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

The aetiology of maxillofacial trauma in Australia: A scoping review

BACKGROUND

The oral and maxillofacial complex is subject to a range of traumas. Injuries to the region are devastating and have a great impact on social health outcomes. This review intends to investigate the aetiologies of maxillofacial trauma across Australia.

METHODS

This review was written in accordance with the PRISMA-ScR. Comprehensive searches of CINAHL, MEDLINE, Ovid, Scopus, and Web of Science databases were conducted to identify potentially relevant literature. Quantitative observational epidemiological studies were sought and were required to include at least one aetiology to the maxillofacial region in their data set. A total of 31 eligible studies were included.

RESULTS

The greatest recorded causes of maxillofacial injuries included inter-personal violence (34.98%) falls (20.87%), sports (15.62%), and motor-vehicle accidents (14.31%). These four aetiologies cumulatively accounted for more than 85% of maxillofacial injuries. From all sustained injuries (n = 7661), the orbit was the most prevalent site of fracture (31.85%), followed by the zygoma (22.01%), mandible (21%), nasal bone (12.45%), maxilla (10.04%), dentoalveolus (1.84%), antrum (<1%), and frontal bone (<1%).

CONCLUSION

Violence was an unprecedented cause of trauma-additional research is recommended to further characterize the correlation between the two variables. Research is also recommended specifically in regional/rural communities, where data was particularly limited. © 2024 Australian Dental Association.

The Pattern of Midface Fractures in Jordan: A Retrospective Review of Medical Records

Introduction

Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018-2021.

Methods

This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021.

Results

During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures.

Conclusions

Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.

Patterns of Maxillofacial Injures Caused by Motorcycle Accidents

Introduction  Motorcycles are used as a common means of transportation, and motorcycle accidents are responsible for a major portion of trauma injuries. Objectives  The purpose of this study was to analyze the patterns of facial injuries in motorcyclists, to evaluate the types of injuries, and to investigate if the accident-related factors had any impact on the characteristics of the injuries. Methods  This retrospective observational study included 74 patients with maxillofacial injuries following motorcycle-related accidents. Investigated data were divided into four main categories: sociodemographic, accident-related, injury-related, and treatment-related. Results  All the patients were males with a mean age (±SD) of 25.03 (±9.986) years. Most accidents ( n  = 44, 59.4%) occurred in the evening. Most of the patients ( n  = 40, 54%) were traveling on motorcycle models that had maximum speed of over 120 km/h. Furthermore, 15 patients (18.9%) were under the influence of alcohol during the crashes and only one patient was wearing a helmet. Fractures of the maxillofacial bones were observed in 50 (67.5%) crash victims; 24 of them (48%) had middle third fractures, 11 (22%) had mandibular fractures, and 15 patients (30%) presented with a combination of lower, middle, and upper third fractures. Conclusion  Almost all patients were not wearing helmets at the moment of the crash. The most common fractured site was the maxilla. The majority of the patients received surgical treatment. Increased enforcement of safety measures for riders and raising awareness about the dangers of motorcycle crashes are required measures to improve traffic safety and, ultimately, population health.

The Causes and Prevalence of Maxillofacial Fractures in Iran: A Systematic Review

Background

Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes.

Methods

A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed.

Results

A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low.

Conclusion

Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.

The Epidemiology and Management of Maxillofacial Fractures at a Tertiary Care Hospital in a Conflict-Torn Region in Somalia

The etiology of maxillofacial fractures (MFFs) varies according to the geographical location and density of the population. This study aimed to analyze the etiology, pattern, and treatment of MFFs. Epidemiological characteristics and treatment modalities of MFFs have never been evaluated in Somalia. The study included 45 patients who were operated on for MFFs at a tertiary care hospital in Somalia (2018-2019). Patient demographics, fracture causes, types, associated non-facial injuries, treatment modalities, and hospitalization-time were evaluated. The most common etiological factors of the MFFs were explosion (24.4%) and assault (24.4%), followed by gunshot (22.2%), sports accident (15.6%), motor vehicle accident (11.1%), and fall from height (2.2%) patients, respectively. The main site of injury was the mandible bone (64.4%) followed by nasal bone, maxilla, zygomatic, and orbital region. The most common non-facial injuries of the MFFs were soft tissue laceration (37.8%) followed by femoral fracture (6.7%), clavicle fracture (4.4%), and femoral fracture with chest injuries (2.2%). The most applied treatment was open reduction microplate +/- intermaxillary fixation (77.8%). Due to the size of the mandible fractures, an iliac autograft (6.7%) was performed. The mean length of the hospital stay was 11.8 +/- 8.4 days (range, 1-45 days), and some patients (15.6%) needed intensive care due to severe injuries. This will be the first study aiming to analyze the etiology, pattern, and treatment of MFFs in Somalia. This study deals with the social aspects of Somalia, and it shows that MFFs develop as a result of highly interpersonal violence in a young man.

Maxillofacial trauma in the gulf countries: a systematic review

PURPOSE

The objective of this review was to determine the prevalence, major causative factors and the most common sites of Maxillofacial Trauma in the Gulf Cooperation Council (GCC) Countries.

METHODS

All articles that were published in the English language in the databases such as Google Scholar, EBSCO, PubMed, NCBI, Medline, COCHRANE, ELSEVIER and SCOPUS were reviewed for MFT from GCC during the last 23 years.

RESULTS

A total of 19,151 patients (16,567 males and 2584 females) (86-14%) with an age range between 0 and 97 years were included in the study. In all of the Gulf countries males outnumber females in terms of maxillofacial injuries with a ratio of 6.4:1. The mandible was the most common site of trauma followed by the maxilla. Road Traffic Accidents (RTA) was the most common cause of injury in the GCC followed by falls.

CONCLUSION

Maxillofacial injuries are highly prevalent, distributed among the Gulf countries, and is mainly caused by RTAs especially among males who are highly prone to MFT in the gulf. The reasons are due to lack of road safety culture and weak enactment of traffic legislation, other possible factors include intrinsic car safety features, high speed driving and the amount/use of highways in these societies.

