Patterns of maxillofacial fractures in goa

A retrospective epidemiological review of maxillofacial injuries in a tertiary care centre in Goa, India

PURPOSE

Trauma accounts for the leading cause of morbidity and mortality worldwide in the present day and may rightly be called the new pandemic. The prominent nature of the face exposes it to various traumatic injuries. A timely, prompt diagnosis along with employment of correct and quick treatment greatly improves the outcome for these patients. The aim of this retrospective study was to analyse the characteristics of maxillofacial injuries over a decade.

METHODS

The data were collected manually from the medical records of patients who reported to the tertiary centre from 1 January 2011 to 31 December 2019. All injured patients irrespective of age/gender with complete hospital records of clinical and radiographical diagnosis of maxillofacial injuries were included. The demographic data, etiology, site and type of injury, and seasonal variation were analyzed. Data were tabulated into 6 age groups (0 - 7 years, 8 - 18 years, 19 - 35 years, 36 - 40 years, 41 - 59 years, and > 60 years). Five etiological factors, i.e. road traffic accidents, falls, assaults, sports-related, and occupational accidents, were further evaluated based on genders. Facial injuries were classified into 6 types: panfacial fractures, mandibular fractures (subcategorized), midface fractures (subcategorized), dentoalveolar fractures, dental injuries, and soft tissue injuries. The monthly and seasonal variation of the injuries was also charted. Data were expressed as frequency and percent.

RESULTS

A total of 10,703 maxillofacial injuries were included from the tertiary centre from the period of 2011 - 2019, including 8637 males and 2066 females, with the highest occurrence in the 19 - 35 years age group. Road traffic accident was the principal etiological factor of maxillofacial injuries in both genders (80.5%), followed by falls (9.6%), assaults (8.0%), occupational accidents (1.2%), and sporting injuries (0.7%). Midface fractures accounted for 52.5% (5623 fractures), followed by mandibular fractures (38.1%).

CONCLUSION

The current study describes a change in the incidence of maxillofacial injuries along with variation in the demographic data. The implementation of safety gears and stricter traffic laws along with public awareness may aid in the reduction of maxillofacial injuries.

A Changing Trend in Pattern of Maxillofacial Trauma in Mumbai: A Prospective Study

INTRODUCTION

Maxillofacial skeleton is the most vulnerable site for trauma due to its prominence. The aim of our study was to analyse the cause and pattern of maxillofacial injuries & to correlate the aetiology and pattern of facial injury.

MATERIALS AND METHODS

This prospective study includes 304 patients with facial trauma, who reported to our institute within a time span of 2 years. Data were collected on basis of sociodemographic status plus additional data obtained on type of injury, aetiology, location and status of the victim.

RESULT

The most frequent cause of maxillofacial trauma (MFT) was fall (43.3%) followed by RTA (34.2%) and assault (15.1%). In upper 3rd face region frontal bone fracture was prevalent with 1.3%, while in the midface, zygomatic complex (ZMC) fracture (3.9%) and in lower 3rd part of face, mandible fracture (42.8%) and dentoalveolar fracture (30.2%). Mandible was the most prevalent site for trauma. Although fall was the main aetiological factor in our study, midfacial injuries were mainly due to assault and RTA. Combination of mandibular fracture and soft tissue injury were mainly seen in RTA and injury due to fall. Conservative management was mainly employed for treatment with 46.1% followed by ORIF with 36.2%.

CONCLUSION

Changing trend in aetiology of MFT was noted. Furthermore, study should be conducted for better understanding, and to carry out preventive measure for the same.

Pattern of associated brain injury in maxillofacial trauma: a retrospective study from a high-volume centre

The incidence of head injury in maxillofacial trauma patients varies widely in the literature. A good understanding of the patterns of association between these injuries would aid in efficient multidisciplinary treatment. The aim of this study therefore was to understand the associations between head injury and facial trauma by retrospectively analysing the records of patients seen at a tertiary care trauma centre. Demographic data were also described. Records of 4350 facial trauma patients over a five-year period were reviewed. A total of 3564 (81.9%) patients were victims of motor vehicle accidents (MVA). Male patients predominated, comprising 3711 (85.3%), and 36.6% were in the third decade of life. Facial fractures were seen in 2120 (48.7%), the most common being zygomatic fractures (60%). At the time of trauma, 2383 (57.3%) patients were under the influence of alcohol, and 2821 (87.8%) victims of two-wheeler MVAs were not using their helmet. Of all patients, 29.75% sustained a traumatic brain injury (TBI). Midface fractures were strongly associated with TBI. Maxillofacial injury may be considered a risk factor for TBI, and as such should immediately be suspected and investigated in all patients. Prompt recognition and management can improve outcomes in these patients.

