Maxillofacial trauma and the role of alcohol

Does Alcohol Use Influence Hospitalization Outcomes in Adults Suffering Craniomaxillofacial Fractures From Street Fighting?

Study Design

This retrospective cohort study utilized the National Inpatient Sample (NIS) database for the years 2016-2018. Incidences of street fighting were identified using the corresponding ICD-10 codes.

Objective

To determine whether alcohol use (measured by blood alcohol content (BAC)) in patients sustaining maxillofacial trauma from hand-to-hand fighting influence hospitalization outcomes.

Methods

The primary predictor variable was BAC stratified into six categories of increasing magnitude. The primary outcome variable was mean length of hospital stay (days). The secondary outcome variable was total hospital charges (US dollars).

Results

Our final sample consisted of 3038 craniomaxillofacial fractures. Each additional year in age added +$545 in hospital charges (P < .01). Non-elective admissions added $14 210 in hospital charges (P < .05). Patients admitted in 2018 experienced approximately $7537 more in hospital charges (P < .01). Le Fort fractures (+$61 921; P < .01), mandible fractures (+$13 227, P < .01), and skull base fractures (+$22 170; P < .05) were all independently associated with increased hospital charges. Skull base fractures added +7.6 days to the hospital stay (P < .01) and each additional year in patient age added +.1 days to the length of the hospital stay (P < .01).

Conclusions

BAC levels did not increase length of stay or hospitalization charges. Le Fort fractures, mandible fractures, and skull base fracture each independently increased hospital charges. This reflects the necessary care (ie, ICU) and treatment (ie, ORIF) of such fractures. Older adults and elderly patients are associated with increased length of stay and hospital charges-they are likely to struggle in navigating the healthcare system and face socioeconomic barriers to discharge.

The effectiveness of electronic screening and brief intervention for alcohol-related maxillofacial trauma: a randomized controlled trial

OBJECTIVES

This study aims to deliver a novel web-app-based electronic Screening and Brief Intervention to patients with alcohol-related facial trauma and assess changes in at-risk drinking behaviors and attitudes toward their drinking and alcohol-related trauma.

STUDY DESIGN, SETTING, AND SAMPLE

This was a 2-arm parallel randomized controlled trial. Participants who had sustained alcohol-related facial injuries were recruited from 3 Australian hospitals.

RESULTS

Fifty-six participants were enrolled and randomized initially with 45 participants completing the questionnaire at baseline and 3-month follow-up. Most of the participants were male (71.1%), aged between 18 and 29 (40%), and presented to the ED for the first time (68.9%). The study revealed that the intervention group participants found the information provided via the e-SBI helpful in changing their drinking habits and seek help. The e-SBI intervention had a moderate effect on ASSIST Scores (d = -.59; 95% CI, -.03, 1.18). The effect sizes of the e-SBI on the secondary outcomes also ranged between small and moderate.

CONCLUSIONS

The novel app-based e-SBI can effectively deliver information on harmful drinking and provide brief intervention and other venues for help and subsequently improve awareness and willingness to seek help and reduce the risk of injury recurrence.

Predictors of Facial Fractures in Trauma Patients: Retrospective Review at a Level I Trauma Center

BACKGROUND

The incidence and causes of facial fractures differ between patients, but patterns arise within populations. These patterns vary by gender, age, and between countries. This study aims to determine variables to identify patients at risk for facial fractures in a United States trauma population.

METHODS

This is a single-center study of Trauma Registry data, inclusive of years July 1, 2016, to January 31, 2022. Inclusion criteria were based upon all trauma patients. Confirmation of a non-isolated facial fracture (dependent variable) was verified using ICD10 diagnosis codes. A logistic regression was performed in SPSS to ascertain the effects of predictor variables on the likelihood that a trauma patient will experience a facial fracture.

RESULTS

20377 patients were included in the analysis based upon the requirements specified in the methods section; 1575 (7%) had a positive facial fracture. The logistic regression model was statistically significant (N = 18507, P < .01). Significant risk factors for facial fracture identified included helicopter transport (OR = 1.35, P < .01) and increasing injury severity scores (OR = 1.07, P < .01). Modes of injury most likely to predict facial fracture included assault (OR = 6.62, P < .01), moped (OR = 2.02, P < .01), and motorcycle trauma (OR = 1.55, P < .01). The discharge disposition most likely among facial fracture patients included short-term general hospital (OR = 1.71, P < .01) and intermediate care facility (OR = 4.47, P < .01).

CONCLUSIONS

Patients with traumatic injuries from assault, moped, and motorcycle accidents were more likely to present with facial fractures. These patients had more severe injuries, seen as increased ISS scores, higher likelihood of transport by helicopter, and the need for additional care after discharge.

Emergency versus semi-elective management of mandible fractures: a Maxillofacial Trainee Research Collaborative (MTReC) study

INTRODUCTION

Recent evidence suggests that acute emergency management of mandible fractures does not improve surgical outcomes yet is associated with increased financial burden. Current NHS policy advocating for increased adoption of day-case and semi-elective surgical procedures to reduce bed strain must be balanced with providing timely, effective treatment. Our research aims to determine patient groups currently managed via semi-elective admission and whether this can be extended to other groups to provide safe and effective management of mandible fractures.

METHODS

A multi-national trainee-led audit of mandibular fractures across 49 units was completed by the Maxillofacial Trainee Research Collaborative (MTReC). Each unit prospectively collected data on fractures on admission and at follow-up. Data collected included patient demographics, behaviour, health, injury, timing to intervention and surgical complications.

RESULTS

Data were collected on 947 mandibular fractures. Of the surgically managed patients, 649 (90%) were managed via acute emergency admission at the time of presentation, while 68 (10%) were managed semi-electively. Patient demographics, injury pattern and mechanism appeared to significantly affect timing of management, whereas patient behaviour, health status, timing of injury and presentation did not. Semi-elective management was associated with a significantly shorter inpatient duration (0.9 versus 1.9 days, p=0.000) with no differences in readmission, antibiotic usage or surgical complications (p=1.000, RR 1.030).

