The aetiology of maxillofacial injuries and the seat belt law

Analysis of the pattern of maxillofacial injuries in Saudi Arabia: A systematic review

Objectives

Maxillofacial trauma (MFT) is a serious health problem and in Saudi Arabia is mainly caused by road traffic accidents (RTAs). MFT commonly associated with injuries to the face, head, and jaws and may cause soft tissue lacerations and bruises. MFT can also cause fatal blood loss and airway obstruction. The objective of this review was to determine the prevalence of MFT, identify the major causative factors in males and females in the main cities of Saudi Arabia.

Materials and methods

We performed literature searches of all published studies describing MFT from KSA during the last 20 years.

Results

In Saudi Arabia, males are more prone to MFT than females, although the male: female ratio of MFT varies between different cities. Specifically, Aseer has the highest male: female ratio (10:1), followed by AlHofuf (8.3:1) while AlQurayyat had the least gender ratios of MFT (2:1). Most cases of MFT are associated with RTAs, which accounted for (63%-90.3%) in Medina, (89.1%) in Aseer, (86.1% -87.1%) in Riyadh, (67%-73.1%) in Jeddah, (71%) in Khamis Mushait, (64.2%) in Makkah and (63.3%) in Al-Hofuf. The least percentage of RTA resulting into MFT was recorded in AlQurayyat (24%).

Conclusion

Maxillofacial trauma is a serious health problem in Saudi Arabia. RTAs remain the major cause of maxillofacial injuries especially among males, thus strict implementation of traffic rules is a must to minimize maxillofacial injuries and its physical and psychological impact.

An in-depth technical and medical investigation of facial injuries caused by car accidents

BACKGROUND

Many studies have investigated the issue of facial injuries caused by car accidents, but only a few have addressed the technical and clinical aspects of such accidents and injuries in depth. The aim of this study was to identify risk factors and protective elements for facial injuries in car accidents.

METHODS

We analysed the technical and clinical data of patients with facial injuries caused by car accidents over a 16-year period (2000-2016) and investigated the following factors: sitting position, sex, age, accident time, use of a seatbelt, deployment of the front airbag, direction of impact, speed at the time of collision, and occurrence and location of facial injuries.

RESULTS

Of the 1291 patients involved in car accidents who were included in our study, 291 (22.5%) had suffered facial injuries. We found a significant association between occurrence of facial injuries and sex, speed at the time of collision, impact from the back, seatbelt usage, and deployment of the front airbag. In accidents occurring at speeds over 40 km/h, automobile security measures had no significant influence on the occurrence of facial injuries in drivers and front-seat passengers. In accidents occurring at speeds between 0 and 20 km/h, seatbelt usage (without airbag deployment) solely showed a significant protective influence against the occurrence of facial injuries (odd ratio [OR], 0.130; confidence interval [CI], 0.038-0.451). In contrast, patients who were in accidents at speeds between 21 and 40 km/h suffered significantly fewer facial injuries when wearing a seatbelt with the front airbag being deployed (OR, 0.245; CI, 0.091-0.665) or undeployed (OR, 0.216; CI, 0.084-0.561).

CONCLUSION

Male sex and a high speed at the time of collision are significant risk factors for the occurrence of facial injuries. The security measurements evaluated in this study only exerted a protective influence at low speeds (below 40 km/h). This indicates a possible weakness of these security systems with regard to preventing facial injuries. Engineers could benefit from these findings and improve the efficiency of existing security measures and eventually help decrease the incidence of facial injuries.

Functional and Psychological Impact of Nasal Bone Fractures Sustained during Sports Activities: A Survey of 87 Patients

Nasal bone fractures that require reduction are a common sequela of sports injuries. We conducted a survey to ascertain the outcomes of patients who had experienced a nasal bone fracture and who subsequently underwent manipulation under anesthesia. We reviewed data on 217 nasal bone fractures that had been seen at our institution over a 3-year period. Of these, 133 (61.3%) had occurred as a result of a sports activity. Thirty of the 133 patients (22.6%) had been managed conservatively, while the other 103 (77.4%) had undergone manipulation under anesthesia. We were able to contact 87 of the 103 patients (84.5%) by telephone, who served as the study population. The most common sports associated with these 87 injuries were hurling (n = 26; 29.9%), rugby (n = 22; 25.3%), Gaelic football (n =20; 23.0%), and soccer (n = 13; 14.9%). Patients who had undergone treatment within 2 weeks were significantly more satisfied with their outcome than were those who had been treated later (p < 0.01). Twenty-six patients (29.9%) reported that their injury had had a detrimental impact on their subsequent performance in their sport; 12 (13.8%) described a fear of reinjury when they returned to play, 7 (8.0%) experienced functional problems, 3 (3.4%) complained of diminished performance, and 4 others (4.6%) quit playing contact sports altogether. To the best of our knowledge, our study is the first to demonstrate that a fracture of the nasal bones may have a notable psychological impact on an athlete and that it can lead to diminished performance or a complete withdrawal from contact sports.