Retrospective Evaluation of Maxillofacial Fractures With Cone-Beam Computed Tomography

ÖZ Amaç: Bu çalışmanın amacı maksillofasiyal bölgede meydana gelen fraktürlerin yaş ve cinsiyete göre dağılımlarını, lokalizasyonlarını, sayısını, deplasman varlığını, radyolojik özelliklerini Konik Işınlı Bilgisayarlı Tomografi (KIBT) ile retrospektif olarak değerlendirmektir. Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi Diş Hekimliği Fakültesi, Ağız Diş ve Çene Radyolojisi Anabilim Dalı’na 2019 ve 2021 yılları arasında travma nedeniyle başvuran 84 hastadan alınan KIBT görüntüleri retrospektif olarak incelenmiştir. Yaş, cinsiyet, fraktür lokalizasyonu, fraktürlerde deplasman varlığı kayıt altına alındı. İstatistiksel analiz için tüm hasta grubuna tanımlayıcı ve frekans analizleri uygulanırken, hastaların yaş ve cinsiyetlerini; fraktür hattı ve fraktür bölgesi ile karşılaştırırken ki-kare testi uygulandı. Bulgular: 60 erkek 24 kadın hasta (E/K, 2,5/1) olmak üzere toplam 84 hastanın maksillofasiyal travma nedeniyle KIBT görüntüsü incelendi. Çalışmada incelenen hasta grubunun yaşları 6 ve 72 arasında değişmekte olup yaş ortalaması 33.17±1.48 olarak belirlendi. Farklı etiyolojik nedenlerden kaynaklı çeşitli lokalizasyonlarda meydana gelen 116 fraktür hattı sayısı radyolojik olarak tespit edildi. İncelenen tüm fraktürlerin 73’ünde deplasman izlenirken kalan 43 fraktür hattında deplasman görülmedi. Meydana gelen fraktürler en sık angulus mandibulada (%22,61:n=19) tespit edildi. En az fraktür mandibula ramus (%3,57; n=3) ve koronoid proseste (%3,57; n=3) görüldü. Sonuçlar: Fraktür hatlarının varlığının, lokalizasyonlarının ve kırık parçalarının yer değişiminin doğru radyografik teknikler aracılığıyla tespit edilmesi, gerekli tedavi prosedürlerinin uygulanması açısından önem taşımaktadır. İki boyutlu radyografilerin kullanımının yetersiz kaldığı durumlarda KIBT gibi üç boyutlu görüntüleme yöntemleri tercih edilmelidir. Anahtar Kelimeler: Konik Işınlı Bilgisayarlı Tomografi, Fraktür, Mandibula, Teşhis

Changing patterns of Oral & Maxillofacial injuries before and during COVID-19 pandemic: A retrospective study

Introduction

Oral and maxillofacial injuries can be defined as injuries involving soft and hard tissue structures of the facial region and oral cavity, including the teeth and vital structures of the head and neck area as a result of trauma^. The maxillofacial injuries are multifactorial and vary from one country to another and even from region to region. Despite, societal restrictions imposed by the government in the form of lockdowns and curfews, patients still experienced trauma and required significant healthcare services for management.

Methods

Patients of either gender reporting to the emergency department of Lata Mangeshkar Hospital with maxillofacial injuries, attended by residents of OMFS from October 2019 to August 2020 were included in the retrospective study. The demographic data about age, gender and status pertaining to under the influence of alcohol was recorded. The aim of this retrospective study was to evaluate the changing patterns of the maxillofacial injuries during the Covid-19 pandemic.

Results

In the present study, the road traffic accidents were 72.50% pre-lockdown which reduced to 47.37% during the alcohol ban and nationwide lockdown and gradually increased to 63.83% post-lockdown. The second most common cause of maxillofacial injury was falls which showed a significant increase from 22.50% before the lockdown to 31.58% during the lockdown and decreased to 26.6% after lockdown during the pandemic. There was an increase in the number of assaults from 2.50% pre-lockdown to 15.79% during the lockdown and again a decrease to 6.38% post-lockdown.