CONCLUSION

Our study demonstrates the efficacy of planned admissions and semi-elective management of mandibular fractures. Simple mandibular fractures in compliant patients are suitable for semi-elective treatment. Holistic patient assessment and tailored surgical planning is crucial in determining admission modality to effectively manage mandibular trauma.

Socioeconomic disparities in rates of facial fracture surgeries for women and men at a regional tertiary care centre in Australia

BACKGROUND

Assault is the most common mechanism of injury in patients presenting with facial trauma in Australia. For women, there is a propensity for maxillofacial injuries to stem from intimate partner violence (IPV). Those with a low socioeconomic status have higher rates of IPV. This study examines variations in the proportion of surgical procedures that are due to facial trauma for Australian women and men by employment status and residential socioeconomic status.

METHODS

A single centre retrospective study was conducted (2008-2018). The proportion of operative patients presenting with facial fractures was examined. Multivariable logistic regression adjusting for year and age, was performed for women and men.

RESULTS

Facial fractures comprised 1.51% (1602) of all surgeries, patients had a mean age of 32, and 81.3% were male. Unemployed patients were more likely to require surgery for a facial fracture (OR 2.36 (2.09-2.68), P <0.001), and there were no significant variations by index of economic resources (IER). Unemployed males had higher rates of facial fractures (OR 2.09 (1.82-2.39), P <0.001). Unemployed and disadvantaged IER females had higher rates of facial fractures (OR 5.02 (3.73-6.75), P <0.001 and OR 2.31(1.63-3.29), P <0.001).

CONCLUSIONS

This study found disparities in rates of surgery for facial fractures; unemployment increased the rates for men and women, whereas disadvantaged IER increased rates for women. Studies have demonstrated higher rates of IPV for unemployed and low socioeconomic status women. Further research ascertaining the aetiology of these disparities is important both for primary prevention initiatives and to enable treating clinicians to better understand and address the role of IPV and alcohol consumption in these injuries.

The Impact of Lockout Laws on Maxillofacial Fractures in South Australia

INTRODUCTION

Alcohol outlet density and unrestricted trading hours are strongly predictive of domestic and non-domestic assault rates, respectively. International studies report a strong male predominance for facial fractures. Harm minimization policies such as lockout laws have gained considerable attention to reduce accessibility of alcohol consumption and drinking patterns.

METHODS

A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures that attended or were referred to the unit were included in this study. The primary objective was to determine the impact of facial fracture presentations, particularly assaults, for the pre- and post-lockout periods.

RESULTS

From 2012 to 2017, there was a 5.1% decrease in assaults per year (P = 0.002). Assaults increased by 11.7% for women and alcohol related assaults decreased by 10.2% for men (P < 0.05). Assault and alcohol related assault rates decreased by 9.3% and 10.5%, respectively, between lockout periods (P < 0.001). Comparative analysis between Adelaide and control (inner regional city) showed assaults decreased by 9.8% between lockout periods (51.2% versus 41.4%, P < 0.001). Multivariate analysis showed alcohol, open reduction internal fixation and men were associated with a lower risk of assault related fractures, but women and night time presentations had a higher risk (P < 0.05).

CONCLUSIONS

The influence of lockout laws contributed to an overall decrease in assaults and operative interventions, particularly alcohol related incidences amongst men. Ongoing longitudinal surveillance should guide current evidence for policy developers to reduce the risk of harm.

What Are the Risk Factors of Incurring Maxillofacial Fractures From Unarmed Hand-To-Hand Combat?

PURPOSE

The purpose of our study was to determine the risk factors of incurring maxillofacial fractures among individuals who engage in unarmed hand-to-hand combat.

METHODS

The following retrospective cohort study was competed using data from the Nationwide Inpatient Sample. The primary predictor variable was blood alcohol level. The primary outcome variable maxillofacial fracture. We used SPSS to conduct all statistical analyses.

RESULTS

Our final sample consisted of 9,441 patients injured from unarmed hand-to-hand combat. The mean age of the sample was 38.7 years. The most common age group was young adults (42.9%), followed closely by middle-aged adults (41.9%). The number of males was nearly 4 times that of females. The mandible was the most frequently fractured maxillofacial bone. Concerning the mandible per se, the angle (37.1%) was the most frequently fractured site, while the coronoid process (0.2%) was the least frequently fractured site. Relative to females, males were 2.7 times more likely to incur a craniomaxillofacial fracture (P < .5).

CONCLUSIONS

Males had an increased risk of maxillofacial fracture relative to females. The mandible, particularly the angle, was the most frequently fractured maxillofacial bone. We speculate this is because hooks are frequently thrown in unarmed hand-to-hand combat.

Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team

Introduction:

This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon.

Methods:

We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical).

Results:

182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol.

Conclusion:

In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.

Potentially modifiable patient factors in mandible fracture complications: a systematic review and meta-analysis

The mandible is the most common bone to develop complications following treatment of facial fractures. This is due to a complex interaction of both fracture specific and patient factors. Our aim was to identify those patient factors, with a specific focus on those that may be potentially modifiable to reduce the incidence of complications. A systematic review of the literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to identify patient factors ascribed to an increased risk of complications following the treatment of mandibular fracture. These were divided into non- modifiable and potentially modifiable factors. A meta-analysis was performed to weight those factors for which statistical analysis had been performed. Twenty-two pertinent papers were identified, of which eight described non-modifiable and seven potentially modifiable factors. The most common potentially modifiable factor identified was smoking. Meta-analysis established that tobacco smoking demonstrated an increased risk of complications in three studies (Odds Ratio: 4.04 - 8.09). Division of patient factors into those that are potentially modifiable and those that are not will enable clinicians to focus on those in which change within the immediate postoperative period can be instigated. This includes smoking cessation assistance, education as to the need for a soft diet, and facilitating postoperative clinic attendance. It also enables stratification of risk in terms of consent, and choice of treatment. Further research should use standardised terminology, particularly in stopping the use of generalisable terms such as patient compliance and instead describing its individual components.

