Characteristics of maxillofacial trauma in females: A retrospective analysis of 367 patients

Patterns and characteristics of maxillofacial fractures in women

PURPOSE

Facial trauma in women is complex with physical, psychosocial, and cultural influences impacting clinical presentations. Although multifactorial, assaults and falls are principally reported as the main causes.

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 in women that attended or were referred to the unit were included in this study. The primary objective was to analyse epidemiological trends of facial fractures and clinical outcomes in the South Australian female population.

RESULTS

There is a bimodal distribution of facial fractures at 25-35 years and 65 + years. Indigenous females were 19.5 years younger than non-indigenous females (30.5 vs 49.9, P < 0.001). Approximately half the cohort had a fall-related facial fracture, followed by assault (26.2%), and sports (10.3%). There was a higher proportion of non-alcohol-related trauma from assaults than alcohol-related assaults (72.5% vs 27.5%, P < 0.001). Over half (58.0%) of the cohort had a midface fracture. The elderly had increased odds of 1.9 fold for facial fractures in winter, largely from falls, compared to younger women. Associated injuries were present in almost half the elderly women with 2.6 times the risk compared to younger women. Younger women had higher incidences of surgical intervention (52.6% vs 14.3%, P < 0.05).

CONCLUSIONS

Young women disproportionately experience larger incidences of non-alcohol-related assaults requiring operative intervention of the mandible, whereas elderly women principally suffer fall-related facial fractures with higher rates of associated injuries.

A multicentric, prospective study on oral and maxillofacial trauma in the female population around the world

BACKGROUND/AIMS

Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1-year period.

METHODS

The following data were collected: age (0-18, 19-64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization.

RESULTS

Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20-39 years. The main causes were falls (43% [median age, 60.5 years]), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% [median age, 29.5 years]). Assaults (15% [median age, 31.5 years]) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction.

CONCLUSION

Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19-64 years, and they are related to alcohol use.

Maxillofacial fractures in females: a 5-year retrospective review

BACKGROUND

This retrospective study reviews the maxillofacial fractures (MF) over a 5-year period at the National Maxillofacial Unit, St James Hospital Dublin, with an emphasis on female patients.

MATERIALS AND METHODS

The trauma database was analysed from January 2015 to December 2019. The following demographic details were recorded: patient age and gender, mechanism of injury, and facial fracture sites. This retrospective study did not require approval from the local IRB.

RESULTS

A total of 4761 patients had facial fractures during the study: 1125 (24%) female, 3636, (76%) male. Females had 1190 facial fractures, with two fracture peaks: 20-39 years and 70-89 years. In males, the majority of fractures occurred between 20 and 39 peaking at 20-29 years and tailed off thereafter. In the females the most common fracture sites were zygomatic 402 (34%), nasal 311(26%), orbital (22%), and mandibular 141(12%). There were also smaller percentages of frontal (0.8%), maxillary (4%), and Le Fort fractures (1%). Two hundred and sixty-two (23%) females were managed surgically and 853 (77%) non-surgically.

CONCLUSION

This study confirms maxillofacial fractures are less common in females. The female age distribution demonstrates two peaks, one in early adult and a second in old age. This may be explained by females living longer and independently and at risk for falls. The most commonly reported fracture aetiology in females was "falls." This raises concerns as to whether "falls" are used to explain an assault. There is an informal concern amongst maxillofacial surgeons that females presenting with facial trauma may be the victims of domestic violence, which may be denied by the victims.

Comparing Urban Maxillofacial Trauma Patterns to the National Trauma Data Bank©

OBJECTIVES

We aimed to determine whether certain maxillofacial fracture patterns and injury mechanisms were more prevalent in an urban environment. In addition, we aimed to determine if maxillofacial trauma incidence correlated with income.

METHODS

Data was collected from Einstein Healthcare Network and Temple University Health System. These data were compared to the 2016 National Trauma Data Bank© (NTDB©) using chi-square analysis. Multivariate analysis was used to identify correlations between demographic variables and fracture patterns. Sociodemographic data was further characterized utilizing neighborhood mapping.

RESULTS

A total of 252 patients from our urban campuses and 14 447 patients from the NTDB© were identified with facial fractures. Maxillofacial trauma patients in the urban population were more likely to be minorities and less likely to be Caucasian compared to the NTDB© (P < .001). Patients in the urban setting were more likely to sustain mandibular and orbital fractures, and less likely to sustain maxillary fractures and multiple fractures (P < .001). Urban maxillofacial trauma patients were more likely to sustain assault and sporting injuries, and less likely to sustain injuries from motor vehicle accidents and self-harm (P < .001).