Traffic accidents, maxillofacial injuries and risk factors: A systematic review of observational studies

AIM

This study aimed to evaluate the scientific evidence regarding the risk factors for maxillofacial injuries among victims of traffic accidents.

METHOD

A systematic review of articles published until February 2017 was carried out in the following databases: PubMed, Web of Science, Scopus, and Cochrane Library. Studies were selected by two independent reviewers (ϰ = 0.841). The risk of bias in the selected studies was assessed using an adapted version of the Newcastle-Ottawa Scale for observational studies.

RESULTS

A total of 2703 records were found, of which only three articles fulfilled the inclusion criteria and were analyzed, including 422 244 patients. The male/female ratio ranged from 3.4: 1 to 6: 1. All eligible studies performed the multivariate statistical analysis. Eleven risk factors for maxillofacial traumas were identified: victim's gender (P < 0.05), age group (P < 0.05), residence region (P < 0.05), impact characteristics (P < 0.05), increased net change in velocity due to collision (P < 0.05), increase in occupant's height (P < 0.05), nonuse of protective equipment (P < 0.05), type of accident (P < 0.05), time of occurrence (P < 0.05), lesion severity (P < 0.05), and occurrence of concomitant lesions (P < 0.05).

CONCLUSION

The results suggest that sociodemographic characteristics, as well as those related to the collision patterns and circumstances of traffic accidents, may influence the occurrence of maxillofacial injuries. However, the results should be interpreted with caution due to the high heterogeneity among studies.

Traumatic Facial Fractures in Children and Adolescents

This study showed a retrospective analysis of the incidence and pattern of traumatic facial fractures in a pediatric and adolescent population (≤18 years old) in China. The authors retrospectively reviewed 154 children and adolescent who had traumatic facial fractures and who were admitted to our university-affiliated hospitals from 2005 to 2010. This study enrolled 109 males and 45 females aged 11.9 ± 5.2 years old. The incidence peaked around the periods of 12 to 18 years in the male, ≤6 and 16 to 18 years in the female. The most common etiologies were motor vehicle collisions (MVCs) (60, 39.0%), followed by high fall (40, 26.0%), low fall (32, 20.8%). The most common fracture sites were mandible (78, 50.6%) and nose (33, 21.4%), followed by orbit (31, 20.1%). A total of 35 (22.7%) patients suffered neurological deficit. The patients in the 12 to 18 age range group accounted for the largest proportion of 54.5%. Fracture incidence showed peaks between the hours of 12:00 to 16:00 PM (33.7%), during the autumn season (30.5%) and on Friday to Sunday (50.0%). The most common etiology and fracture site were MVCs and mandible, respectively. Etiologies and patterns of traumatic facial fractures vary with age. Continued efforts toward injury prevention of traumatic facial fracture among the children and adolescents are warranted.

Maxillofacial Fracture Patterns in Road Traffic Accidents

Objective:

The objective of this study is to analyze the maxillofacial fracture pattern from road traffic accidents (RTAs) in cases treated surgically in a tertiary hospital during July 2008–June 2018.

Materials and Method:

Data available in the department of oral and maxillofacial surgery of the institution of patients with maxillofacial fractures sustained due to RTAs that were treated in the department between the period July 2008 and June 2018 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation.

Results:

A total of 348 patients with maxillofacial fractures were diagnosed, of which 335 were male and 13 were female. The ages ranged from 7 to 70 years. The maximum cases were in the age group of 16–30 years with 181 fractures followed by 31–45 group with 133 fractures, 45–60 years with 21 fractures, 0–15 years with 8 fractures, and >60 years with five fractures. The maximum incidence of fractures was in the mandible with 168 cases followed by 92 in zygomatic complex, combination of fractures in 53 cases, 13 LeFort I fractures, nine frontal bone fractures, three fractures in other areas, five nasal fractures, and five LeFort II fractures. Males predominated the cases of mandibular fractures involving multiple sites and cases involving multiple bones.

Conclusion:

A maximum number of maxillofacial fractures cases were in the second and third decades of life, and the high-speed vehicles and lack of protective safety accessories such as helmets and seatbelts were responsible for the wide variety of pattern fractures of facial bones.

Patterns of maxillofacial fractures in Hofuf, Saudi Arabia: A 10-year retrospective case series

Objectives

This retrospective study was performed to analyze the incidence, etiology, and types of maxillofacial fractures in a major city in Eastern Province, Saudi Arabia.

Materials and methods

The medical records of all patients treated in the operating rooms for maxillofacial fractures by the Oral and Maxillofacial Surgery Department at King Fahad Hospital, Hofuf, Al-Ahsa, Saudi Arabia, between January 1, 2007, and December 31, 2016, were reviewed. A total of 270 patients with complete records were included. The data extracted included the age, gender, nationality, causes of injury, and patterns of maxillofacial fractures involved.

Results

Among the 270 patients, 241 (89.3%) were males, and 29 (10.7%) were females. The young adult (19-44 years) age group was the most affected (65.6%). Road traffic accidents (63.3%) were found to be the most frequent causes of maxillofacial fractures; falls were the second most common (15.9%). The rate of mandibular (54.6%) fractures was higher than that of mid-facial (45.4%) fractures. Among the mandibular fractures, the most common type was the parasymphyseal fracture (24.6%). Zygomatic fractures were the most common (48.6%) of midface fractures.

Conclusions

Similar to reports of other studies in different regions of Saudi Arabia, Al-Ahsa showed that road traffic accidents were the most predominant etiology of maxillofacial fractures affecting most frequently males of young adult age group. These findings emphasize the need for better education of road safety and enforcement of traffic laws, especially for the most affected age group.

Incidence and Pattern of Mandible Fractures in the Madinah Region: A Retrospective Study

Objectives

The objective of the study is to study the incidence and pattern of mandible fractures in the holy city of Madinah in the Kingdom of Saudi Arabia over a retrospective period of 3 years from 2013 (1434H) to 2016 (1436H) and to compare the results with those from other regions of Saudi Arabia and elsewhere.