Health-related quality of life in patients surgically treated for orbital blow-out fracture: a prospective study

Purpose

The purpose of this study was to evaluate patients’ health-related quality of life (HRQoL) before and after surgical treatment of orbital blow-out fracture.

Methods

This prospective study comprises of all adult patients undergoing a surgical reconstruction of an orbital blow-out fracture in 2006–2010. Their HRQoL was evaluated for 6 months postoperatively with the aid of the standardized 15D instrument and was compared with that of an age- and gender-standardized sample of the general Finnish population. A complementary questionnaire for more detailed information was also administered.

Results

Twenty-six patients completed the study. Mean 15D score among the patients preoperatively (0.898) was statistically significantly and clinically importantly worse than the score of the control population (0.936). Six months postoperatively, the mean 15D score was 0.920, with no significant difference compared with the control population and the significant differences on the different dimensions had disappeared. The most common complaint at 6 months postoperatively was diplopia in daily life (19%). Disturbances in facial sensation (27%) and defects in facial appearance (15%) were the most unpleasant subjective outcomes.

Conclusion

The HRQoL is significantly decreased after orbital blow-out fracture compared with the general population but will recover completely in 6 months. Thus, the negative impact of orbital blow-out fracture on HRQoL is only transient. Disturbances in facial sensation, defects in facial appearance, and diplopia are the most common subjective complaints after the injury and its surgical treatment. However, these do not appear to affect the overall quality of life in the long term.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10006-020-00923-x.

A new approach to recording nasal fracture in skeletonized individuals

OBJECTIVE

This work describes a new method for recording nasal fracture in skeletonized individuals, suitable for use in biocultural studies of violence and fracture in past societies.

METHODS

The method consists in recording the 'side of fracture', 'side of deviation', 'type of fracture', 'other facial fractures', and stage of 'bone remodeling'.

RESULTS

A lateral impact force to the facial area is typical of interpersonal violence. This may result in a unilateral nasal fracture and/or a laterally deviated nose. Given the predominance of right-handedness in human populations, side of fracture and, especially, side of deviation, may be useful indices of interpersonal violence. As regards fracture type, although a distal fracture of the nasal bones is the most common type, their comminution may be associated with higher impact forces. The presence of other facial fractures may also be an indicator of high-energy impacts.

CONCLUSIONS

Different patterns of nasal trauma may be consistent with different etiologies.

SIGNIFICANCE

The method is focused at improving our ability to distinguish the direction and type of impact that caused the injury and, in particular, whether, at a population or sub-group level, such injuries are likely to be predominantly due to violence or to other causes.

LIMITATIONS

Well healed fractures of the nasal bones or injury to the septum may be difficult to identify. Also, it is not possible to confirm if nasal and other facial fractures are temporally concurrent.

SUGGESTIONS FOR FURTHER RESEARCH

To test this method using skeletal collections with known trauma history or 3D prints of modern nasal injuries of known etiologies.

Combined trauma in craniomaxillofacial and orthopedic-traumatological patients: the need for proper interdisciplinary care in trauma units

Aim

The primary aim of this study was to analyze frequency and characteristics of combined facial and peripheral trauma with consecutive hospitalization and treatment.

Materials and methods

The study included all patients with concomitant orthopedic-traumatolgical (OT) and craniomaxillofacial (CMF) injuries admitted to our level I trauma center in 2018. The data were collected by analysis of the institution’s database and radiological reviews and included age, sex, injury type, weekday and time of presentation. All patients were examined and treated by a team of surgeons specialized in OT and CMF directly after presentation.

Results

A total number of 1040 combined OT and CMF patients were identified. Mean age was 33.0 ± 26.2 years. 67.3% (n = 700) were male patients. Primary presentation happened most frequently on Sundays (n = 199) and between 7 and 8 pm (n = 74). 193 OT fractures were documented, where cervical spine injuries were most frequent (n = 30). 365 facial and skull fractures were recorded. 10.8% of the 204 patients with fractures of the viscerocranium presented with at least one fracture of the extremity, 7.8% (16/204) with cervical spine fractures, 33.3% (68/204) with signs of closed brain trauma and 9.8% (20/204) with intracranial hemorrhage.

Discussion

The study shows a high frequency of combined facial with OT-injuries and brain damage in a predominantly young and male cohort. Attendance by interdisciplinary teams of both CMF and OT surgeons specialized in cervical spine trauma surgery is highly advisable for adequate treatment.

Conclusion

Diagnostics and treatment should be performed by a highly specialized OT and CMF team, with a consulting neurosurgeon in a level-1 trauma center to avoid missed diagnoses and keep mortality low.

Effects of alcohol consumption on maxillofacial fractures in simple falls

Objectives

This study aimed to investigate the effects of alcohol consumption (AC) on maxillofacial fractures caused by falls on a level surface (simple falls).

Material and Methods

Patients with maxillofacial fractures caused by falls who visited the Oral and Maxillofacial Surgery Clinic from January 2006 to December 2016 were evaluated. Patients with simple falls were subdivided into those who fell with AC (Falls with AC) and those who fell without AC (Falls without AC).

Results

Of 180 patients with falls with maxillofacial fractures, 155 had simple falls, and 25 patients had falls from a height. Of the simple falls, 52 were Falls with AC, and 102 were Falls without AC. Falls with AC were significantly more frequent in males (p = .0005). The average number of fracture lines in the mandible was significantly higher in Falls with AC (2.13 ± 0.99 [mean ± SD]) than in Falls without AC (1.76 ± 0.91) (p = .011). The average Facial Injury Severity Scale was significantly higher in Falls with AC (3.08 ± 1.43) than in Falls without AC (2.43 ± 1.29) (p = .007).

Conclusions

Falls with AC were associated with more severe maxillofacial fractures than Falls without AC.