CONCLUSIONS

Maxillofacial trauma patterns and injury mechanisms were shown to be significantly different in an urban environment as compared to national data.

Maxillofacial Prosthesis in Dentofacial Traumas: A Retrospective Clinical Study and Introduction of New Classification Method

Background. Maxillofacial trauma represents a field of common interest as regards both the maxillofacial surgery and prosthodontics, especially for the functional and aesthetic stomatognathic rehabilitation. This condition necessitates relationship between maxillofacial surgeon and prosthodontist, to achieve the ultimate treatment goal. Purpose. The purpose of this study is to make predictable patients outcomes classifying their clinical data, using certain parameters and introducing a new classification method. Materials and Methods. We have chosen 7 parameters to classify the entity of the damage of these patients and to make their treatment and their prognosis predictable: number of teeth lost (T1–T4), upper/lower maxilla (U/L), alveolar/basal bone (Alv/B), gingival tissues (G), soft tissues (S), adult/child (a/c), and reconstructed patient (R). Results and Conclusions. The multidisciplinary approach and the collaboration between multiple clinical figures are therefore critical for the success of the treatment of these patients. The presence and quantification of above parameters influence the treatment protocol; patients undergo different levels of treatment depending on the measured data. The recognition of certain clinical parameters is fundamental to frame diagnosis and successful treatment planning.

Incidence and patterns of maxillofacial trauma-a retrospective analysis of 3611 patients-an update

BACKGROUND

Maxillofacial fractures occur in a significant proportion worldwide and can occur as an isolated injury or in combination with other severe injuries including cranial, spinal, and upper and lower body injuries requiring prompt diagnosis with possible emergency interventions. The epidemiology of facial fractures varies with regard to injury type, severity, and cause and depends on the population studied. Hence, understanding of these factors can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries.

MATERIALS AND METHODS

In this present retrospective study, we provide a comprehensive overview regarding cranio-maxillofacial trauma on 3611 patients to assist the clinician in assessment and management of this unique highly specialized area of traumatology. A preformed pro forma was used to analyze the medical records of patients treated for facial trauma in The Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai. The distribution according to age, gender, etiology, type of injury, time interval between accident and treatment, loss of consciousness, facial bones involved, pattern of fracture lines, treatment offered, and postoperative complications were recorded and evaluated.

RESULTS

We inferred male patients sustained more injuries mostly in the third decade of age. Road traffic accidents were the most common cause of injury. Mandible was the most commonly fractured bone in the facial skeleton. Soft tissue injuries occurred more in road traffic accidents and upper lip was the commonest site of injury.

CONCLUSION

Our study provides insights into the epidemiology of facial injuries and associated factors and can be useful not only in developing prevention strategies but also for grading the existing legal regulations and also for framing a more effective treatment protocol.

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.

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.

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.

Maxillofacial Fractures due to Falls: does Fall Modality Determine the Pattern of Injury?

Objectives

In several epidemiological studies of maxillofacial trauma, falls were one of the most frequent causes of facial injury. The aim of this study is to analyse the patterns of fall-related maxillofacial injuries based on the height of the fall.

Material and Methods

Using a systematic computer-assisted database of patients hospitalised with maxillofacial fractures, only those with fall-related injuries were considered. The falls were divided into four groups: falls from slipping, tripping or stumbling (STSF), loss of consciousness (LOCF), stairs (SAF), and height (HF). Data on the age, gender, fracture site, Facial Injury Severity Scale (FISS), facial lacerations, associated lesions, type of treatment, and length of hospital stay were also analysed.

Results

This study included 557 patients (338 males, 219 females; average age 51.5 years [range 4 - 99 years]). In the over 60 age group, females were more prevalent in STSF than males. According to aetiology, STSF was the most frequent cause of maxillofacial fractures (315 patients; 56.5%) followed by LOCF (157; 28.2%), HF (55; 9.9%), and SAF (30; 5.4%). The middle third of the face was affected most frequently. After LOCF, however, the inferior third was prevalently involved. The majority of associated fractures, as well as the most severe injuries and greatest rate of facial lacerations, occurred secondary to HF.

Conclusions

This study showed that fracture severity and site are influenced not only by patient age, but also by the nature of the fall.

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.