Discussion

Our study demonstrates the impact of nationwide lockdown in the month of April and May 2020, may have an association with the significant statistical decrease in the monthly average number of trauma admissions. There was a significant decrease in the number of road traffic collisions and falls during the "lockdown period".

Conclusion

The etiology and pattern of maxillofacial injuries reflect the trauma pattern within the community. We need more coordinated strategies of action to minimize maxillofacial injuries and its implication on physical and psychological wellbeing of patients.

Retrospective radiological evaluation to study the prevalence and pattern of maxillofacial fracture among Military personal at Prince Sultan Military Medical City [PSMMC], Riyadh: An institutional study

Purpose

The aim of the present study was to analyze the prevalence, causes, and patterns of maxillofacial fractures retrospectively in patients who were treated at Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Methods

Patients′ medical records were reviewed from 2005 to 2014. Patient′s age, gender, cause, and the pattern of maxillofacial fractures were studied. Associated body injuries were also recorded.

Results

Out of 263 patients, 207 (78.7%) were male and 56 (21.3%) were female. The age range was from 3 to 67 yr with a mean age of 26.21 yr. Road traffic accidents 236 (89.8%) were the most commonly reported cause of maxillofacial fractures, followed by falls 14 (5.3%), assaults 4 (1.5%), gunshot 3 (1.1%), and sport accidents 2 (0.8%). Most of the cases of maxillary fracture were Le Fort II 27 (36.5%), followed by LeFort I 23 (31.1%), LeFort III 20 (27.0%) and palatal fractures 4 (5.4%). Of the mandibular fractures, parasymphysis fractures constituted 61 (27.4%), body 50 (22.4%), condyle 45 (20.2%), angle 40 (17.9%), symphysis 16 (7.2%), ramus 7 (3.1%) and coronoid 4 (1.8%). Zygomatic complex fractures 110 (94.8%) were the most commonly reported fractures in the mid and upper facial region. Other facial fractures included orbital floor 61 (97.0%), naso-orbito-ethmoidal 18 (19.8%), and frontal 12 (13.2%).

Conclusion

Road traffic accidents were the most common cause of maxillofacial fractures. Spreading awareness among young drivers regarding road safety regulations is highly recommended.

Mandibular Ramus Fractures: A Proposed Classification

Aims

The purpose of this article was to study and devise a classification of fracture patterns of the mandibular ramus to facilitate management.

Methods

Mandibular ramus fracture demographics in literature were reviewed along with evaluation of the patients diagnosed with mandibular ramus fractures who had reported to the emergency/outpatient clinic of our Institute in the last 5 years. Epidemiology of these ramus fractures was studied, and these ramus fractures were categorized into repetitive patterns on the basis of radiological observations in an effort to achieve a simplified classification.

Results

A total of 1372 trauma patients were diagnosed with mandibular fractures, of which an incidence of 2.4% was recorded for ramus fractures. These were predominantly in males and mainly due to road traffic accidents commonly in people driving two-wheeler vehicles (64%). Ramus fractures seldom occur in isolation. Five predictable fracture patterns were observed and accordingly classified as types I to V. Type I was the most common and type IV the least. Open reduction was done in 45.5% patients with non-compression plating systems. Satisfactory aesthetic and functional outcomes were achieved in all patients.

Conclusion

The mandibular ramus fractures although rare need to be well understood and demarcated. The classification highlights the importance of this mandibular buttress and focuses on the importance of its technically and anatomically more complicated fracture treatment. Future studies are needed to compare the modalities of management.

Maxillofacial Fracture Patterns in Military Casualties

PURPOSE

Morbidity and death after facial trauma are substantial issues of concern both in civilians and in military personnel. This cross-sectional retrospective study sought to assess the prevalence, pattern, treatment, and complications of soft and hard tissue injuries of the face in military personnel from 2012 to 2018.

PATIENTS AND METHODS

This cross-sectional, retrospective, chart study analyzed the descriptive statistics of 591 patients by use of Microsoft Excel software (version 2013; Microsoft, Redmond, WA); we assessed military casualties treated at our hospital from 2012 to 2018. All military personnel were documented in our trauma registry. The patient records were studied, and information relating to patients' injuries was documented and assessed after compilation of patient data. This study was approved by our local institutional review board; the causes and complications of maxillofacial (MF) trauma were assessed. Statistical analysis was done. This study used descriptive statistics based on a total of 591 patients and Microsoft Excel software (version 2013).