Relation between facial fractures and socioeconomic deprivation in the north east of England

Patients with a low socioeconomic status suffer disproportionately from trauma, and have a high incidence of mandibular fractures. To explore how deprivation affects the incidence of facial fractures in the north east of England, we reviewed 1096 patients who were admitted to the oral and maxillofacial surgical (OMFS) unit at Sunderland Royal Hospital for treatment of a facial fracture between December 2013 and December 2017. Levels of socioeconomic deprivation, which were obtained from postcodes and the UK Government Open Data Communities database, were compared with a random sample of deprivation data from the catchment area of our hospital. Patients with nasal and mandibular fractures were more likely to be socioeconomically deprived than those in the catchment area of our hospital (p = 0.006 and p < 0.001, respectively), but this was not the case in those with malar/maxillary or orbital floor fractures (p = 0.184 and p = 0.641, respectively). The incidence of fractures that were caused by assault was not associated with increased socioeconomic deprivation (p = 0.241). Patients of low socioeconomic status were more likely to have been under the influence of a substance when the injury occurred (p = 0.014). There is a strong association between socioeconomic deprivation and facial fractures. OMFS departments should therefore be as accessible as possible to patients from more disadvantaged backgrounds, given their greater risk of injury.

Inter personal violence-related facial injuries: a 10-year survey

Introduction: Interpersonal violence (IPV) has emerged as a worldwide health problem affecting predominantly the face. Patients and methods: This study reports the characteristics of violence, victims and injuries in IPV-related facial injuries patients, in a 10-year survey, in a tertiary hospital of Burkina Faso. Results: Patients’ age ranged from 11 to 75 years (mean 31 years) and 58.2% of the patients were aged between 20 and 39 years. There were 74 males and females 24 giving a male-to-female ratio of 3.1:1. The circumstances of injuries were brawls (80.6%) consisting mostly in facial blows, and hold-ups (19.4%). Fractures involving predominantly the mandible or the zygomatic complex were the most common injury, accounting for 53.2%. Soft tissues injuries accounted for 37.2% and dental trauma for 9.2%. In 27.5% of the patients, extra facial injuries were encountered, dominated by cerebral trauma and limb fractures. Conclusion: In this study, IPV-related facial injuries are mostly mandibular or zygomatic fractures in young and males adults involved in brawls. These findings command strategies for prevention of violence in this specific group.

A Festive Case Series of Emergencies, Admissions and Friendship at a Busy Oral and Maxillofacial Unit

The festive season presents oral and maxillofacial surgery (OMFS) dental core trainees (DCTs) with the challenges of managing an eclectic mix of emergencies. We present three such patients in this case series. First, Patient A, a 39-year-old homeless male who presented with a maxillary extra-oral draining sinus. Secondly, Patient B, a 38-year-old intra-venous (IV) drug user who suffered pan-facial fractures following an alcohol-fuelled assault. Finally, Patient C, a 38-year-old male who sustained a left zygomatic complex fracture a week previously, in attendance for corrective surgery. Despite the hardship, there was still festive cheer to be had by these individuals. Clinical relevance: Primary and secondary care practitioners should be aware of the advanced clinical presentation of dental and maxillofacial emergencies that occur over holiday periods.

Brief alcohol intervention in alcohol involved facial fracture patients-a survey of patient attitudes to screening and intervention

PURPOSE

Alcohol intoxication is an important contributor to traumatic facial injuries. The period following injuries afford clinicians a useful window of opportunity to provide alcohol screening and brief intervention (SBI) which may affect changes in patients' future drinking behaviour. Although SBI has been reported to decrease at risk drinking and potentially trauma recurrence, it is not routinely utilised in most clinical settings in the world. This study aims to assess utilisation of, as well as patients' knowledge and attitude towards SBI in the management of patients presenting with alcohol-related facial fractures.

METHODS

Twenty consecutive patients who presented to Western Health with facial fractures who met selection criteria were offered an alcohol screening and survey questionnaire.

RESULTS

Ninety percent of patients were male and 50% were aged between 19 and 34. ASSIST score showed 65% were in the moderate risk category; 75% reported this was their first admission with alcohol related trauma. Although 75% acknowledged alcohol as a main cause of injury, only 40% agreed they drink too much. Forty-four percent felt that talking to a healthcare worker might help and 33% would consider accepting help. Forty-seven percent felt reading materials would be helpful in changing future drinking habits. Whilst 63% would like to know safe drinking limit, only 45% would like to have a discussion about alcohol-related harms.

CONCLUSIONS

Most patients presented in this survey were in moderate risk category who are amenable to behavioural change with provision of SBI. However, there is resistance to implementation of this intervention due to lack of knowledge, self-awareness and willingness to change. Nonetheless, patients are prepared to accept advice from clinicians and some formats of intervention. It is important to formulate a simple screening questionnaire and intervention strategy that are easy to administer to affect positive changes in patients with harmful drinking behaviours.

Surgical Reconstruction of Lower Face Degloving

One of the most impressive soft tissue injuries is the facial degloving, normally associated with industrial machines and traffic accidents. This injury is characterized by the separation of the skin and cartilage from the bones, compromising the soft tissues correlated in the trauma area, nerves, and blood vessels. A 28-year-old patient, male, was referred to Araçatuba's Santa Casa Hospital, after a motorcycle accident, hitting his face on the sidewalk. The patient was conscious, oriented, denying fainting and unconsciousness during the accident, and complaining of pain in the nasal region of the face. The suture of wounds was performed using 5-0 absorbable sutures for muscle planes, and reconstruction of the septum and nasal cartilages. The skin was sutured with interrupted stitches using 6-0 nylon. After reducing the edema, a slight increase in alar base was observed. Subsequently, the alar base cinch suture was performed aiming to bring the alar bases to a measure of 34.0 mm in diameter. As a conclusion, the knowledge of the anatomy of the region involved, the healing of tissues, and suture techniques for the facial region process were critical to the successful treatment. The evaluation of the alar base in degloving cases can involve aesthetic features.

