The psychosocial characteristics and needs of patients presenting with orofacial injury

Urban Violence and Maxillofacial Trauma: Sex Differences in a Cross-Sectional Study From Belo Horizonte, Brazil

BACKGROUND/AIM

Urban violence represents a significant public health issue globally due to its profound impact on daily life and the high prevalence of victims seeking care in health services. This study aims to evaluate sex differences in victimization patterns, using maxillofacial trauma as a marker for urban violence.

MATERIAL AND METHODS

This cross-sectional study analyzed data from medical records of patients treated for traumatic injuries at a referral hospital for traumatology in Belo Horizonte, Brazil, between January 2008 and December 2022. Statistical analysis included both descriptive and multivariate methods, with logistic regression used to examine the association between epidemiological variables and sex in cases of urban violence leading to maxillofacial trauma, especially those resulting from interpersonal violence and traffic accidents.

RESULTS

A total of 6447 records were reviewed, with 32.5% of the cases involving female patients. Among female victims, the age group of 30 to 59 years was the most frequently affected. Violence predominantly occurred at night (75.8%) and on weekdays (52.8%), with most cases classified as naked aggression (71.4%). Women were less likely to sustain multiple fractures than men (OR = 0.72, 95% CI 0.57-0.92) when compared to dentoalveolar trauma. Additionally, female patients with facial trauma were more likely to receive conservative treatment compared to male patients (OR = 1.58, 95% CI 1.31-1.91).

CONCLUSION

Sex differences are an important parameter in understanding victimization patterns associated with maxillofacial injuries resulting from urban violence. Is the findings suggest that men are more frequently victims of severe trauma and are more likely to undergo surgical treatment for maxillofacial fractures than women.

Post-traumatic stress disorder in maxillofacial trauma victims- A systematic review and meta-analysis

BACKGROUND

Maxillofacial trauma often results in visible facial disfigurements and can lead to psychological complications such as post-traumatic stress disorder (PTSD). However, PTSD often remains unrecognized and un/undertreated. The goal of the current systematic review was to determine the incidence of PTSD after maxillofacial trauma, associated risk factors, assessment tools employed, and management.

METHODS

A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases following PRISMA guidelines up to March 2024. Collected variables included the number of patients included, PSTD assessment tool, PTSD incidence, and risk factors and management. The meta-analysis was conducted using random effect models in STATA 16.

RESULTS

The review included 14 studies (1633 patients, male=1025, female=230, not mentioned=378). Assessment tools varied widely among studies. Meta-analysis revealed a pooled incidence of PTSD of 27 % (n = 14, 95 % CI, 24 %-30 %) at 1-3 months post-trauma and 10 % (n = 3, 95 % CI, 3 %-17 %) at the 6-12 months follow-up, with a statistically significant 60 % reduction between these periods.

CONCLUSION

The overall incidence of PTSD following maxillofacial trauma was 27 % at 1-3 months and decreased to 10 % after 6 months. The emphasis should be given to the importance of early intervention strategies and awareness among the treating surgeon to prevent PTSD.

Face Treatment Using Nonsurgical Mini-Invasive Techniques as Postsurgical Procedure for Traumatic Injury

BACKGROUND

Facial trauma can cause major psychological damage and compromise a patient's quality of life. Unfortunately, surgery cannot always solve this problem or provide an acceptable result.

OBJECTIVES

Treatment with injectables may provide a solution that is minimally invasive and better accepted by patients as a means to improve poor outcomes after facial trauma.

METHODS

This retrospective study involved 50 patients (29 men, 21 women) who underwent primary surgery to treat facial trauma between January 2015 and January 2017. Based on the facial area affected by poor outcomes (upper face, midface, and lower face), patients underwent ≥1 aesthetic medicine treatments with hyaluronic acid dermal fillers and botulinum toxin injections. To evaluate patient satisfaction and the effect of the treatment on quality of life, patients were asked to complete 2 questionnaires, POSAS and FACE-Q, prior to treatment and 90 days after the last treatment session.

RESULTS

Questionnaire scores indicated improvements in aesthetic and psychological metrics, perceived both by the patient and the observer.

CONCLUSIONS

Minimally invasive aesthetic treatments represent a valuable adjunct to surgical procedures for improving facial aesthetics after injury and consequently the quality of life of patients affected by facial trauma.

LEVEL OF EVIDENCE: 4

Prevalence and predictive factors of psychological morbidity following facial injury: a prospective study of patients attending a maxillofacial outpatient clinic within a major UK city

Adults presenting to maxillofacial surgery services are at high risk of psychological morbidity. This study examined the prevalence of depression, post-traumatic stress disorder (PTSD), anxiety, drug and alcohol use, and appearance-related distress among maxillofacial trauma outpatients over medium-term follow-up. It also explored socio-demographic and injury-related variables associated with psychological distress to inform targeted psychological screening protocols for maxillofacial trauma services. Significant associations were found between level of distress at time of injury and number of traumatic life events with levels of depression at 3 months. No significant associations were found between predictor variables and PTSD at 3 months, or with any psychiatric diagnosis at 6 months. The lack of evidence for an identifiable subgroup of patients who were at higher risk of psychological distress indicated that routine screening of all maxillofacial trauma outpatients should be offered in order to best respond to their mental health needs. The feasibility of the medical team facilitating this is challenging and should ideally be undertaken by psychologists integrated within the MDT. This study led to the funding of a clinical psychologist to provide collaborative care with the maxillofacial surgeons, resulting in brief assessment and treatment to over 600 patients in the first year of the service.