Materials and Methods

Relevant data of patients admitted to the King Fahad Hospital, Madinah with a fracture of the mandible during the study were collected from their medical records and radiographs. The age, gender, etiology, role of the patient, site, and number of fractures in the patients were evaluated. The data were analyzed by standard statistical methods.

Results

A total of 197 patients with fracture of the mandible were admitted in the period of the study by the Oral Maxillofacial Surgery Department, King Fahad Hospital, Madinah. There were 165 male and 32 female patients. The ages ranged from 3 to 86 years with a mean of 24 years. A total of 260 fractures of Mandible were documented. The largest number (113) of patients was found in the age group between 16 and 30 years. Trauma caused by motor vehicle road traffic accidents (RTAs) was the main etiology of the fractures followed by falls and assault. The majority of the patients were in the role of vehicle drivers. The condylar anatomical site of mandible was most frequently affected and constituted the largest number (103) of fractures followed by the angle (51), parasymphysis (45), and then by the body (23) of the mandible. Dentoalveolar fractures were present in 22 cases. Very less number of coronoid fractures (7), followed by those of the ramus (5), and least number at the symphysis (4) of the mandible were found.

Conclusion

RTA was the most common etiology for trauma and fracture of the mandible. The males outnumbered the female patients, the largest number of patients with trauma and mandible fracture was found in the age group between 16 and 30 years and frequency of condylar fractures was higher.

Epidemiology and patterns of facial fractures due to road traffic accidents in Taiwan: A 15-year retrospective study

OBJECTIVE

The facial region is a commonly fractured site, but the etiology varies widely by country and geographic region. To date, there are no population-based studies of facial fractures in Taiwan.

METHODS

We conducted a retrospective study of patients diagnosed with facial fracture and registered in the National Health Insurance Research Database of Taiwan between 1997 and 2011. The epidemiological characteristics of this cohort were analyzed, including the etiology, fracture site, associated injuries, and sex and age distributions.

RESULTS

A total of 6,013 cases were identified that involved facial fractures. Most patients were male (69.8%), aged 18-29 years (35.8%), and had fractures caused by road traffic accidents (RTAs; 55.2%), particularly motorcycle accidents (31.5%). Falls increased in frequency with advancing age, reaching 23.9% among the elderly (age > 65 years). The most common sites of involvement were the malar and maxillary bones (54.0%), but nasal bone fractures were more common among those younger than 18 years.

CONCLUSION

Most facial injuries in Taiwan occur in young males and typically result from RTAs, particularly involving motorcycles. However, with increasing age, there is an increase in the proportion of facial injuries due to falls.

Maxillofacial fracture epidemiology and treatment plans in the Northeast of Iran: A retrospective study

Background

The epidemiology of facial injuries varies based on lifestyle, cultural background and socioeconomic status in different countries and geographic zones. This study evaluated the epidemiology of maxillofacial fractures and treatment plans in hospitalized patients in Northeast of Iran (2015-2016).

Material and Methods

In this retrospective study, the medical records of 502 hospitalized patients were evaluated in the Department of Maxillofacial Surgery in Kamyab Hospital in Mashhad, Iran. The type and cause of fractures and treatment plans were recorded in a checklist. Data were analyzed with Mann–Whitney test, chi-squared test and Fisher’s exact test, using SPSS 21.

Results

The majority of patients were male (80.3%). Most subjects were in 20-30-year age range (43.2%). The fractures were mostly caused by accidents, particularly motorcycle accidents (MCAs), and the most common site of involvement was the body of the mandible. There was a significant association between the type of treatment and age. In fact, the age range of 16-59 years underwent open reduction internal fixation (ORIF) more than other age ranges (P=0.001). Also, there was a significant association between gender and fractures (P=0.002).

Conclusions

It was concluded that patient age and gender and trauma significantly affected the prevalence of maxillofacial traumas, fracture types and treatment plans. This information would be useful for making better health policy strategies.

Key words:Epidemiology, treatment, facial injuries, maxillofacial fractures, trauma.

Analysis of the Changing Patterns of Midface Fractures Using 3D Computed Tomography: An Observational Study

This article aims to analyze the changing Le Fort fracture patterns using computed tomography (CT) scans with three-dimensional (3D) reconstruction. A prospective observational study was conducted on 60 patients with midface trauma, who had reported to MS Ramaiah Group of Hospitals, Bangalore, between January 2015 and October 2016. CT scans using 1.6 mm axial, sagittal, coronal sections were taken and their 3D reconstruction was made. The images were studied and compared with the standard Le Fort lines. The deviations from the classical Le Fort lines were analyzed and recorded. A note was also made of any additional fixation that was required for these deviations. Descriptive analysis was done and the results expressed in numbers and percentages. Study revealed that the most common cause for the midface fractures was found to be road traffic accidents (81.7%) with a male preponderance (88.3%) and peak incidence in 21 to 30 years of age (40%). Among the 60 patients, 18 (30%) patients had fracture patterns similar to the ideal Le Fort lines, 4 (6.6%) had a combination of Le Fort patterns, and 38 (66.3%) patients had deviations seen from the ideal Le Fort lines. Four types of deviations were recorded, namely, D1(60%), D2(5.4%), D3(10.9%), and D4(23.6%). It was observed that D1 and D3 required additional fixation. Majority of the cases presented as a deviation from ideal Le Fort fractures. CT was a valuable tool in the assessment of these fracture patterns. Deviations, if any, could be better analyzed using the 3D reconstruction images. Proper diagnosis and detection of these deviations make the planning for fixation easier. Repetition of these deviations could propose a newer or modified classification system for Le Fort fractures.