Pattern of oral-maxillofacial trauma from violence against women and its associated factors

BACKGROUND/AIM

Violence against women is a global public health problem. The aim of this study was to characterize the profile of women victims of violence and identify factors associated with maxillofacial injuries.

MATERIAL AND METHODS

A cross-sectional study was performed based on an evaluation of 884 medico-legal and social records of women victims of physical aggression treated at the Center of Forensic Medicine and Dentistry in Brazil. The variables investigated were related to the sociodemographic characteristics of victims, circumstances of aggressions, and patterns of trauma. Descriptive and multivariate statistics using decision tree analysis by the Chi-squared automatic interaction detector (CHAID) algorithm, as well as univariate and multivariate Poisson regression analyses were performed.

RESULTS

The occurrence of maxillofacial trauma was 46.4%. The mean age of victims was 29.38 (SD=12.55 years). Based on decision tree, the profile of violence against women can be explained by the aggressor's gender (P<.001) and sociodemographic characteristics of victims, such as marital status (P=.001), place of residence (P=.019), and educational level (P=.014). Based on the final Poisson regression model, women living in suburban areas were more likely to suffer maxillofacial trauma (PR=1.752; CI 95%=1.153-2.662; P=.009) compared to those living in rural areas. Moreover, aggression using a weapon resulted in a lower occurrence of maxillofacial trauma (PR=0.476; CI 95%=0.284-0.799; P=.005) compared to cases of aggression using physical force.

CONCLUSIONS

The prevalence of oral-maxillofacial trauma was high, and the main associated factors were place of residence and mechanism of aggression.

Assessment of Oro-Maxillofacial Trauma According to Gender, Age, Cause and Type of the Injury

OBJECTIVES

The occurrence and causes of maxillofacial trauma varies in different regions of the world. The aim of this study was to identify the occurrence, types and causes of maxillofacial injuries according to the age and gender differences in patients treated at the Department of Maxillofacial Surgery, University Hospital Center Osijek, between January 2011 and December 2013.

MATERIALS AND METHODS

A total of 64 patients, 41 males (64.1%) and 23 females (35.9%), aged from 18 to 86 years (mean age 42) participated in the study. Data collected and analyzed included gender, age, cause of injury and the type of maxillofacial injuries.

RESULTS

The most common cause of injuries in both gender groups was falling down (39% males; 65% females). The second leading cause of injuries in males was interpersonal violence (29%) and in females traffic accident (26%) (p<0.05). The most common type of injury in both gender groups was bone injury (50%; in males zygomatic bones 55%, in females mandible 40%) (p>0.05). The most common causes of injuries in the youngest patients was violence (43%), and in others fall (50-70%; p<0.05). The most common reported type of injury in all age groups was bone injury (more than 50%; p>0.05). The majority of the falls and violence caused bone tissue injuries, and soft tissue and dentalveolar injuries were detected in traffic and sports accidents (p>0.05).

CONCLUSION

Falling down was the most common cause of oro-maxillofacial injuries in both men and women and in all three age groups. The leading type of injury was bone injury. The data obtained from this study provide important information for future prevention from injuries.

Systematic review of Australian policing interventions to reduce alcohol-related violence - A maxillofacial perspective

Alcohol-related violence remains to be a health concern, and the oral and maxillofacial surgeons are routinely exposed to its impact on the victims and the healthcare system. At a community level, various policing interventions have been implemented to address this violent crime in and around licensed premises. Current study sought to examine the effectiveness of these interventions in Australia. Ten eligible studies, that evaluated the impact of 15 Australian policing interventions on reducing alcohol-related violence in the night-time economy, were included in this systematic review. Due to the heterogeneity of the study designs and the insufficiency of the reported data, quantitative meta-analysis of the findings was precluded. Instead, a critical narrative approach was used. Police-recorded assault rate was the primary outcome measured to assess the level of alcohol-related violence, which was influenced by the level of police duties implemented during the intervention period. The overall evidence base to support Australian policing interventions was found to be poor and was limited by the low-quality study design observed in the majority of the included studies. However, there is some evidence to suggest interventions involving proactive policing to be more effective than traditional reactive policing. There was also an increased emphasis on developing policing interventions in collaborative partnerships, demonstrating the synergistic benefits in crime prevention through community partnerships, where communities were encouraged to take ownerships of their own problems and develop targeted responses to alcohol-related violence rather than a one-size-fits-all approach. Further research is required to define their effectiveness with the use of more appropriate and robust methodologies.

•

The overall quality of studies on Australian policing interventions in and around licensed premises was poor.

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Police-recorded assault rate was found to be an unreliable source to measure the level of alcohol-related violence.

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There lacks evidence to support the effectiveness of Australian policing interventions in reducing alcohol-related violence.

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There were potential benefits for proactive policing in collaborative partnerships with community stakeholders.

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Studies of higher quality designs are urgently required to appropriately assess current Australian policing strategies.

The effect of deprivation on the incidence of mandibular fractures in a British city

AIM

To examine the relationship between social and material deprivation and mandibular fractures.

METHOD

Three hundred and forty three consecutive patients who underwent mandibular fracture fixation were selected for the study. After exclusions, 290 were divided into age groups and ranked according to their Index of Multiple Deprivation (IMD) score. Rankings were determined using postcodes, and divided into quintiles for statistical analysis.

RESULTS

Ages ranged from 7 to 82 with 146 (50%) patients aged between 20 and 29. Males accounted for 85% of cases. The most common site of fracture was the angle (n = 195) and assault was shown to be the most common mechanism of injury (63.3%). A strong relationship was demonstrated between fractures of the mandible and worsening deprivation, with the most striking relationship seen with fractures sustained as a consequence of assault. Females were less likely than males to sustain a fracture of the mandible as a consequence of assault; however, when assault was the mechanism of injury they were also likely to be from a deprived background.

CONCLUSION

This study has demonstrated that a strong relationship exists between deprivation and the incidence of mandibular fractures in our catchment area. Fractures that resulted from interpersonal violence were shown to have a particularly strong correlation with deprivation.