RESULTS

Among maxillofacial (MF) fractures, midface fractures (49%) were most prevalent, followed by lower face fractures (43%) and upper face fractures (24%). The most common cause of injury was explosives (58%). The most frequent site of fracture in the mandible was the angle region, followed by the mandibular body and condyle. Nasal fractures were seen in 44% of midface fractures. The most commonly used technique for treatment was open reduction-internal fixation, which was used in 89% of patients.

CONCLUSIONS

The pattern of MF injuries and the treatment modalities used to treat these patients showed that the most frequent type of injury was midface fracture and most patients were treated by open reduction-internal fixation.

A retrospective study of mandibular fractures in children

Objectives

The incidence and patterns of mandibular fractures vary by country and population age. This retrospective study evaluated the etiologies and patterns of mandibular fractures in children.

Materials and Methods

The clinical records of 89 children (45 males and 44 females) aged 0 to 12 years who presented with mandibular fractures from July 2012 to June 2016 were retrospectively reviewed. The sex, patient age, site of fracture, etiology of trauma, and monthly variations of the fractures were recorded. Descriptive statistics, the z-test and chi-square test were used for statistical analysis and the P-value was set at <0.05.

Results

Eighty-nine children (male-to-female ratio 1.02:1) sustained 131 mandibular fractures. Within the study sample, the 6 to 9 year age group most frequently experienced fractures (47.3%). Falls and road traffic accidents (RTA) were the two most common etiological factors that accounted for 44.9% and 24.7% of cases. The condylar fracture was the most common anatomical location (38.9%) followed by the angle (20.6%), parasymphysis (18.3%), body (15.3%), and symphysis (5.3%). A single fracture (51.7%) was more common than multiple fractures (48.3%). The month-wise distribution of mandibular fractures was fairly constant.

Conclusion

The condylar region was the most common anatomic site for fractures; in addition, a fall and RTA were the major etiological factors for mandibular fractures. A single fracture was observed in 51.7% of patients while multiple fracture lines accounted for 48.3% of cases.

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.

A Single-Center Review of Radiologically Diagnosed Maxillofacial Fractures: Etiology and Distribution

The etiology of fractures of the maxillofacial skeleton varies among studies, with motor vehicle accidents and assaults oftentimes the most common. The number of males outnumbers females throughout most studies. Fractures of the zygoma, orbit, and mandible are usually cited as most common fracture types. This study examines a single center's experience with regards to etiology and distribution of fractures. A retrospective review of all radiologically confirmed facial fractures in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patient demographics, etiology of injury, and location of fractures were collected. During this time period, 2,998 patients were identified as having sustained a fracture of the facial skeleton. The average age was 36.9 years, with a strong male predominance (81.5%). The most common etiologies of injury were assault (44.9%) and motor vehicle accidents (14.9%). Throughout the study period, the number of fractures as a result of assault remained relatively constant, whereas the number as a result of motor vehicle accidents decreased slightly. The most common fracture observed was of the orbit, followed by mandible, nasal bones, zygoma, and frontal sinus. Patients sustaining a fracture as a result of assault were more likely to have a mandible fracture. Patients in motor vehicle accidents were more likely to suffer fractures of the maxilla, orbit, and frontal sinus. Mandible fractures are more common in cases of assault. Motor vehicle accidents convey a large force, which, when directed at the craniofacial skeleton, can cause a variety of fracture patterns. The decreasing number of fractures as a result of motor vehicle accidents may represent improved safety devices such as airbags.

Otorhinolaryngological manifestations in head trauma: A prospective study of the epidemiology, clinical presentations, management, and outcomes

Background

Otorhinolaryngological injuries following head trauma may be missed, overlooked, or forgotten in the acute phase resulting in worsened management outcomes. This study aims to report the epidemiology, clinical presentations, management, and outcomes of otorhinolaryngological injuries in head trauma with a view to creating awareness for early recognition and prompt treatment.

Patients and Methods

Head injured patients consecutively presenting over a 5-year period were prospectively studied for age, gender, otorhinolaryngological presentations, interventions, and outcome of interventions. Data obtained were statistically analyzed.