Medial canthopexy of old unrepaired naso-orbito-ethmoidal (noe) traumatic telecanthus

INTRODUCTION

Traumatic telecanthus resulting from injuries to the naso-orbito-ethmoidal (NOE) complex is a difficult deformity to treat and involves both esthetic and functional aspects. Delayed or inadequate primary treatment often results in scarring and secondary deformities that are severe and make them extremely problematic to correct. The intricate anatomy of this area makes NOE injuries one of the most challenging areas of facial reconstruction. Several techniques were described to reconstruct the medial canthal tendon (MCT) and repair the telecanthus deformity. Transnasal wiring remains the gold standard. However, the procedure is technically difficult. It necessitates wide exposure sufficient to allow transverse passage of wires through bony fenestrations deep within the orbit, and involves dissection of the contralateral orbit.

AIM

This study proposes a minor modification to simplify transnasal-wiring technique in the difficult cases presenting with telecanthus following unrepaired NOE fractures.

PATIENTS & METHODS

The study included 13 patients (11 males and 2 females) presenting with telecanthus, at least six months after sustaining NOE fractures. Transnasal canthopexy was the fundamental step in reconstruction. Two wires held independently the anterior and posterior limbs of the MCT to ensure an adequate grip. They were delivered in a single pass through a single hole instead of two to avoid weakening of the thin lacrimal bones. The wires were then secured to a titanium mesh fixed to the contralateral medial orbital rim to guarantee a stable fixation.

RESULTS

The technique restored the normal canthal position along the lacrimal crest. Good functional and esthetic results are reported based on the measurement of pre- and postoperative intercanthal & canthal-midline distances over a period of 2-years, with an average follow-up period of 12 months.

CONCLUSION

The results reveal the simplicity and reliability of this technique in restoring palpebral shape and intercanthal distance without any recoded functional complications throughout the follow-up.

Closed head injury

Closed head injuries vary from the very minor to the catastrophic. It is often difficult to differentiate the severity at initial presentation. Serial assessment is very valuable. Awareness of facial injuries is aided by familiarity with facial bone anatomy and the clinical presentation of orbital, zygomatic, maxillary, and mandibular fracture. Functional injury such as concussion may coexist with other injuries. This article will discuss closed head trauma and outline specific injuries to the face, brain, skull, and its surroundings.

Mandibular cortical shape index in non-standardised panoramic radiographs for identifying patients with osteoporosis as defined by the German Osteology Organization

The aim of this prospective controlled study was to determine the validity of the mandibular cortical shape index (CI) on panoramic radiographs in distinguishing patients with osteoporosis as defined by the German Osteology Organization (Dachverbands der Deutschsprachigen Osteologischen Fachgesellschaften, DVO). The study group contained 50 patients (33 female, 17 male, mean age: 74.9 years), who had a high risk of osteoporosis. 50 young patients (33 female, 17 male, mean age: 37.9 years) with no anamnestic evidence of osteoporosis served as control. Three blinded observers evaluated panoramic views of the study and the control group in a mixed manner regarding the mandibular cortical shape index. The study group underwent bone mineral density measurement using dual energy X-ray absorptiometry and received a diagnosis according to the Organization's guidelines (normal, osteopenia, osteoporosis). The CI showed a high sensitivity of 72.2% and a high specificity of 93.9% with a highly significant predictive value (Chi-square = 22.96, p < 0.001), while the observer's agreement was moderate (kappa = 0.47). We concluded that patients with a cortical shape index of the category assessed as "severe" on non-standardised panoramic radiographs have a higher risk of suffering systemic osteoporosis. The CI in panoramic radiographs is a good screening tool, which could be implemented in the routine assessment of panoramic radiographs in elder patients.

Development of a regional database for studying epidemiology of maxillofacial trauma

This article discusses the development of the first regional computerized database for the epidemiological evaluation of maxillofacial trauma and tests its usefulness by evaluating the appropriateness and completeness of the resulting information.The database was developed using Microsoft Access, implemented using Visual Basic. Data were entered in the database by 4 different maxillofacial specialists, one from each of the 4 main regional hospitals where maxillofacial trauma is treated. Clinical information was taken from 100 complete records of patients hospitalized for maxillofacial fractures at the Maxillofacial Division of San Giovanni Battista Hospital in Turin from January to June 2009.Thirteen database fields were used: general information, cause and mechanism of injury, fracture site, Facial Injury Severity Scale, head and neck examination, associated injuries, timing and type of surgery, and days of hospitalization.Overall, the data entered were 99.45% complete and 99.5% accurate. Thus, our regional maxillofacial database can be considered complete and accurate. Some of the errors, mainly in the fields "fracture site" and "Facial Injury Severity Scale," were attributable to an incorrect interpretation of facial fracture diagnoses, based on the medical records that were provided.