An Overview of Maxillofacial Trauma in Oral and Maxillofacial Tertiary Trauma Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah

The aims of this study were to provide an overview of maxillofacial trauma and its relationship to patient's demographic data and alcohol consumption within the state of Sabah. It was a retrospective study of maxillofacial trauma cases treated by Oral and Maxillofacial Surgery Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, from January 1, 2009, until December 31, 2013. A total of 630 maxillofacial trauma cases were included. Details of the trauma were collected from patients' record, including patients' cause of injuries, injuries suffered, treatment indications, and treatment received. Patients' demographic data (age, gender), alcohol consumption in relation to causes, and type of maxillofacial injury were analyzed. There were 538 male (85.4%) and 92 female (14.6%) patients (ratio: 5.8:1), with mean age of 31.0 years. Most common causes of maxillofacial injury were motor vehicle accident (MVA; 66.3%), followed by fall (12.4%) and assault (11.6%). Motorcyclists made up more than half of the total cases (53.1%). Cases referred were primarily due to soft-tissue injury (458 cases). Other cases were dentoalveolar and maxillofacial bone fractures. Treatment provided for the fractures included open reduction and internal fixation (22.9%), closed reduction (28.7%), and conservative management (48.4%). Toilet and suturing were done for all patients with soft-tissue injury. Maxillofacial trauma is a major problem in Sabah. It affects mostly males in the age group of 21 to 30 years. Most of the MVA patients were motorcyclists. Mandibular fracture with parasymphysis involvement recorded the highest number. Most of the patients preferred conservative management, probably due to financial and logistic issue.

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.

The Effect of Trauma Intervention on the Satisfaction of Patients Admitted to the Emergency Department: A Clinical Trial Study

BACKGROUND

Patient satisfaction is a key determinant of the quality of medical care. Moreover, satisfaction can be used as a criterion for examining the adequacy of the care, health, and competency of personnel.

OBJECTIVES

This study was conducted to determine the satisfaction of patients receiving trauma care in the emergency department of a hospital affiliated with Isfahan University of Medical Sciences.

PATIENTS AND METHODS

This simple clinical trial was performed on 104 patients admitted for traumatic injury to an emergency department in Iran. Given that patients frequently enter an emergency department for care, the sampling of patients in the department was done on days that were randomly assigned to the study group. The experimental group received trauma intervention in four areas from their admission to the emergency department to their discharge from the hospital, and the control group received routine nursing care. The data were collected through a questionnaire that asked for demographic characteristics and then went on to ask about patient satisfaction. The satisfaction questionnaire was completed after the trauma intervention at the end of patients' stay in the hospital. The data were analyzed using SPSS 22 software and descriptive statistical tests and analytical tests (independent t and Chi-square).

RESULTS

The mean score for total satisfaction after trauma intervention in the experimental group (45.6 ± 3.69) was significantly different from that of the control group (32.01 ± 7.78) (P < 0.001). Therefore, the levels of total satisfaction in the experimental and control group were favorable and relatively favorable, respectively.

CONCLUSIONS

In this study, trauma intervention increased satisfaction in patients admitted to the emergency department. Therefore, managers and personnel of hospitals and healthcare training centers are urged to implement trauma intervention in their hospitals or healthcare training centers.

Maxillofacial Fractures in Bhopal, India: Analytic Study of 1268 Cases

PURPOSE

To ascertain the pattern, incidence, causes, age and sex distribution, types, condition and treatment of maxillofacial fractures and their interwoven relationship being practiced in Bhopal.

MATERIALS AND METHODS

Retrospectively 3 year records of patients with maxillofacial fractures from 12 selected centres in Bhopal were reviewed. The following data were extracted from the medical records: age; gender; site of the fracture(s); other associated injury(ies); cause of the trauma and method of treatment(s).

RESULT

In 1268 patients, a total of 2613 fractures were found of which 44.58 % patients had mandibular fractures. Parasymphysis was the most common site of fracture overall. Most patients were in the 21-30 year old age group, and the male: female ratio was 3.3:1. Road traffic accident accounted for 858 cases (67.67 %). Head injury was the highest occurring associated injury. Open surgical modalities was the most employed treatment modality in 52.60 % of cases.

CONCLUSION

Preference for open surgical treatment along with increasing trend of supplemental intermaxillary fixation was found, which prompts us to check for the underlying reason behind this, which could be the increasing number of displaced and comminuted fracture cases or the decreasing efficiency of open reduction treatment rendered. Latter reason prompts to re-evaluate the existing surgical techniques and expertise of the practicing surgeons.

Meta Analysis of Etiology and its Clinical and Radiological Correlation in Cases of Craniomaxillofacial Trauma

AIM

The present study was planned to investigate the etiology of injuries and to analyze correlation between clinical and radiological findings in cases of craniomaxillofacial trauma.

STUDY DESIGN

An 18 months cross-sectional study was done and 325 patients with maxillofacial fractures were analyzed from January 2013 to June 2014 who reported to the department of oral and maxillofacial surgery, Aligarh, Uttar Pradesh. Data was recorded in a preformed case sheet which included: patient's demographic data, cause of injury, type of injury, treatment plan.

RESULTS

Out of the 325 patients, 74.4 % were males with a male: female ratio of 2.91:1. The 21-30 year age group was found to be maximum. Road traffic accidents accounted for 71.3 %, followed by fall from height (19 %) and assault (9.5 %). Most commonly involved vehicles were two wheelers followed by public transport. Mandibular fractures (65 %) were most prevalent, followed by zygomaticomaxillary complex (44.27 %), parietal bone (48 %) and orbital fractures (21.3 %). Thirty-seven fractures (7.14 %) were missed clinically which were confirmed later by radiographic technique. Maximum were in cranium region (57 %) followed by mandible (27 %), mid face region (16.21 %). Thirty-three fractures (6.37 %) were overestimated or suspected clinically which could not be confirmed by radiographic technique. Maximum were in mandible (48.5 %) followed by mid face (36.33 %) and cranium (15.15 %).

CONCLUSION

The idea behind this article is to analyze the various trends and affecting factors and correlation between clinical and radiological findings. A better understanding of the above said would help in future treatment planning and management of facial injuries.