Results

There were 91 (1.3%) otorhinolaryngological presentations among 7109 head injured patients. Mean age of 34 years, standard deviation = ±15.6 with a male:female ratio of 2.4:1. Severe head injury (Glasgow coma scale <9) occurred in 46 (50.5%) patients. Patients aged 30-39 years were mostly affected (n = 30; 32.9%). Most injuries were from motor vehicular accidents (n = 61; 67%) and assaults (n = 23; 25.3%). The most common otorhinolaryngological presentations were cerebrospinal fluid (CSF) rhinorrhea (n = 26; 28.6%) and CSF otorrhea (n = 25; 27.5%). Conservative management was achieved in 59.3% of patients. Mean time of hospital presentation was 13.8 h. There was no statistical correlation between outcomes and each of etiology and time of presentation (P values 0.18 and 0.9, respectively). Seventy-five (82.4%) were discharged without neurological deficits. A case fatality rate of 6.6% was recorded.

Conclusion

Frontal skull base and temporal bone fractures with CSF rhinorrhea and otorrhea are the most common injuries occurring mostly in young active males with favorable outcomes following conservative management.

The Effect of Local Rosuvastatin on Mandibular Fracture Healing

Mandibular fracture is the most common injury seen in facial fractures and plays an important role for oral and maxillofacial surgery department. The purpose of this study is to investigate the potential of the local administration of rosuvastatin (RSV) on mandibular fracture healing in rats. Thirty-two rats were divided into 4 groups: group C-14 (control), group R-14, group C-28 (control), and group R-28. A unilateral standard vertical osteotomy was performed right side of the mandibula extending from the tooth to the mandibular basis for each animal. In groups C-14 and C-28 sterile saline treated absorbable collogen sponge was applied to the fracture area, in groups R-14 and R-28 absorbable collogen sponge with saline solution containing 1 mg RSV was applied to the fracture area. Animals in groups C-14 and R-14 were euthanized on the 14th day, groups C-28 and R-28 were euthanized on the 28th day after operation. Stereologic analyses were performed. New bone area and connective tissue volumes were measured. Stereologic analysis showed that group R-14 had significantly more new bone at 2 weeks compared with group C-14. Connective tissue volumes were also significantly higher in R-14. New bone and connective tissue volume differences were not statistically significant between groups C-28 and R-28. Locally administered RSV enhances early bone regeneration on mandibular fracture in rats.

Maxillofacial Injuries in Women: A Retrospective Study of 10 Years

INTRODUCTION

Diversities exists in incidence, etiology and epidemiology of facial fractures among male and female individuals due to various reasons. Many of the epidemiological studies published during the millennium have shown male predilection. This study was carried to evaluate the etiology, patterns and distribution of facial fractures among different age groups in women.

MATERIALS AND METHODS

This Retrospective epidemiological study dealt with a total of 302 women with 422 fractures in maxillofacial region during a period of June 1st 2005 to May 31st 2015 at Mamata Dental College and Hospital, Khammam, Telangana, India.

RESULTS

Mean age of incidence was 31.58 years, mandibular fractures were highest (44.07 %) followed by zygomaticomaxillary complex injuries (ZMC) (20.37 %). Road traffic accidents (RTA) injuries (53.7 %) were highest, followed by assault (23.9 %) and other causes. Highest number (33.8 %) of fractures were sustained in the 3rd decade and least (0.7 %) in the 8th decade of life. Among soft tissue injuries most commonly seen were lacerations (51 %).

CONCLUSION

Results of this study suggest that there is an increase in the number of maxillofacial injuries in women, representing changes in the society, exposing women to similar conditions like men and increased number of working women. This study helps to identify trauma burden, assess the awareness of current preventive measures, women protection laws, for instituting new guidelines for prevention and planning health care services for women.

Transbuccal versus transoral approach for management of mandibular angle fractures: a prospective, clinical and radiographic study

Objectives

We compared the transbuccal and transoral approaches in the management of mandibular angle fractures.

Materials and Methods

Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P-value less than 0.05 was considered significant.

Results

No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up.

Conclusion

The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the neutral mid-point area of the mandible.

Effect of mouthguards on impact to the craniomandibular complex

BACKGROUND

The aim of this study was to investigate the effect of wearing a mouthguard and teeth-clenching on impact to the head and temporomandibular joint (TMJ) during a blow to the jaw.