Impact of Injury Mechanisms on Patterns and Management of Facial Fractures

Mechanisms causing facial fractures have evolved over time and may be predictive of the types of injuries sustained. The objective of this study is to examine the impact of mechanisms of injury on the type and management of facial fractures at our Level 1 Trauma Center. The authors performed an Institutional Review Board-approved review of our network's trauma registry from 2006 to 2010, documenting age, sex, mechanism, Injury Severity Score, Glasgow Coma Scale, facial fracture patterns (nasal, maxillary/malar, orbital, mandible), and reconstructions. Mechanism rates were compared using a Pearson χ2 test. The database identified 23,318 patients, including 1686 patients with facial fractures and a subset of 1505 patients sustaining 2094 fractures by motor vehicle collision (MVC), fall, or assault. Nasal fractures were the most common injuries sustained by all mechanisms. MVCs were most likely to cause nasal and malar/maxillary fractures (P < 0.01). Falls were the least likely and assaults the most likely to cause mandible fractures (P < 0.001), the most common injury leading to surgical intervention (P < 0.001). Although not statistically significant, fractures sustained in MVCs were the most likely overall to undergo surgical intervention. Age, number of fractures, and alcohol level were statistically significant variables associated with operative management. Age and number of fractures sustained were associated with operative intervention. Although there is a statistically significant correlation between mechanism of injury and type of facial fracture sustained, none of the mechanisms evaluated herein are statistically associated with surgical intervention. Clinical Question/Level of Evidence: Therapeutic, III.

Comparative analysis of fracture characteristics of the developing mandible: the Mayo Clinic experience

OBJECTIVE

To review and compare the epidemiology and treatment of mandibular fractures in subgroups of a pediatric population.

METHODS

We conducted a retrospective review of pediatric patients (age, ≤18 years) with mandibular fractures treated at our institution from January 1996 through November 2011.

RESULTS

We identified 122 patients (93 [76%] male) with 216 mandibular fractures. The prevalent mechanisms of injury were motor vehicle accidents (n=52 [43%]), sports injuries (n=24 [20%]), and assault (n=13 [11%]). The most common fracture sites were subcondylar, parasymphyseal, angle, and body. Two patients (2%) were treated conservatively by observation only, 67 (55%) underwent maxillomandibular fixation alone, 41 (34%) underwent maxillomandibular fixation with plate fixation, and 7 (5.7%) underwent plate fixation only. The average duration of maxillomandibular fixation was 26 days (range, 7-49 days). Complications occurred in 11 patients (9.0%) over a mean follow-up of 92 days (range, 21-702 days). Fifty patients (41.0%) had comorbid conditions or a history of mental illness at the time of injury, including attention deficit hyperactivity disorder (n=11 [9%]), mental disorders other than attention deficit hyperactivity disorder (n=23 [19%]), and asthma (n=17 [14%]). Twenty-six patients (21%) had a history of substance use, the most common being tobacco (n=18 [15%]), alcohol (n=13 [11%]), and marijuana (n=11 [9%]).

CONCLUSIONS

Treatment approach and outcomes were affected by age and fracture characteristics. In addition, a marked proportion of this cohort had preexisting mental disorders and history of substance use, which may have implications on treatment approach.

Maxillofacial fractures: twenty years of study in the department of maxillofacial surgery in kosovo

THE AIM

The aim of this study was to analyze maxillofacial region fractures during the past 20 years in the Department of Maxillofacial Surgery in Prishtina.

METHODS

We have analyzed the histories of all patients with trauma who were hospitalized in the Department of Maxillofacial Surgery in Prishtina since the opening of the clinic in 1983 through 2005. Narrowing the subject of our research, we concentrated on fractures of the maxillofacial region treated at the Clinic of Maxillofacial Surgery for the period 2001-2005. We have analyzed those fractures and compared them with the period from 1983 to 2005 only when it was reasonable.

