Analysis of 46 maxillofacial fracture victims in the 2008 Wenchuan, China earthquake

Oral Health Interventions in Natural Disasters: A Scoping Review

OBJECTIVES

This work aimed to identify, appraise, and summarize existing knowledge about oral health interventions in the context of natural disasters and verify the main research gaps.

METHODS

We searched in PubMed (National Library of Medicine, Maryland, USA), EMBASE (Elsevier, Amsterdam, Netherlands) and Epistemonikos (Epistemonikos Foundation, Santiago, Chile) until 2021 for primary studies and systematic reviews, assessing any oral health intervention in the context of natural disasters. The interventions were classified according to Cochrane Effective Practice and Organization of Care (EPOC) categories, and the type of natural disaster was defined according to the classification by the Centre for Research on the Epidemiology of Disasters (CRED).

RESULTS

We assessed a total of 19 studies (majorly in Japan, n = 8), all performed in the context of an earthquake or mixed natural disasters (earthquake and tsunami). Regarding interventions, 12 studies reported a promotional/ preventive intervention, with oral examination being the most frequent. 7 studies reported therapeutic interventions, mainly related to emergency management of fractures and injuries.

CONCLUSIONS

The evidence accessed in our study was limited, highlighting the need for further research to focus on different oral health care interventions and outcomes in the context of different natural disasters, thus enhancing the formulation and implementation of recommendations and protocols worldwide.

The Role of Dental Professionals in Pandemic Events and Disaster Responses

The past 20 years have seen major public health emergencies and natural disasters, including the Severe Acute Respiratory Syndrome outbreak caused by the SARS-associated coronavirus (SARS-CoV) in 2003; the Wenchuan earthquake in 2008; and the novel coronavirus pandemic (COVID-19) of 2019, which caused mass casualties, infections, and panic. These also resulted in complex demands for medical resources and information, and a shortage of human resources for emergency responses. To address the shortage of human resources required for these emergency responses, Chinese dental professionals made useful contributions. From this work, deficiencies in emergency response training and opportunities for the expansion of rescue capabilities were identified, and relevant recommendations made.

Epidemiological Profile of Facial Fractures and Their Relationship With Clinical-Epidemiological Variables

The objective of this study was to identify the epidemiological profile of facial fractures and to associate with clinical-epidemiological variables. An epidemiological survey was conducted in which data retrieved from the records of patients with facial fractures were analyzed. Pearson χ(2) test, Student t-test, one-way analysis of variance, Bonferroni post-hoc test, and logistic regression were used for statistical analysis, adopting a level of significance of 5%. The sample consisted of 718 patients ranging in age from 21 to 30 years (56.4%), including 480 (66.9%) men. Traffic accidents were the main etiological agent (62.7%) and the nasal bones were the most affected (41.8%). An association was observed between age and etiology (P < 0.001), fractured bone (P < 0.001), type of treatment (P < 0.001), hospital length of stay (P < 0.001), and complications (P = 0.001). Patients with traffic accident [odds ratio (OR) = 3.08, P < 0.001] and fall (OR = 2.50, P = 0.049) as etiology had more risk of complications. The type of fractured bone was associated with etiology (P < 0.001), type of treatment (P < 0.001), hospital length of stay (P < 0.001), and complications (maxilla--OR = 1.90, P = 0.004). In conclusion, facial fractures predominantly affect men aged 21 to 30 years. Traffic accidents are the main etiology and the nasal bone is the site most affected. It was observed that the older the patient, the greater the susceptibility to falls, surgical treatment, hospital stay, and complications. Patients with maxillary or mandibular fractures remain hospitalized for longer periods of time. Fractures by traffic accident and fall had more risk of complications. The risk of complications was also higher in patients with maxilla fracture.

Posttraumatic stress disorder of Red Cross nurses in the aftermath of the 2008 Wenchuan China Earthquake

This study investigated the symptoms, psychological distress characteristics, and related factors in China Red Cross disaster relief nurses following the 2008 Wenchuan Earthquake in China that began on May 12 and lasted to June 23, 2008. A sample of 210 exposed nurses and a reference group of 236 nonexposed Red Cross nurses were surveyed within 1 year after the catastrophic earthquake. They were given a self-report questionnaire to assess demographics, posttraumatic stress disorder, and depression symptoms. Exposed nurses reported higher psychological distress on all aspects than nonexposed nurses. Scores on the Traumatic Stress Symptom Checklist were predicted by the avoidance of traumatic thoughts during the earthquake, personality traits, prior disaster experience, and preexisting stress, and other background factors were associated with scores on measures of psychological distress in exposed nurses. The conclusion indicated that disaster relief nurses experienced psychological distress and that immediate psychological intervention should be initiated.

Treatment of earthquake-related craniofacial injuries aboard the USNS Comfort during Operation Unified Response

BACKGROUND

Craniofacial injuries secondary to earthquake-related trauma are uncommonly reported and can pose a significant reconstructive challenge. The objective of this study is to report and analyze earthquake-related craniofacial injury reconstruction and the disaster relief capabilities of a U.S. Navy hospital ship.

METHODS

A review of earthquake-related injuries treated over 40 days requiring craniofacial reconstruction onboard a U.S. Navy hospital ship was performed.

RESULTS

From January 20 to February 28, 2010 (40 days), 869 patients were admitted to the USNS Comfort. Thirty-three patients (4 percent) treated by the craniofacial service underwent 93 craniofacial surgical procedures. Average patient hospitalization time was 17 days (range, 5 to 38 days). The fractures treated included nine mandibles, 12 zygomaticomaxillary-orbital complexes, 16 orbital floors, eight Le Fort, four naso-orbitoethmoid, and two cranial vault fractures. The soft-tissue injuries treated were two heminasal avulsions, two traumatic cleft lips, and eight other complex facial lacerations. Short-term complications included wound dehiscence (6 percent) and postoperative malocclusion (6 percent). There were no postsurgical wound infections, visual field changes, or mortality.

CONCLUSIONS

Complex craniofacial surgery services can be safely delivered onboard a United States Navy hospital ship for devastating injuries caused by natural disasters. Although craniofacial injuries represented a small percentage of the total patients admitted to our hospital ship, the survivors of facial injury required complex and multiple procedures to achieve optimal results. Despite heavy wound contamination and the intrinsic delay in presentation associated with mass casualty triage, facial fractures can be treated adequately and with low morbidity and mortality.