Retrospective study maxillofacial fractures epidemiology and treatment plans in Southeast of Iran

Background

The epidemiology of facial injuries varies in different countries and geographic zones. Population concentration, lifestyle, cultural background, and socioeconomic status can affect the prevalence of maxillofacial injuries. Therefore, in this study, we evaluated the maxillofacial fractures epidemiology and treatment plans in hospitalized patients (2012-2014) which would be useful for better policy making strategies.

Material and Methods

In this retrospective study, the medical records of 386 hospitalized patients were evaluated from the department of maxillofacial surgery at Bahonar Hospital of Kerman, Iran. The type and cause of fractures and treatment plans were recorded in a checklist. For data analysis, ANOVA, t-test, Chi-square, and Fisher’s exact test were performed, using SPSS version 21.

Results

The majority of patients were male (76.5%). Most subjects were within the age range of 20-30 years. Fractures were mostly caused by accidents, particularly motorcycle accidents (MCAs), and the most common site of involvement was the mandible (parasymphysis). There was a significant association between the type of treatment and age. In fact, the age group of 16-59 years under went open reduction internal fixation (ORIF) more than other age groups (P=0.02). Also, a significant association was observed between gender and the occurrence of fractures (P=0.01).

Conclusions

Considering the geographic and cultural indices of the evaluated population, it can be concluded that patients age and gender and trauma causes significantly affect the prevalence of maxillofacial traumas and fracture kinds and treatment plans.

Key words:Epidemiology, treatment, facial injuries, face fractures, maxillofacial trauma, trauma.

Changing pattern in the characteristics of maxillofacial fractures

PURPOSE

This study was designed to assess the changes in the etiology, incidence, and pattern of maxillofacial fractures during 2 different study periods in our department.

PATIENTS AND METHODS

In this retrospective study, patients treated for maxillofacial fractures at our department from January 2000 to December 2009 were included. Data regarding patient's age, sex, etiology of fracture, time of injury, site of fracture, and pattern of fracture were collected and grouped chronologically into two 5-year periods: 2000 to 2004 (period 1) and 2005 to 2009 (period 2); the results of the study during these periods were analyzed and compared.

RESULTS

A total of 1131 patients sustained maxillofacial fractures: 422 in the first period and 709 in the second period. During the second period, the male-female ratio increased from 3.35:1 to 3.63:1. Road traffic accidents remained the major etiologic factor, which increased remarkably from 49.3% to 54.6% (P = 0.085), whereas assault-related injuries decreased significantly from 16.8% to 12.4% (P = 0.039). The proportion of patients with mandibular fractures decreased from 59.6% to 55.3% (P = 0.037), whereas the proportion of patients with midfacial fractures increased from 40.4% to 44.7% (P = 0.037).

CONCLUSIONS

The changing pattern of maxillofacial fractures in our center is correlated to the socioeconomic status, population mobility, and etiologic factors. Strict enforcement of traffic laws and regulations is still a focal factor in attaining appreciable reduction in maxillofacial fractures associated with road traffic accidents.

Incidence and pattern of mandibular fractures in Rohilkhand region, Uttar Pradesh state, India: A retrospective study

AIMS

To understand and evaluate the significance of various aetiological factors in determining the incidence and dictating the patterns of mandibular fractures in Rohilkhand region.

METHODS

The patient records and radiographs for 144 patients treated for mandibular fractures were reviewed between the time periods from January 2012 to December 2013. Data on age, gender, aetiology, use of intoxicants, head injury, associated injuries, days of the week, anatomic site and multiple fractures within the mandible were recorded and assessed.

RESULTS

Maximum incidence of fractures was observed among the individuals in 3rd decade (35.4%) followed by 2nd and 4th decades, which exhibited 32 and 30 cases (22.2% and 20.8%), respectively. Male to female ratio was biased (4:1) portraying a male predominance. Road traffic accidents (RTAs) were observed to be the predominant aetiological factor responsible accounting for 79.2% of the total injuries followed by assaults (11.8%) and falls (9%). Parasymphysis exhibited the highest incidence (32.63%) amongst the anatomic sites, followed by body (18.75%), angle (16.66%), condyle (15.27%), symphysis (12.50%), ramus (2.77%) and coronoid (1.38%).

CONCLUSION

The study reveals that majority of affected patients were in the 2nd and 3rd decades. A definitive relationship existed between RTA and the incidence of mandibular fractures. The frequency further increased with consumption of social intoxicants. The most commonly fractured site was parasymphysis either isolated or associated with other fractures in the mandible.

Maxillofacial Fractures in Women and Men: A 10-Year Retrospective Study

PURPOSE

The purpose of this study was to evaluate and compare the demographic characteristics of maxillofacial fractures between women and men in China.

PATIENTS AND METHODS

The sample was composed of all patients who sustained maxillofacial fractures during a 10-year period (2000 through 2009). Incidences, age distributions, etiologies, fracture patterns, associated injuries, and occupation distributions were recorded and analyzed. Data analysis included the χ(2) test, the Fisher exact test, and the t test. A P value less than .05 was considered significant.

RESULTS

There were 1,131 patients (881 male and 250 female) who sustained maxillofacial fractures, with a male-to-female ratio of 3.5:1. Male patients sustained injuries most frequently during the autumn (P = .048), whereas female patients sustained more maxillofacial injuries during the summer (P = .006). Men sustained motorcycle (P = .023) and assault-related accidents (P = .036) more frequently than women, whereas women were more frequently injured in bicycle-related accidents (P < .001) or falling while at ground level (P = .001) than men. Women presented more frequently with condylar fracture than men (P = .028), whereas men were more prone to symphysis fractures than women (P = .037). For drivers, only men were involved (P = .001). Male workers sustained maxillofacial fractures more frequently than female workers (P < .001). Female children, students, and company staff were more prone to maxillofacial fractures than their male counterparts (P = .010, P = .004, and P = .044 respectively).

CONCLUSIONS

The demographic characteristics of maxillofacial fractures in female patients considerably differ from those in male patients.