RESULTS

During this period, 1,945 patients were treated for trauma in the maxillofacial region by the Department of Maxillofacial Surgery. This group included 19.8% females and 80.2% males. The largest age group were those between 20 and 20 years of age. Causes of trauma for both periods were predominantly traffic accidents; however, during the period 2001-2005, interpersonal conflicts were increasingly the cause of fractures.

CONCLUSION

Interpersonal conflict as a cause of maxillofacial trauma has risen in recent years. With this increase the methods of treating fractures in this region are also changing.

Maxillofacial injuries in western Iran: a prospective study

INTRODUCTION

Although the epidemiology of facial injuries has been studied in many populations, there is a paucity of information in the literature in this relation in the Middle East including Iran. The aim of this study was to assess the epidemiology and mode of treatment of facial injuries in western Iran.

MATERIAL AND METHODS

We examined all patients with a maxillofacial injury who presented to the outpatient department or who were hospitalized in the Besat Hospital of Hamedan City, Iran, between 20 December 2007 and 20 December 2009.

RESULTS

Of 2,450 patients (77% male, 23% female) with a facial injury, 90% sustained soft tissue injuries and 37% had bone fractures. Motor vehicle accidents (MVAs) were the most common cause of injuries (35%). The most frequent bone fracture occurred in the nasal bone (63.4%). The incidence of associated injuries was 8.3% (mostly orthopedic). Rigid internal fixation was the main treatment of facial fractures. Malpositioned zygomas and functional and aesthetic problems after reconstruction of nasal-orbital-ethmoid injuries were the most common postoperative complications.

DISCUSSION

Although in many countries the rate of facial injuries due to traffic accidents is decreasing, MVA is still the major cause of facial trauma in Iran. This may be due to the lack of enforcement of traffic laws by police and insufficient compliance of the population in obeying traffic rules. Rigid internal fixation was the most common mode of treatment of facial fractures, and in spite of the severity of facial injuries, the rate of postoperative complications was relatively low.

1,454 mandibular fractures: a 3-year study in a hospital in Belo Horizonte, Brazil

OBJECTIVE

To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.

METHODS

The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson's chi-square, Bonferroni, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests, and analysis of variance.

RESULTS

There were 1,454 mandibular fractures in 1,023 patients. Males of 20-29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends.

CONCLUSION

The individuals with mandibular fractures due to "traffic accidents" were younger than those due to "violence" and "falls". There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures.

Craniomaxillofacial Injuries in the United Arab Emirates: A Retrospective Study

PURPOSE

To analyze craniomaxillofacial injuries in selected hospitals in the United Arab Emirates (UAE).

PATIENTS AND METHODS

This is a retrospective study of craniomaxillofacial injuries treated in 3 major hospitals in the UAE. Patient files were retrieved, reviewed, and analyzed. The main analysis outcome measures were the patients' name, age, and gender and the injuries' time, site, type, treatment and outcome.

RESULTS

A total of 288 patients sustained 475 craniomaxillofacial injuries; road traffic accidents caused the majority of injuries. The patients ranged in age from 2 to 82 years (mean, 27.3 years), and the male-to-female ratio was 7:1. The yearly distribution of fractures peaked during 2001, and the monthly distribution peaked in January. The greatest number (41%) of patients were UAE nationals. Most patients (70.5%) had mandibular fractures, and the most common site was the body. There were 139 patients (48.3%) with a total of 171 midface fractures (36%); the most common fracture site was the zygomatic complex (29.8%). The most common treatment for jaw fractures was plating plus intermaxillary fixation. Stable zygomatic complex fractures were closely reduced (elevated), and unstable ones were treated by internal fixation. About 25% of the cases had 1 or more postoperative complication.

CONCLUSIONS

Craniomaxillofacial injuries in the UAE included in this study are somewhat similar to those reported in other countries. Differences from other countries are probably related to factors peculiar to the UAE, such as climate, social trends, and the cosmopolitan population.