MATERIAL AND METHODS

A custom-made mouthguard was fabricated for five participants. A 4.1-N impact load was applied to the chin with a pendulum. Two acceleration sensors were attached to the forehead and left TMJ. The amplitudes and durations of the accelerations were obtained under five conditions: mouth-open without mouthguard; light teeth-clenching without mouthguard; maximum voluntary clenching (MVC) without mouthguard; mouth-open with mouthguard and MVC with mouthguard.

RESULTS

Wearing a mouthguard led to significant decreases in the amplitude (mouth-open with mouthguard vs mouth-open without mouthguard, P = 0.035 at forehead, P = 0.022 at TMJ) and duration (mouth-open with mouthguard vs mouth-open without mouthguard, P = 0.043 at forehead, not significant at TMJ). Similarly, teeth-clenching caused significant decreases in the amplitude (mouth-open without mouthguard vs MVC without mouthguard, P = 0.024 at forehead, P = 0.025 at TMJ) and duration (mouth-open without mouthguard vs MVC without mouthguard, P = 0.033 at forehead, not significant at TMJ). Furthermore, wearing a mouthguard in itself provided an impact reduction effect similar to the combination of teeth-clenching and wearing a mouthguard.

CONCLUSIONS

Wearing a mouthguard and/or teeth-clenching reduced the impact to the head and TMJ during a blow to the jaw. However, it should be noted that the findings are the results from a small impact load to the jaw.

Trends of maxillofacial fractures in the Garhwal Himalayas at Government Medical College, Srinagar, Uttarakhand

CONTEXT

Evaluation of Maxillofacial fractures in hilly region of Garhwal Himalyas and its relation with age, gender, anatomical location, seasonal variation and treatment provided.

AIMS

The aim of the present study is to analyze the pattern of maxillofacial fractures in the Garhwal Himalayan region of India and to compare the results with similar studies in India and the rest of the world.

SETTINGS AND DESIGN

This was a prospective study conducted on 102 patients with 128 facial fractures.

MATERIALS AND METHODS

This study was conducted on 102 patients who were admitted for the treatment of maxillofacial fractures in the Department of Dentistry at Government Medical College, Srinagar, Uttarakhand, India.

STATISTICAL ANALYSIS USED

All analyses were performed using Chi-square test and level of significance.

RESULTS

Peak incidence was noted in the second to fourth decades of life. Male: female ratio was 4:1. Road traffic accident was the main etiology (42.2%), followed by fall (37.2%) and assault (11.8%). Among other etiology of injury, distinguishing feature was bear bite, which was only seen in winters causing 5.9% of total injury. Fall was reported high in females whereas road traffic accident in males. Mandible was fractured in 73.5% of patients while mid-face in 26.5% of patients. Open reduction with internal fixation was the choice of treatment in 60.8% of cases. Nearly 79.4% of patients were treated under local anesthesia. The mean duration of hospitalization was (standard deviation 5.2 days) 5.3 days.

CONCLUSIONS

Road traffic accidents still remain the main cause of maxillofacial fractures in developing countries such as India. In hilly area, road traffic accident can be minimized by better wide roads with guide walls/parapet, strict law enforcement for overspeed, overload, and to use seat belts while driving, and use of helmet while riding two-wheeler. Open reduction internal fixation remains the first choice of treatment in facial fractures due to early return of function with minimal morbidity and better nutritional status in patients compared to closed reduction.

Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite

Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF) over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF), and posttreatment occlusion. Results. Out of 388 mandibular fractures treated, ramus fractures were 12 (3.09%). In the present study, predominant cause of mandibular ramus fracture was road traffic accident (RTA) n = 07 (58.33%) followed by fall n = 04 (33.33%) and assault n = 1 (8.33%). The average age was 35.9 years with a male predilection. Of these, 9 patients were treated with ORIF while remaining 3 with closed treatment. The average MMF after closed treatment was 21 days and 3 to 5 days after ORIF. There was improvement in occlusion in all 12 patients posttreatment with no major complication except for reduced mouth opening in cases treated with ORIF which recovered with physiotherapy and muscle relaxants. Conclusion. Mandibular ramus fractures accounted for 3.09% with RTA as a common aetiology. ORIF of ramus fractures facilitated adequate functional and anatomic reduction with early return of function.