Etiology and injury patterns of maxillofacial fractures from the years 2010 to 2013 in Mecklenburg-Western Pomerania, Germany: A retrospective study of 409 patients

OBJECTIVE

The aim of the present study was to illustrate the injury patterns and the etiology of accident victims with maxillofacial fractures in the state of Mecklenburg-Western Pomerania (M-P), Germany.

MATERIAL AND METHODS

Between 2010 and 2013, patients with maxillofacial fractures from the Department of Oral and Maxillofacial Surgery at the Helios Kliniken Schwerin, were evaluated with a specially constructed data set in a retrospective analysis. After review of the patient records, a case-related data collection was performed with the pre-set characteristics: age, gender, age group, maxillofacial fracture, and cause of injury.

RESULTS

Of 409 patients, 79% (n = 323) were male and 21% (n = 86) were female. A fracture of the zygomaticomaxillary complex was most frequently observed (31%; n = 240). Midface fractures with orbital floor involvement were the most common fracture types (48.4%; n = 137). A significant percentage of the fractures (45.2%; n = 185) were caused by interpersonal violence; 70.8% (n = 131), and thus the majority of the patients who were treated due to a brutal offense, had consumed alcohol. Within this group, men in the age group of 20-29 years were most prevalent (38.7%; n = 125). Etiologically, 25.2% (n = 103) of fractures were caused by a fall.

CONCLUSION

The regionalization of data on the distribution, emergence, and localization of maxillofacial fractures in M-P allows not only a national comparison but also an international comparison with areas that are in a similar strong socio-demographic change, as it applies to the East German population. This provides the opportunity to develop the global preventive measures and to apply suitable quality management.

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study

OBJECTIVE

The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year.

STUDY DESIGN

The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years.

RESULTS

The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures.

CONCLUSIONS

Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

Etiology, incidence and patterns of mid-face fractures and associated ocular injuries

A prospective study on mid-face fractures was carried out in the Department of Oral and Maxillofacial Surgery at College of Dentistry, Indore, from August 2007 to September 2009 to analyze etiology, incidence and patterns of midface fractures and associated ocular injuries. Two hundred patients were included in this study, amongst those who reported to the Department of OMFS, College of Dentistry, Indore. After confirmed diagnosis of mid face fracture all the patients were stratified according to age, sex, cause of the accident, influence of alcohol, location, type of fractures and associated ocular injuries. The study included 200 patients with a mean age of 29.6 years. The most frequently injured patients belonged to the 21-30 year-old age group. The male predilection was 76 %. Road traffic accident was the most common causative factor (64 %), followed by assault (21 %), cases of fall (9.5 %) and other causes (5.5 %). The most common fracture in this study was found to be zygomatic complex fractures (62.5 %) (more in the age group of 21-30 years). This was followed by Lefort II fractures (23 %), multiple fractures (10 %) and Lefort I fractures (6 %), Lefort III fractures (4.5 %) and Naso-ethmoidal fractures (4 %) in descending order. 84.5 % subjects were having ocular involvement. Subconjunctival hemorrhage was present mostly in 83.5 % followed by remaining as corneal injury 15 %, reduced acuity 11.5 %, diplopia 10.5 %, enophthalmos 8.5 %, telecanthus 5 %, hyphema 3.5 %, blindness 3 % and proptosis 0.5 %. Zygomatic complex fractures were the most frequent type of injury that was complicated by blindness or a serious eye injury (61 %). Collection of data regarding the epidemiology of maxillofacial fractures is important because it may assist healthcare providers to provide necessary information for the development and evaluation of preventive measures. Ocular injuries should have an early ophthalmological examination at the time of trauma to detect any kind of ocular dysfunction.

Assessment of maxillofacial trauma in emergency department

INTRODUCTION

The incidence and epidemiological causes of maxillofacial (MF) trauma varies widely. The objective of this study is to point out maxillofacial trauma patients' epidemiological properties and trauma patterns with simultaneous injuries in different areas of the body that may help emergency physicians to deliver more accurate diagnosis and decisions.

METHODS

In this study we analyze etiology and pattern of MF trauma and coexisting injuries if any, in patients whose maxillofacial CT scans was obtained in a three year period, retrospectively.

RESULTS

754 patients included in the study consisting of 73.7% male and 26.3% female, and the male-to-female ratio was 2.8:1. Mean age was 40.3 ± 17.2 years with a range of 18 to 97. 57.4% of the patients were between the ages of 18-39 years and predominantly male. Above 60 years of age, referrals were mostly woman. The most common cause of injuries were violence, accounting for 39.7% of the sample, followed by falls 27.9% and road traffic accidents 27.2%. The primary cause of injuries were violence between ages 20 and 49 and falls after 50. Bone fractures found in 56,0% of individuals. Of the total of 701 fractured bones in 422 patients the most frequent was maxillary bone 28,0% followed by nasal bone 25,3%, zygoma 20,2%, mandible 8,4%, frontal bone 8,1% and nasoethmoidoorbital bone 3,1%. Fractures to maxillary bone were uppermost in each age group.8, 9% of the patients had brain injury and only frontal fractures is significantly associated to TBI (p < 0.05) if coexisting facial bone fracture occurred. Male gender has statistically stronger association for suffering TBI than female (p < 0, 05). Most common cause of TBI in MF trauma patients was violence (47, 8%).158 of the 754 patients had consumed alcohol before trauma. No statistically significant data were revealed between alcohol consumption gender and presence of fracture. Violence is statistically significant (p < 0.05) in these patients.

CONCLUSION

Studies subjected maxillofacial traumas yield various etiologic factors, demographic properties and fracture patterns probably due to social, cultural and governmental differences. Young males subjected to maxillofacial trauma more commonly as a result of interpersonal violence.