Multiple and Comminuted Mandibular Fractures

This study was conducted to evaluate prospectively the simple and more reliable methods in the treatment of multiple and comminuted mandibular fractures in hospitals with limited facilities and a high influx rate of trauma patients such as ours in Baghdad. One hundred patients with multiple and comminuted mandibular fractures of different severities were included in this study. Fifty-four patients were with comminuted and 46 were with multiple mandibular fractures. Eighty-eight patients had isolated mandibular fractures, and 12 had other associated facial bones fractures. Seventy-two patients were treated solely with maxillomandibular fixation. Thirteen patients were treated with different methods of internal fixation; the remainder was treated conservatively, functionally, or with different combinations of closed and open reduction methods. There was a statistically significant difference (P < 0.05) for fractures healing in relation to the type, severity, and etiology of the fracture. Eighty-four patients had fractures healed to bony union, 4 ended with nonunited fractures, and 10 patients had bone loss. Four patients developed infection, thus the infection rate was 4% for all, and 2.17% and 5.56% for patients with multiple and comminuted fractures, respectively. Seventeen patients required further surgeries for facial recontouring. The results of this study underscore the efficacy of closed reduction for treating multiple and comminuted mandibular fractures in terms of its simplicity, the availability of materials and instruments, and the favorable outcomes.

Three-year review of facial fractures at a teaching hospital in northern Iran

During the three years March 2001-February 2004, 7200 patients with maxillofacial trauma were seen at Poorsina Hospital, of whom 2160 had 4752 fractures of facial bones, 3089 (65%) mainly mandibular and 1663 (35%) mainly midfacial. Road traffic collisions accounted for the injuries in 6552 of the 7200 patients (91%), falls in 396 patients (5.5%), assault in 208 (2.9%) and sport and other causes in 44 (0.6%). The male (n=6646) to female (n=554) ratio was 12:1. During summer, Iranian weekends (Thursdays-Fridays) and the Iranian new year (begins on 21 March), the incidence was much higher than at other times.

Etiology and Patterns of Pediatric Mandibular Fractures in Portugal: A Retrospective Study of 10 Years

OBJECTIVE

To determine the pattern of occurrence of mandibular fractures in the pediatric population in Portugal.

MATERIALS AND METHODS

This retrospective study reviews the records of patients 18 years of age or younger from the 10-year period 1993 to 2002. Age, gender, anatomic site, cause of the accident, weekly and monthly variation, location and type of fractures, presence and location of associated injuries, treatment methods, and complications were reviewed.

RESULTS

During this 10-year period, 521 patients with 681 mandibular fractures were treated. Motor-vehicle accident (MVA) was the most common (53.9% patients) cause of fracture. Almost half of the patients (48.8%) were in the oldest age group (16 to 18 years old). The condyle of the mandible was involved in 31.0% of the fractures. Maxillomandibular (MMF) fixation was used in 534 (78.4%) fractures. Overall mortality in this series was 0.6% (3 patients); mortality was caused by multiple traumas, mainly head trauma.

CONCLUSION

There is a need to reinforce legislation aimed to prevent MVA and the total enforcement of existing laws to reduce maxillofacial injuries among children and adolescents.

The prevalence and causes of maxillofacial fractures in patients attending Accident and Emergency Departments in Recife-Brazil

AIM

This study aimed to investigate the epidemiological characteristics of maxillofacial fractures among patients admitted to the Accident and Emergency Departments of three major hospitals in Recife, Brazil.

MATERIAL AND METHODS

A prospective design. The data were collected from each hospital over 3 months. A timetable was developed which randomly allocated visits to the three hospitals, six times a week for 6 hours a day. Data on socio-demographic variables, presence of bone fractures and/or maxillofacial fractures, type of injuries, aetiological factors, and place of occurrence were recorded.

RESULTS

The final sample size was 5,644 patients. The prevalence of any bone fractures was 32.1% and for maxillofacial fractures 4.1%. Multiple logistic regression analysis showed that maxillofacial fractures were related to age, sex and level of education but not to employment status. Violence was the main cause of maxillofacial fractures, and the most frequent place of occurrence was the street.

CONCLUSIONS

Maxillofacial fractures represented 12.6% of all bone fractures, males and less educated subjects were more likely to be affected than their females and more educated counterparts, and violence was the most common cause.

A multicentre audit of unilateral fractures of the mandibular condyle

OBJECTIVE

To audit a series of isolated unilateral fractures of the mandibular condyle treated in a number of units in the United Kingdom.