Prevalence and etiology of midfacial fractures: a study of 799 cases

BACKGROUND AND OBJECTIVE

The prevalence and etiology of midfacial fractures varies among countries. Until now, knowledge about such type of injuries in the region of the Baltic countries was rather scarce. The purpose of the study was to analyze the prevalence, etiology and localization of midfacial fractures treated at the Vilnius University Hospital Žalgiris Clinic, Vilnius, Lithuania.

MATERIALS AND METHODS

The medical records of patients treated for midfacial fractures during the period January 2005 to December 2010 were analyzed for gender, age distribution, frequency and type of injury, cause of fractures, consciousness status and alcohol abuse during trauma.

RESULTS

The records of 799 patients were analyzed. The male-to-female ratio was 4.4:1. The mean age of the patients was 33.16±14.0 years (min 1, max 87). As much as 68.8% of injuries were zygomatic fractures, 27.9% were maxillary, and 3.3% were isolated orbital floor fractures. The most frequent causes for injury were interpersonal violence (64%), followed by falls (16.3%) and traffic accidents (8.3%). Most midfacial fractures (65.3%) occurred between April and October (P<0.05), on weekends (58.2%; P<0.05) and at night (62.0%; P<0.05). In 14%, trauma reports indicated the abuse of alcohol. More often such persons received more than one midfacial bone fracture (P<0.05) concurrently.

CONCLUSIONS

This study revealed that the main cause of midfacial fractures was assault. Male patients, aged 15-34 years, more often sustain midfacial fractures. Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family, school and community institutions.

Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study

OBJECTIVES

To assess the changing mid-face fracture patterns using a computed tomography scan.

METHODOLOGY

Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%).

CONCLUSION

With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.

Aetiology of maxillofacial fractures: a review of published studies during the last 30 years

The epidemiology of facial trauma may vary widely across countries (and even within the same country), and is dependent on several cultural and socioeconomic factors. We know of few reviews of published reports that have considered the sex distribution and aetiology of maxillofacial trauma throughout the world. The aim of this review was to discuss these aspects as they have been presented in papers published during the last 30 years. We made a systematic review of papers about the epidemiology of maxillofacial trauma that were published between January 1980 and December 2013 and identified 69 studies from Africa (n=9), North America and Brazil (n=6), Asia (n=36), Europe (n=16), and Oceania (n=2). In all the studies men outnumbered women, the ratio usually being more than 2:1. In American, African, and Asian studies road traffic crashes were the predominant cause. In European studies the aetiology varied, with assaults and road traffic crashes being the most important factors. In Oceania assaults were the most important. A comparison of the incidence of maxillofacial trauma of different countries together with a knowledge of different laws (seat belts for drivers, helmets for motocyclists, speed limits, and protection worn during sports and at work) is crucial to allow for improvement in several countries. To our knowledge this paper is the first attempt to study and compare the aetiologies of maxillofacial trauma.

Concomitant dental injuries in maxillofacial fractures - a retrospective analysis of 1219 patients

BACKGROUND/AIM

Traumatic dental injuries are frequently combined with maxillofacial fractures, but literature addressing this topic is rare. In a retrospective study, the frequency of dental lesions in inpatients with traumatic facial injuries was analyzed.

MATERIAL AND METHODS

All patients referred to the Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University Mainz for inpatient treatment due to facial fractures between January 2001 and December 2007 were analyzed regarding the type of fracture, its localization, and potential concomitant dental injuries. In addition a systematic review was performed to compare the findings of this study with existing data.

RESULTS

Altogether 1219 facial trauma patients underwent inpatient treatment. 184 (15.87%) out of those had 451 injured teeth, and 4.9% were edentulous. The most frequent causes were assaults (25.1%), followed by falls (19.6%) and bike accidents (10.1%). Avulsion, especially of the upper incisors, occurred in most cases (27.9%). Assaults caused 1.29 dental fractures per patient, while traffic-related accidents led to three to four times higher injury-rates.

CONCLUSIONS

With almost every sixth patient having at least one kind of dental injury, this study shows that a thorough anamnesis and examination of the dental status are absolutely necessary, especially in patients who suffered from high-speed impacts or collisions with low-resilience surfaces.

Prevalence of mandibular fractures reported at C.S.M.S.S Dental College, aurangabad from february 2008 to september 2009

Aim:

The aim of this study is to determine the etiology, frequency of mandibular fractures among different age and sex, to determine the frequency of anatomic distribution, and to report the different modalities of treatment provided to the patients reported at our institution from February 2008 to September 2009.

Materials and Methods:

All patients fulfilling the selection criteria and having mandible fracture were selected for the study. Patient information was collected by means of a medical data form specifically designed for the present study. The values were subjected to Z and Chi-square tests.

Results:

Out of 35 patients, thirty one were males (88.57%) and four were females (11.43%) with a male:female ratio of 8:1. We found a peak occurrence in young adults, aged 21-30 years (n = 15, 42.86%). In case of etiology of fracture, road traffic accidents (RTAs) was the most common (n = 25, 71.43%) and condyle was most frequently involved site (n = 19, 38.78%). In most (n = 16, 45.71%) of the patients, an open reduction and rigid internal fixation using bone plate and screws was done.

Conclusion:

In the present study, the prevalence of mandible fractures was more prevalent in male patients, especially during the 3^rd decade of life. The most common cause was road traffic accident and the more frequently affected region was condyle of the mandible. Open reduction and rigid internal fixation using miniplates and screws was the most commonly used treatment.

Facial fracture management in northwest Nigeria

Background:

Facial fracture is gradually become a public health problem in our community due to the attendant morbidity and mortality. Hence, the aim of this study was to determine the pattern of facial fracture in Dental and Maxillofacial Surgery Department of Usmanu Danfodiyo University Teaching Hospital. This cross-sectional study was undertaken to provide information regarding gender, age, etiology, and diagnosis of patients with maxillofacial fractures.