Maxillofacial fractures in the province of pescara, Italy: a retrospective study

The aim of the present study was to assess the etiology and pattern of maxillofacial fractures in the Province of Pescara, Abruzzo, Central Italy. Was performed a retrospective review of patients treated at the Department of Maxillofacial Surgery of Spirito Santo Hospital from January 2010 to December 2012. Data collected and analyzed included sex, age, cause of injury, site of fracture, monthly distribution, and alcohol misuse. A total of 306 patients sustaining 401 maxillofacial fractures were treated. There were 173 males (56.5%) and 133 females (43.5%). Most of the patients (36.9%) were in the age group of 18–44 years. The most common causes of injuries were road traffic accidents (26.4%); the second leading cause was interpersonal violence (23.2%), followed by injuries associated with falls (19.2%). Fractures of the mandible (31%) and zygoma (23%) were the most common maxillofacial fractures in our study. The monthly distribution peaked in the summer (July and August, 30.4%) and in October (13.1%). In conclusion, this study confirms the close correlation between the incidence and etiology of facial fractures and the geographical, cultural, and socioeconomic features of a population. The data obtained provide important information for the design of future plans for injury prevention and for education of citizens.

A lei seca cumpriu sua meta em reduzir acidentes relacionados à ingestão excessiva de álcool?

OBJETIVO: avaliar se a Lei Seca cumpriu sua meta após três anos da promulgação. MÉTODOS: estudo retrospectivo dos pacientes com fraturas craniofaciais submetidos a tratamento cirúrgico em um hospital universitário, em dois períodos: antes (2005 a 2008) e após a implantação da lei (2008 a 2011). RESULTADOS:foram operados 265 pacientes (220 homens e 45 mulheres) nesse período sendo, 149 (56%) antes da lei e 116 (44%) após a lei, indicando redução no número de traumatismos (p=0,04). Houve predomínio da faixa etária entre 19 e 40 anos, em ambos os períodos. As principais causas dos traumas foram os acidentes automobilísticos, as agressões físicas e as quedas. O abuso de álcool foi identificado em 15,4% dos pacientes antes e 19% após a lei. A mandíbula e o complexo maxilozigomático foram os ossos mais acometidos. CONCLUSÃO:a redução no número de politraumatizados operados ficou aquém do esperado e almejado.

Pattern of oral-maxillofacial trauma stemming from interpersonal physical violence and determinant factors

BACKGROUND/AIM

Facial trauma is among the most common types of injury. The aim of the present study was to assess the prevalence and pattern of oral-maxillofacial trauma stemming from interpersonal physical violence (IPV) and determine whether IPV is factor associated with oral-maxillofacial trauma.

MATERIALS AND METHODS

A retrospective analysis was conducted of 790 complete patient charts for data on the type of IPV for the gender, area of residence (urban or rural), age and type of trauma. Statistical analysis involved the chi-squared test (P < 0.05), univariate/multivariate Poisson, and logistic regression (P < 0.20). Type of oral-maxillofacial trauma was the dependent variable. Socio-demographic status and type of IPV were the independent variables.

RESULTS

One hundred forty (17.7%) individuals had oral-maxillofacial injuries stemming from IPV [80 (10.1%) due to urban violence (UV) and 42 (5.3%) due to domestic violence (DV)]. DV was more prevalent among females (69%), and UV was more prevalent among males (67.5%). The most common types of trauma were facial contusion and laceration, dental concussion, and mandibular fracture. Age and UV were explanatory factors for mandibular fracture. Females from rural areas and who suffered DV were more likely to exhibit facial contusion and dental concussion.

CONCLUSIONS

Interpersonal physical violence was identified as a factor associated with oral-maxillofacial trauma, specifically mandibular fracture, facial contusion, and dental concussion.

Overview of the fast alcohol screening test and some patient characteristics from a regional maxillofacial trauma clinic based in Glasgow, United Kingdom

A huge body of evidence exists as to the efficacy of alcohol screening and alcohol brief interventions in a range of settings including maxillofacial trauma clinics. An overview of the Fast Alcohol Screening Test (FAST) and some patient characteristics were gathered from those attending a regional maxillofacial trauma clinic in Glasgow, United Kingdom. A 3-month study was undertaken from March 2011 using the FAST as a means of detecting hazardous or harmful alcohol use. Gender, age, and deprivation were examined from patient records. Descriptive statistics were obtained, and gender, deprivation, and alcohol consumption were analyzed using Spearman's rho to ascertain potential correlations between these variables. Two hundred and eighteen patients (157 men and 61 women) participated in the study. A total of 120 participants were deemed to be FAST positive, with a score of 3 or more. The mean age of all patients was 34 years. Forty-six participants (21.3%) fell into the most deprived category. There was no significant correlation between deprivation and age, and deprivation and alcohol intake, but a significant negative correlation between age and alcohol intake was underscored (r = -.183, n = 218, p = .007, two-tailed). Alcohol screening and alcohol brief interventions appear to be a worthwhile contribution to the service studied. Screening could be utilized more effectively through targeting the young male population. Moreover, additional research needs to be carried out to further ascertain if relationships are present between deprivation and age, deprivation and alcohol intake, and age and alcohol intake.

When nightclub security agents assault clients

In 2006, a medico-legal consultation service devoted to adult victims of interpersonal violence was set up at the Lausanne University Hospital Centre, Switzerland: the Violence Medical Unit. Most patients are referred to the consultation by the Emergency Department. They are received by forensic nurses for support, forensic examination (in order to establish medical report) and community orientation. Between 2007 and 2009, among community violence, aggressions by security agents of nightclubs on clients have increased from 6% to 10%. Most of the victims are young men who had drunk alcohol before the assault. 25.7% presented one or several fractures, all of them in the head area. These findings raise questions about the ability of security agents of nightclubs to deal adequately with obviously risky situations and ensure client security.

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.

[Facial wounds: an epidemiological review of 850 cases]

BACKGROUND

Facial wound are among the most frequent emergencies. They often affect a young population. We studied the epidemiological profile of facial wounds admitted in our hospital.

PATIENTS AND METHODS

This prospective study was carried out in the Emergency Unit from June 2008 to June 2009. It included all patients having presented with at least one facial wound. The analysed parameters were patient, trauma, and wound characteristics.