DESIGN

Prospective confidential multicentre audit with review by a single external examiner between July 1993 and January 1994.

SETTING

Nine Maxillofacial units. Pro-formas were alphanumerically coded. Units are referred to by code letter.

SUBJECTS

142 patients with fractures of the mandibular condyle.

MAIN OUTCOME MEASURES

Pain, crepitus, interincisal opening, mandibular deviation on movement, occlusion and posteroanterior and lateral radiographic analysis by a single examiner.

RESULTS

Of the 142 patients, 135 over the age of 12 years had unilateral condylar fractures. Seventy-three attended appointments at both 6 and 12 weeks. Forty-one had identifiable symptoms attributable to the injury at 12 weeks, and most of these had fracture displacements or dislocations which had not been openly reduced. There was a 50-85% positive correlation between radiographic findings of the first clinician and the external auditor. Open reduction and internal fixation was uncommon.

CONCLUSIONS

Follow-up studies of trauma patients are difficult because of poor attendance. Fractures of the mandibular condyle should be treated by specialists in the management of facial fractures. Accurate clinical and radiographic diagnosis is more difficult than commonly supposed. Fracture displacements and dislocations have a suboptimal outcome in nearly 30% of cases. More should be spent to improve care of these patients. A consensus on objective indicators of satisfactory outcome is needed to establish a 'gold standard' and close the audit loop.

The aetiology of mandibular fractures at an urban centre

The objectives of this study were to determine the common aetiological factors leading to the fracture of the lower jaw (mandible) at an urban centre in England. A total of 96 patients presented to the Manchester Royal Infirmary with mandibular fractures during the calendar years 1991 and 1992. It was determined that the main aetiological factor leading to the disturbance of the mandibular contours was assault or interpersonal violence (74%) followed by falls, road traffic accidents and sporting injuries. The majority of the subjects were males and most of the patients were in the age group of 20-29 years. In most of the patients there was a unilateral pattern of injury and the angle was the most vulnerable area of the lower jaw to be traumatised.

Should patients with facial fractures be regarded as high risk for HIV?

OBJECTIVE

To determine the prevalence of HIV seropositivity in patients with facial fractures in Edinburgh, UK.

DESIGN

A prospective study of 100 consecutive patients in 1994.

SETTING

Department of Maxillofacial Surgery, City Hospital, Edinburgh, UK.

SUBJECTS

100 patients with facial fractures who were willing to participate in the study.

MAIN OUTCOME MEASURES

Details of facial fractures. Assessment of risk factors for HIV. The seroprevalence of HIV based on unlinked anonymous testing of saliva.

RESULTS

None of the participants were HIV positive on saliva testing. Nine patients were found to have one or more risk factors for HIV. Eight patients had been tested for HIV previously.

CONCLUSION

Direct history taking appears to be effective in eliciting risk factors for HIV. A detailed risk factor history should be taken for all patients with facial fractures. Continuation of this study may establish whether or not there is a link between facial bone fractures and HIV seropositivity.

Maxillofacial fractures: a study of recurrent victims

A study of 760 patients treated for maxillofacial fractures over a 2 year period revealed 3 per cent of them to have had one or more previous fractures in the maxillofacial region. This group of patients are nearly all victims of assault but are indistinguishable from a control group of patients with maxillofacial injuries on the grounds of age, sex, anatomical type of injury or socioeconomic status. They are however more likely to have been drinking alcohol at the time of their injury than the control group. We advocate targeting of this sub-group of patients with maxillofacial fractures for appropriate counselling.

Prospective audit of the pattern, severity and circumstances of injury sustained by vehicle occupants as a result of road traffic accidents

The pattern and severity of injuries sustained by 174 vehicle occupants consecutively admitted to the Accident and Emergency Department of the Edinburgh Royal Infirmary were prospectively documented. Drivers (DR) accounted for 66% of the patients, 20% were front seat passengers (FSP) and 14% were rear seat passengers (RSP). Injured patients were more likely to be male, young, intoxicated and not wearing a seat-belt. The position of the patient within the vehicle at the time of the accident and point of impact significantly affected the pattern of injury sustained. The majority of injuries were sustained by the upper body and the pattern of injury is discussed. Most accidents occurred at low speeds and higher speeds were associated with an increased severity of injury. Seat-belts reduced the overall severity of injuries, in particular those to the face and chest, but may increase the risk of neck injury. Head-rests do not appear to influence the incidence of neck injury. Clinically apparent alcohol intoxication was associated with a markedly increased risk of severe injury.

