Maxillofacial injuries following steering wheel contact by drivers using seat belts

Patterns of Maxillofacial Injuries in the Middle East and North Africa: A Systematic Review

OBJECTIVE

The objective of this review was to investigate the epidemiological characteristics of maxillofacial fractures (MFFs), to establish the prevalence of MFFs, and to recognise the major causative factors in both males and females in the Middle East and North Africa (MENA) region.

STUDY DESIGN

The protocol of this systematic reviews was established according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P); the following databases were searched: PubMed/Medline, Scopus, Google Scholar and Web of Science. We used STROBE checklist to assess the risk of bias in all identified studies, 37 studies fulfilled the eligibility criteria, and hence were selected for analysis.

RESULTS

A total of 27,994 patients (22,965 males and 5,129 females) ranging from 0 to 97 years who experienced maxillofacial injuries during the study period were entered into this review. Road traffic accidents (RTAs) were the most common cause of MFF followed by falls. The mandible was the most common site of injury. In the MENA region, males outnumbered females in terms of maxillofacial injuries with a ratio of 4.5:1.

CONCLUSION

Maxillofacial fractures are highly prevalent in the MENA region, and they are mainly caused by RTAs, especially among young males. Therefore, the concerned authorities need to employ and implement stricter traffic rules in order to minimise the risk of maxillofacial injuries and their subsequent increased morbidity and mortality rates.

A Retrospective Analysis of Oral and Maxillofacial Injuries in Motor Vehicle Accidents

PURPOSE

To clarify the relations of the severity of oral and maxillofacial injuries from traffic accidents (TAs) to seating position and the use of restraint systems.

PATIENTS AND METHODS

Hospital records were reviewed for all patients who had sustained oral or maxillofacial injuries in TAs and then were admitted to the Department of Oral and Maxillofacial Surgery, Dokkyo University School of Medicine (Tochigi, Japan), from 1994 through 2003.

RESULTS

A total of 201 patients, with a mean injury severity score (ISS) of 7.9 +/- 7.6, were included in this study. Although patients with any oral or maxillofacial injury with an Abbreviated Injury Scale (AIS) score of 2 or more had extremely low ISSs, hospitalization was relatively long. The ISS and AIS score of the head or neck were significantly higher in unrestrained drivers (12.4 +/- 11.2, 1.2 +/- 1.4, respectively) than in restrained drivers (6.5 +/- 4.6, 0.4 +/- 1.0, respectively). However, AIS scores of the face were similar in unrestrained drivers (1.9 +/- 0.7) and restrained drivers (1.7 +/- 0.5). Furthermore, the incidence of maxillofacial fractures did not differ between the 2 groups.

CONCLUSION

Because wearing seat belts cannot prevent all oral and maxillofacial injuries in motor vehicle occupants, both physicians and engineers must pay greater attention to the mechanisms of oral and maxillofacial injuries in TAs.

Characteristics of maxillofacial injuries resulting from road traffic accidents--a 5 year review of the case records from Department of Maxillofacial Surgery in Katowice, Poland

Background

In spite of employing numerous devices improving the safety in motor vehicles, traffic accidents are still among the main reasons of maxillofacial injuries. The maxillofacial injuries remain the serious clinical problem because of the specificity of this anatomical region. The knowledge of etiologic factors and mechanisms of injuries can be helpful in a satisfactory trauma prevention. The aim of this study was to find out the incidence and the pattern of maxillofacial injuries resulting from traffic accidents in the patients treated in the Department of Maxillofacial Surgery (Silesian Medical Academy in Katowice, Poland) from January 2001 to December 2005.

Methods

The material consisted of 1024 case records of patients with maxillofacial injuries treated in the Maxillofacial Surgery Department of Silesian Medical Academy. The detailed analysis was carried out on the case records of 198 patients in the age of 3 to 68 with maxillofacial injuries resulting from traffic accidents. On the basis of data from a history, examination on admission, consultations and radiological examinations, patients' age and gender, we obtained the information on a pattern of injury and detailed description of an accident (the date and the time of an accident, the role of the patient in an accident).

Results

The traffic accidents were the cause of 19,93% maxillofacial injuries in the analyzed period of time. Most of the patients had injuries to the soft tissues of the face (22,21%), followed by tooth and alveolar process injuries (20,71%) and mandibular fractures (18,69%). All the types of injuries were more common in men than in women. The majority of the patients were car drivers followed by car passengers, pedestrians, cyclists and motor cyclists. The peak age of the patients was between 18 to 25 years. The prevalent number of accidents resulting in injuries to this region took place in spring, especially between noon and 4 PM.

