Angle###72###19.35%

Condyle###98###26.34%

Ramus###3###0.8%

Coronoid###2###0.53%

Total###372###100

TABLE 6: ANATOMICAL LOCATION OF MIDDLE THIRD FRACTURES

Locations###No. of cases###Percentage

Lefort I###26###12.87

Lefort II###30###14.85

Lefort III###17###8.41

Zygomatico-maxillary###118###58.41

Naso-ethmoid###11###5.44

Total###202###100

Coronoid###2###0.53%

Total###372###100

TABLE 7: TREATMENT PROTOCOLS

Treatment###No. of cases###Percentage

Closed reduction###189###40.73

Open reduction###178###38.36

Open + Closed###78###16.81

reduction

Observation###19###4.09

Total###464###100

Total###202###100

Coronoid###2###0.53%

Total###372###100

TABLE 8: DISTRUBUTION OF TREATMENT MODALITLIES

Treatment Modalities###No. of cases

Closed reduction###189

Arch bar###88

Ivy Loop###29

Gunning splint###2

External pin fixation###2

Suspension wiring###11

Gillies temporal###57

Open reduction###256

Bone plates###178

Bone plates + IMF###16

Transosseous wiring + IMF###53

Bone plates+ wiring + IMF###9

DISCUSSION

Factors such as geographical location, culture, and socioeconomic status influence the causes and incidence of maxillofacial fractures.20 The predominance of men is a relatively consistent findings in most studies.1,2,4,10,11,20

Most affected age group was from 21 to 30 years (27.13%), followed by patients ranging from 11 to 20 years (23.29%). Many surveys of maxillofacial fractures reported same results concerning age.2,20 The possible explanation for this was that individuals between the ages of 11 and 30 years frequently take part in dangerous exercises and sports, drive motor vehicles carelessly, and are more likely to be involved in violence.19 Men aged 21 to 40 years in the active segment of the population represent a group with intense social interaction and higher rates of mobility, making them more susceptible to transport accidents and interpersonal violence, consequently leading to higher rates of maxillofacial fractures.1,2 Traffic accidents are clearly important in the series of maxillofacial fractures in developing7,8 and developed11,16 countries but they have been overtaken in the past decade by those caused by interpersonal violence in developed countries.20

Maxillofacial fractures were prevalently represented by mandibular fractures (53%) in this study. Previous studies concur with these data.7,8,10 Reports with high values of traffic accidents tend to present jaw fractures as the most frequent fracture site, with predominance of Condylar nvolvement,5,9,16 as may be seen in the present study data and second most common is zygomatic complex fractures may appear as the most prevalent fracture location which is inconsistent with the study held in Germany showing Zygomatico-maxillary complex fracture is the commonest as inter personal violence is the common cause in their study.20 In the past 15 years, changes in maxillofacial trauma management have been strongly influenced by innovations in materials and technology,8,18 since objectives such as early recovery, segment stability, and patients' comfort have been considered paramount in the treatment of maxillofacial fractures.17

In our study closed reduction was done in almost 189 fractures 37.05% and most of them with arch bar having 88 fractures with almost 46%. Reports from the United Arab Emirates5 and Nigeria8 confirmed this practice and stated that open reduction and rigid internal fixation of facial fractures has not become popular in most developing countries mainly because of cost.1,21

On the other hand, Gali R, Devireddy SK et al22 advocated that miniplates' osteosynthesis has become the standard procedure in their department, being used 4 times more frequently than wire in open reduction and bone fixation. In this study 44% fractures were reduced by open reduction and 16% by both open and closed. Present study supports that regular epidemiologic evaluations of maxillofacial fractures allow a detailed analysis of these lesions, providing important support to install clinical and research priorities, since risk factors and patterns of presentation can be identified. According to these data it seems reasonable to assume that road traffic legislation enforcement and continuous public education toward the use of restraining devices should be encouraged.

Additionally, it should be emphasized that these patients need postoperative care and assistance and they should be closely followed, particularly in cases of facial fractures submitted to open reduction and rigid fixation in any region around the world.

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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Jun 30, 2016
Words:2481
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