Mandibular fractures in northern Finland in the 1980s--a 10-year study

A total of 317 mandibular fracture patients treated and diagnosed at the Oulu University Hospital and at the Department of Oral and Maxillofacial Surgery, University of Oulu, Finland, between 1981 and 1990 were analyzed from patient files and radiographs. The mean number of mandibular fracture patients per year was 31.7 (range 21 and 45) and the mean age of the patients 31.3 years (range 4-78 years). The female:male ratio was 1:3.1. There seemed to be a tendency for decrease in the proportion of violence and traffic accidents as causes of mandibular fractures toward the end of the period concerned, reflecting partly the influence of mandatory use of safety belts and partly that the hospital in the northernmost part of Finland, where the consumption of alcohol is higher than in the province of Oulu, could treat all mandibular fractures itself during the last year studied thus decreasing the injuries caused by violence at the Oulu University Hospital. It was also noted that fewer fractures were caused at weekends than on weekdays during the latter years of the decade and that the proportion of male victims decreased except for the last year examined, 1990.

Maxillofacial injuries following steering wheel contact by drivers using seat belts

Maxillofacial injuries are common sequelae in road traffic accidents. For the restrained driver, impact against the steering wheel is the most prevalent cause of injury. A sample of drivers restrained by seat belts with facial injury caused by the steering wheel was taken from data at the Accident Research Unit, University of Birmingham, UK. Two hundred and forty facial injuries occurred in 135 drivers, and these are described. Superficial contusion, laceration and nasal fractures predominated. There were 504 injuries at other body regions, and these were often caused by other vehicle components. These were, for 57% of drivers, no more serious than the facial injury caused by steering wheel contact. The role of steering wheel design in maxillofacial trauma is discussed and new solutions briefly reviewed.

Trends in the aetiology of maxillofacial fractures in the United Kingdom (1977-1987)

A survey was undertaken to assess changes in the aetiology of maxillofacial fractures in the United Kingdom between 1977 and 1987, using data which had been collected in British departments of Oral and Maxillofacial Surgery. Data were available from units serving 17 million people and included details of patients from a broad spread of rural and urban areas. Analysis of data from the 27 maxillofacial units able to supply details from both 1977 and 1987 showed an overall increase of 20% in numbers of patients with maxillofacial fractures, though a trend towards fewer severe injuries was also a feature over the same period. Numbers of patients injured in road accidents had decreased by 34%, numbers of patients injured in assaults had increased by 47% whilst numbers of patients injured in all other ways had increased by 39%.

Fractures of the mandible. A 35-year retrospective study

A retrospective survey was carried out of patients presenting with fractures of the mandible over the 35-year period 1951-1985 in Newcastle, Australia. The age, sex and cause of injury were analysed for each of the 1,162 patients. The male:female ratio was 4.4:1. The highest incidence of trauma was in the 20-29-year age group (38.3% of all patients). The number of 20-29-year-olds sustaining mandibular fractures in each 5-year period of study was 2 to 3 times higher than would be expected from the proportion of that age group in the regional population. The major causes of fractures were assault (38.1% of all patients), road traffic accidents (21.5%) and sport (19.0%). The patterns of causes of injury were similar throughout the period of study. Males accounted for most patients in all causes of trauma. In sports, the male:female ratio was 30.6:1, whilst for assaults it was 6.3:1. The number of patients sustaining fractures increased by 364% over the period of study whilst the population involved increased by 47%.

The pattern and aetiology of maxillofacial injuries in Greece. A retrospective study of 25 years and a comparison with other countries

In comparison with other countries, Greece demonstrates a high incidence of road traffic accidents (RTA's). Most are the result of violation of the highway code. Violence as a causative agent of fractures of the facial skeleton is still a minor factor in comparison with other countries. Most of the people involved are young. In a 25-year period we have treated 6,847 fractures of the facial skeleton. Fractures of the mandibular condyle, the genial symphysis and the zygomatico-maxillary complex were the most numerous. 25% of the patients were women and 75% men. 56% were treated conservatively; an open reduction was the treatment of choice in 37%, while no treatment was considered necessary in 7%. In the period under study, K.A.T. Hospital admitted 60% of the maxillofacial trauma in the whole country.