Materials and Methods:

A 1-year review of patients diagnosed and treated for facial fractures in Usmanu Danfodiyo University Teaching Hospital between January 2011 and December 2011. The diagnosis was based on radiographic data and clinical examination. The main analysis outcome measures were etiology, age, gender, site, and treatment. Data were organized and presented by means of descriptive statistics and Pearson's Chi-square test. The level of significance adopted was 5%.

Results:

A total of 40 patients were treated in this period. Over 95% were male, 81% were caused by road traffic crash (RTC) and 86.4% were in the 21-30 years group. Most patients (52%) had mandibular fractures, and the most common site was the body. Most patients with midfacial fractures had fractures of the zygomaticomaxillary region (36%), while fractures of the parasymphyseal region were more common in the mandible 156 (31%). The most common treatment for jaw fractures was mandibulomaxillary fixation (MMF). Stable zygomatic complex fractures were reduced (elevated) intraorally, and unstable ones were supported by antral packs.

Conclusions:

This study highlights facial fractures secondary to RTC as a serious public health problem in our environment. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of RTC. It also bring to the fore the necessity to shift to open reduction and internal fixation (ORIF) of fractures.

Study of the pattern of maxillofacial fractures seen at a tertiary care hospital in north India

AIM

The present study was planned to investigate the etiology of maxillofacial injuries and to analyze the pattern of maxillofacial factures as well as the various factors influencing their distribution.

STUDY DESIGN

A one year cross-sectional study was done and 1,108 patients with maxillofacial fractures were analyzed consecutively from April 2010 to March 2011 who reported to the department of Oral and Maxillofacial Surgery in the Centre for Dental Education & Research and Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. A performa was designed to collect the data that included age and sex distribution, etiology, influence of alcohol, type of fractures, use of restraints devices, associated injuries and treatment delivered.

RESULTS

Out of 1,108 patients, 89.62 % were males with a male:female ratio of 8.63:1. The 21-30 year age group was found to be maximum (39.98 %). Road traffic accidents accounted for 49.01 %, followed by assault (22.38 %) and fall from height (21.66 %). Two wheelers were the most commonly involved vehicle. Out of 437 road traffic accident patients (excluding pedestrian, n = 106), only 52.40 % were found to be using restraints devices at the time of accident. Totally 25.45 % patients were under the influence of alcohol at the time of injury. According to anatomical distribution of fractures, mandibular fractures (33.57 %) were most prevalent, followed by maxilla (31.13 %), nasal (28.33 %) and zygoma (24.36 %). Head injuries (18.32 %) were found to be the most common associated injuries followed by lower limb fractures.

CONCLUSION

The motive behind executing this article is to analyze the various trends of facial fractures and all those factors that affect their distribution. A perfect understanding of pattern of maxillofacial fracture will assist the executors of health care in the treatment planning and management of facial injuries. Knowledge gained from the present study would influence in assessing the effectiveness of existing preventive measures and elaboration of future preventive measures and conducting new research.

Maxillofacial injuries due to work-related accidents in the North West of Italy

INTRODUCTION

The aim of this study was to assess the incidence and patterns of work-related maxillofacial injuries, identifying worker categories with a high risk of injury.

MATERIAL AND METHODS

From a systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients with work-related injuries were considered. Occupation, mechanism of injury, and demographic and clinical data were analyzed.

RESULTS

Work-related facial injuries represented the fifth most common cause of injury, with a percentage of 6.3 %. Maxillofacial fractures were most often seen in construction workers (37.9 %). The middle third was involved in 67 % of the cases; the mandible was the most frequently injured site.

CONCLUSIONS

Work-related maxillofacial trauma is rare, but it is often complex and challenging as Facial Injury Severity Scale values show. In agreement with the few published reports, construction workers, together with farm and forestry workers, are at the highest risk of injuries, mainly because of struck by a thrown, projected, or falling object.

A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India

Background:

The Department of Oral and Maxillofacial Surgery, D.A.V [C] Dental College and Hospital, Yamuna Nagar, Haryana, India conducted a study on patients with maxillofacial fractures in a time span of seven years (2003-2010). The purpose of this study was to evaluate their aetiology, incidence, patterns and different modalities employed for management.

Methods:

In this study, 740 patients with 1054 fractures were evaluated clinically and radiographically, based on which closed reduction and open reduction was undertaken. Review of patient records included: Age, sex, time, mechanism and etiology of injury, history of bleeding, unconsciousness and prior first aid, type of vehicle and use of preventive measures, type of fracture and treatment modalities.

Results:

Road traffic accidents accounted for highest number of fractures predominantly occurring in the age group of 21-30 years (38.3%)1,2. Males incurred more fractures with a male female ratio of 4.2: 1.Mandible was the most commonly fractured bone with parasymphysis being the commonest affected site.76.66% patients had associated head injury and 15.68 % had history of unconsciousness. Open reduction and internal fixation was the preferred modality for mandible whereas the mid face fractures were treated more often by closed methods.

Conclusions:

Injuries occurred more commonly in 20 – 40 age range with road traffic accident being the major etiological factor. Majority of the patients were driving two wheelers and most were under the effect of alcohol. Most of the injuries occurred during night and road traffic accidents (71.89%) were found to be the major etiological factor. Out of 532 road traffic accidents, 490 patients (66.2%) were on two wheelers, among whom 49(10%) were wearing helmet. In the mandible, fractures occurred most commonly in the parasymphyseal region (224, 30.2%), and out of the 314 fractures of the middle third showed, 155 (49.4%) ZMC. OPG was the most commonly advised X-ray. With regard to treatment modalities, 36.8% of all the mandibular fractures (740) were treated by closed reduction, 62.6% were treated using open reduction and 0.5% was under observation only.