Conclusion

Our results exhibit that road traffic accidents remain among the main reasons of maxillofacial injuries following the traumas resulting from assaults and interpersonal violence. This succession of etiologic factors is in accordance with the data from the most developed countries. The relatively high incidence of injuries resulting from traffic accidents indicates the necessity to reinforce legislation aimed to prevent road traffic crashes and thus to reduce maxillofacial injuries among children and adults.

Etiology and patterns of facial fractures in the United Arab Emirates

A retrospective study on facial fractures was carried out in the Department of Oral and Maxillofacial Surgery at Tawam Hospital (Al Ain, United Arab Emirates) between January 1, 1998 and December 31, 2001. The study included 144 patients with a mean age of 26.5 years; the most frequently injured patients belonged to the 16- to 20-year-old age group. The male predilection was 83%. Road traffic accident was the most common causative factor (59%), followed by falls (21.5%), accidents where camels were involved (5.5%), work- and sport-related accidents (4.8% and 4.8%, respectively), and assault (4.1%). A total of 53.4% of the patients suffered isolated mandibular fractures, 32.6% had isolated midface fractures, and 13.8% had combined midface and mandibular fractures. Associated injuries were noted in 22.2% of the patients. The number of patients treated increased from 28.3 (1990-1995) to 36 (1998-2001) on an annual average; a reduction in isolated nasal fractures and associated injuries, including facial lacerations, was noted with no change in age or etiology predilection. Sufficient data could not be obtained to determine if the favorable results with the associated injuries were a result of the effect of a compulsory seat belt law introduced on June 1, 1998, but the increasing number of maxillofacial injuries suggests that the seat belt law is ignored in this country.

Incidence and aetiology of facial injuries resulting from motor vehicle accidents in Queensland for a three-year period

BACKGROUND

No studies have been reported on the frequency and aetiology of facial injuries due to MVAs in Queensland. This study aims to investigate the incidence, aetiology, age and sex distribution of facial injuries resulting from MVAs for a period of three years.

METHOD

Cases were identified from the Motor Accident Insurance Commission, Queensland. Information including the type of injury sustained, the time, age and role of the patient in the accident were recorded and analysed.

RESULTS

There was an average maxillofacial injury incidence of 4.8/100,000 per year, 53.5 per cent in males and 46.5 per cent in females. A peak incidence was found for both sexes aged 18 to 22 years. In males, 57 per cent of facial injuries occurred in this age group compared to 41 per cent in females.

CONCLUSIONS

Maxillofacial injuries as a result of MVAs are still relatively high regardless of the legislation for compulsory seatbelt use. Recent advances in seatbelt systems have the potential to reduce the risk of head and face impacts. The airbag is also well established as an effective means of preventing serious head and face injury. However, more research is required to further reduce the incidence of maxillofacial injuries as a result of MVAs.

Motor vehicle accidents and TMDS: assessing the relationship

Patients involved in a motor vehicle accident, or MVA, may experience signs and symptoms suggesting temporomandibular joint or masticatory muscle injury. Because there are no published clinical studies assessing the potential relationship among reported variables suggesting injury, examination findings, and crash impact and postural variables, the authors gathered data from 219 patients identifying TMD after an MVA. The results suggest that TMJ or masticatory muscle injury may be associated with varying postural characteristics and impact events, including speed, direction of impact and vehicular damage.

The management and repair of wounds of the face

A practical guide to the causes, types, and repair of injuries of the face

Airbag deployment and eye perforation by a tobacco pipe

Airbags have been shown to reduce injuries and save the lives of car occupants in a crash. Like any protection system, airbags potentially introduce some new risks if no appropriate countermeasures are taken. A case of a relatively moderate frontal impact is described where the driver of an airbag-equipped car suffered a severe penetrating eye injury after the airbag deployed. Since the airbag fabric itself was excluded as an injury-producing structure, other objects such as eyeglasses, a wrist-watch, a bracelet, and a large finger ring had to be assessed. The investigation of the car interior as well as the morphologic details of the injuries to the eye and the face revealed that the most likely candidate for the injury was a tobacco pipe, which was probably being held in one hand and was broken apart by the deploying airbag and projected into the face of the driver. This case illustrates the hazard of having any rigid object between the occupant and the deploying airbag. The desirability of warning car occupants of the potential hazards which can result from today's protection systems is also discussed.

Correlation of occupant injuries in traffic accidents and dummy responses in mathematical simulations

This report describes a method of evaluating the real safety of a car or a design feature by correlating data from mathematical simulations and occupant data from accidents. Extensive accident material with a certain car model is used to describe facial injuries for belted drivers in frontal impacts. In a carefully validated model, simulations are carried out at different crash test speeds and for different dummy sizes. The data from the accident material and from the simulations are correlated with special attention to crash severity, occupant size, trajectory, and contact speed.