RESULTS

Eight hundred and fifty patients were included, 20% of whom were female patients. The most frequent etiologies were traffic accidents for men, assault for women, and domestic accidents for children. Alcohol abuse was involved in 12.4% of the cases. The most frequent wound localization was frontal (35.4%). A craniofacial organ (eye, brain…) was affected in 6.1% of the cases; the wound was associated to a craniofacial fracture in 9.6% of the cases, and to an extrafacial lesion in 22% of the cases.

DISCUSSION

Facial wounds are a frequent emergency. They are predominant in young male patients. The high frequency of traffic accident and alcohol abuse requires an adequate prevention policy.

The role of alcohol in maxillofacial trauma: a comparative retrospective audit between the two centers

Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and employment status. Also presented are the differences between the two centers in terms of mechanisms and types of injuries and the locations where these injuries were sustained. Alcohol was involved in 34.78 and 30.77% of patients at Westmead and Birmingham, respectively. A multiple logistic regression analysis revealed a reduced likelihood of alcohol involvement in episodes of maxillofacial trauma where patients were unemployed (P=.04), and where injuries were sustained secondary to mechanisms other than assault (P<.001) and in locations other than pubs and nightclubs (P=.024). There appeared to be no statistically significant contribution to the likelihood of alcohol involvement by treating center, marital status, patient sex, or age. Alcohol continues to be a strong driving factor in cases of maxillofacial trauma, particularly those due to alleged assault, with a typical patient demographic of the gainfully employed frequenting drinking establishments being most at risk for alcohol-related trauma, most commonly sustaining their injuries secondary to assault. Identifying patient groups most at risk is a key step in developing public health strategies aimed at prevention, and our findings would appear to suggest this group of patients as being the most worthwhile to target with measures aimed at reducing alcohol-fueled maxillofacial trauma.

Electronic follow-up of facial lacerations in the emergency department

It is often difficult for emergency department staff to follow up the primary closure of simple facial lacerations. This is important to allow closure of the feedback loop. Consecutive patients who were sutured by a single operator using the same technique were asked to send a photograph of the laceration six months and 12 months afterwards. The patients had Internet access and a digital camera, or a mobile phone with a camera. They were given a leaflet with the details of the email address or mobile number to send the picture to. A reminder telephone call was made to each patient at six months and 12 months, and the email address or mobile number to send the picture to was given again. In each telephone call patients were asked to grade the healing on a 5-point scale from 1 = very happy to 5 = very unhappy. At 13 months all patients were re-contacted and reminded again. Fifty patients were included in the study (33 males). The cause of injury was sport in 17 patients, assault in 18 and accidents in 15. At six months, 23 patients stated that they were happy and 27 were very happy with the scar. The mean score was 1.5. At 12 and 13 months, four patients were happy and 46 very happy. The mean score was 1.1. Twenty-four patients said they would use a computer/camera to send in the follow-up image, and 26 patients had a mobile phone with a camera and said they would use that. Despite the reminders, no patients sent a photograph. The results provide no evidence to support the use of photographs sent by email or text message for the follow-up of facial lacerations sutured in the emergency department.

A summary of trauma and trauma-related papers published in BJOMS during 2008-2009

This paper provides a summary of the 49 trauma and related papers published in British Journal of Oral and Maxillofacial Surgery during the period January 2008 to December 2009. 16/49 (32%) of these publications were full length articles, which covered areas such as epidemiology, service provision, materials and operative surgery. In addition there were other articles including short communications, technical notes, letters to the editor and interesting cases. Whilst fewer full length articles were published compared to the other sub-specialties, it was reassuring to see that the studies represent all aspects of trauma. More basic science and randomized control studies relating to trauma need to be encouraged.

Risk factors for maxillofacial injuries in a Brazilian emergency hospital sample

Background

Maxillofacial injuries occur in a significant number of trauma patients. Epidemiological assessments are essential to reaffirm patterns, identify new trends and develop clinical and research priorities for effective treatment and prevention of these injuries.

Objective

The aim of this study was to identify the epidemiological profile and risk factors associated with maxillofacial trauma treated at a referral emergency hospital for the Public Health System in the State Capital of Goiás, Brazil.

Material and Methods

A cross-sectional study was designed including 530 patients with maxillofacial trauma, 76% male, with a mean age of 25.5±15.0 years. Data were collected between May 2003 and August 2004 over weekly shift-working periods. Results: The main causes of trauma were traffic accidents (45.7%) and physical assaults (24.3%), and differences in etiological factors were identified according to gender (p<0.001). The distribution of patients according to age and etiology showed significant differences for traffic accidents (p<0.01), physical assaults (p<0.001), falls (p<0.001) and sport injuries (p<0.01). In the multinomial logistic regression analysis (R² = 0.233; p<0.05), age was associated with injury in traffic accidents and falls (p<0.01), sports-related accidents were associated with males (p<0.05), and alcohol consumption with assaults and traffic accidents (p<0.001). Facial soft tissue lesions were found in 98% of patients and facial fractures in 51%.

Conclusions

The significant association of maxillofacial trauma with young males and alcohol consumption reinforces the need for educational strategies and the development of policies for the prevention and reduction of associated damage in this specific risk group.

Substance use and facial injury

Substance use is a major contributing factor to the interpersonal violence that accounts for a significant proportion of facial injuries among adults and adolescents; thus, violence is the main "pathway" through which substance use and injuries are linked. Beyond causality, substance use continues to influence recovery from the injury through its impact on the healing process (eg, patient noncompliance, suppression of T-cell counts, susceptibility to bacterial colonization, and protein production). Further exacerbating this issue are significant rates of injury recidivism and the lack of motivation to seek treatment for underlying substance-use problems. As a frontline care provider, the oral and maxillofacial surgeon has a responsibility to screen and refer patients for any needed specialty treatment (including substance-use treatment, violence reduction, and posttraumatic stress reduction). Recognizing and addressing these issues requires a paradigm shift that involves integration of multidisciplinary expertise.