Global trends in maxillofacial fractures

Background The etiology, demographics, fracture site in facial injury patients have been reported worldwide. However, few studies have attempted to identify changes in maxillofacial fractures over time periods and between countries. The statistics are vastly different due to variations in social, environmental, and cultural factors. Methods Data were collected from departmental records between 1996 and 2006 for patients treated at Christchurch Hospital for facial fractures. Variables examined included incidence, demographics, site of fracture, and treatment methods. Results A total of 2563 patients presented during the study period, 1158 patients in the first half and 1404 patients in the second half. Male-to-female ratio was 4:1 in both periods and males in 16- to 30-year group accounted for about half of all patients. Interpersonal violence was the most common cause of injuries, and there was a decrease in injuries caused by motor vehicle accidents. Approximately half of all patients required hospitalization and surgery, and the most common method of treatment was open reduction and internal fixation. Conclusion Maxillofacial fracture is a common injury in young males following interpersonal violence in New Zealand. Studies in other countries and over different time periods yield interesting differences in the etiology, demographics, and fractures patterns. These are due to environmental, societal, cultural, and legislative differences.

Pediatric facial injuries: It's management

Background:

Facial injuries in children always present a challenge in respect of their diagnosis and management. Since these children are of a growing age every care should be taken so that later the overall growth pattern of the facial skeleton in these children is not jeopardized.

Purpose:

To access the most feasible method for the management of facial injuries in children without hampering the facial growth.

Materials and Methods:

Sixty child patients with facial trauma were selected randomly for this study. On the basis of examination and investigations a suitable management approach involving rest and observation, open or closed reduction and immobilization, trans-osseous (TO) wiring, mini bone plate fixation, splinting and replantation, elevation and fixation of zygoma, etc. were carried out.

Results and Conclusion:

In our study fall was the predominant cause for most of the facial injuries in children. There was a 1.09% incidence of facial injuries in children up to 16 years of age amongst the total patients. The age-wise distribution of the fracture amongst groups (I, II and III) was found to be 26.67%, 51.67% and 21.67% respectively. Male to female patient ratio was 3:1. The majority of the cases of facial injuries were seen in Group II patients (6-11 years) i.e. 51.67%. The mandibular fracture was found to be the most common fracture (0.60%) followed by dentoalveolar (0.27%), mandibular + midface (0.07) and midface (0.02%) fractures. Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

Etiology and patterns of facial lacerations and their possible association with underlying maxillofacial fractures

BACKGROUND

This study was designed to analyze the etiology and patterns of soft-tissue facial lacerations associated with maxillofacial fractures and to identify associations between facial lacerations and underlying fractures.

METHODS

Of 1960 patients who had been admitted for maxillofacial fractures between 2001 and 2010, only patients with complete clinical records presenting with facial lacerations were considered for this study. Facial lacerations were classified according to the MCFONTZL system.

RESULTS

Of the 1960 patients admitted with maxillofacial fractures, 637 had 836 associated facial lacerations. Motor vehicle accidents and falls were responsible for most injuries to patients with facial lacerations. According to etiology, fractures resulting from work-related accidents more frequently produced associated lacerations.For all causes of injury, more facial lacerations were observed over the "T" area formed by the upper orbit and forehead, nose, upper and lower lips, and chin. Lacerations and maxillofacial fractures were more frequently localized to the middle third of the face, followed by the inferior third.There was a strong association between lacerations and fractures in the chin region, considering both symphyseal and parasymphyseal fractures (direct trauma) and condylar fractures (indirect trauma).

CONCLUSIONS

An association between facial lacerations and underlying maxillofacial fractures was observed, particularly in the inferior orbital area and over the zygoma, mandible, and chin.

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.

Determinants of helmet use behaviour among employed motorcycle riders in Yazd, Iran based on theory of planned behaviour

This paper reports on predictors of helmet use behaviour, using variables based on the theory of planned behaviour model among the employed motorcycle riders in Yazd-Iran, in an attempt to identify influential factors that may be addressed through intervention efforts. In 2007, a cluster random sample of 130 employed motorcycle riders in the city of Yazd in central Iran, participated in the study. Appropriate instruments were designed to measure the variables of interest (attitude, subjective norms, perceived behaviour control, intention along with helmet use behaviour). Reliability and validity of the instruments were examined and approved. The statistical analysis of the data included descriptive statistics, bivariate correlations, and multiple regression. Based on the results, 56 out of all the respondents (43.1%) had history of accident by motorcycle. Of these motorcycle riders only 10.7% were wearing their helmet at the time of their accident. Intention and perceived behavioural control showed a significant relationship with helmet use behaviour and perceived behaviour control was the strongest predictor of helmet use intention, followed by subjective norms, and attitude. It was found that that helmet use rate among motorcycle riders was very low. The findings of present study provide a preliminary support for the TPB model as an effective framework for examining helmet use in motorcycle riders. Understanding motorcycle rider's thoughts, feelings and beliefs about helmet use behaviour can assist intervention specialists to develop and implement effective programs in order to promote helmet use among motorcycle riders.

Analysis of the pattern of maxillofacial fractures in north western of Iran: A retrospective study

BACKGROUND

Maxillofacial fractures can lead to substantial long-term functional, esthetic and psychological complications.

AIM

The aim of this study is to evaluate these injuries in a Turkish Iranian population.

MATERIALS AND METHODS

A retrospective study of 170 patients with 210 maxillofacial fractures admitted to the emergency department of a central referral emergency hospital in the area over a 5 year period is presented. Patients' data included demographic information, etiology, site and associated injuries and complications.

RESULTS

Road traffic accident was the commonest cause (40%) and the age group of 21-30 comprised the biggest group (30%). Mandibular fractures outnumbered midface fractures (150 vs. 60). Ramus (21.5%) and zygoma (26.5%) were the commonest fracture regions respectively in mandible and midface. Male: female ratio was 3.8:1 Almost half of patients (46%) had sustained associated injuries most of which was soft tissue laceration of the face (17.5%). 22 patient (13%) had associated complication and the hemorrhage was the commonest form of that (9%).

CONCLUSION

It seems that road traffic accidents continue to be the leading cause of maxillofacial fractures and there is an urgent need to implement enhanced regulations and monitoring on motor vehicular traffic.

Factors influencing the incidence of maxillofacial fractures

PURPOSE

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed.

METHODS

An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures.

RESULTS

From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma.

CONCLUSIONS

Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial fractures will be seen.