Trend and Characteristics of 2,636 Maxillofacial Fracture Cases over 32 Years in Suburban City of Japan

Can the Mechanism of Injury Impact the Location of a Mandibular Fracture? A Systematic Review

Purpose

Mandible fractures are the second most common fractures of the facial skeleton because of the prominent position of the lower jaw. The purpose of this study was to calculate the prevalence of mandibular fractures based on their causes and locations.

Materials and Method

A systematic search of 3 electronic databases from January 2010 and January 2020 was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 359 articles identified for screening against selection criteria. The search identified 39 articles to be included in our analysis.

Results

A total of 20,135 patients with 31,468 mandible fractures in this review. There was a 76% male predominance. The third decade was the most common age group (21-30). Motor vehicle accidents (39.89%) were the leading cause of mandible fractures, followed by falls (27.72%) and violence (25.35%). Condylar fractures are the most common cause of MVA and fall (33.11%, 50% respectively). Mandible body fractures are the second most common type of MVA injury (17.06%). When it came to violence, the angle of the mandible was the most common site (31.73%).

Conclusions

The prevalence of mandible fractures was higher in male patients in the current study, particularly in the second and third decades of life. Road traffic accidents were the most common cause, and the condylar process of the mandible was the most frequently affected region. Demographic data such as age, gender, and mechanism of injury can help surgeons predict and identify specific areas of mandibular fracture.

Falls Due to Loss of Consciousness are Associated With Maxillofacial Fracture Severity

PURPOSE

Falls are a common cause of the maxillofacial fractures, and falls associated with loss of consciousness might have special characteristics. The purpose of the present study was to measure the association between the types of falls and maxillofacial injury severity.

PATIENTS AND METHODS

The present retrospective cross-sectional study focused on patients with maxillofacial fractures resulting from falls who had been treated at the Hirosaki University Hospital from 1990 to 2016. The falls were divided into 2 categories according to the reason for their occurrence: 1) falls from slipping, tripping, or stumbling (STSFs); and 2) falls from loss of consciousness (LOCFs). The primary outcome measure of the present study was the severity of the maxillofacial fractures. The secondary outcomes were the pattern of maxillofacial fractures, pattern of concomitant injuries, and treatment modality. Multiple linear regression analysis was performed to evaluate the independent predictors for fracture severity.

RESULTS

A total of 148 patients had been admitted for maxillofacial fractures resulting from falls. The sample included 107 STSFs (72.3%) and 41 LOCFs (27.7%). The cause of the LOCFs was orthostatic-hypotension syncope in 13 patients, neurally mediated syncope in 10, cardiogenic syncope in 9, epilepsy in 5, and other in 4 patients. The proportion of mandibular fractures and the mean facial injury severity scale score were significantly greater in the LOCF group (2.20 ± 1.19) than in the STSF group (1.65 ± 1.15; P = .0067). The incidence of concomitant injuries was significantly greater in the STSF group than in the LOCF group (P = .023), and the distribution of sites was significantly different between the 2 groups (P = .039).

CONCLUSIONS

Our results have shown that maxillofacial fractures secondary to LOCFs tend to be more severe and to have a lower incidence of concomitant injuries compared with STSFs. We believe these features originate from the absence of protective reflexes resulting from the loss of consciousness.

An in-depth technical and medical investigation of facial injuries caused by car accidents

BACKGROUND

Many studies have investigated the issue of facial injuries caused by car accidents, but only a few have addressed the technical and clinical aspects of such accidents and injuries in depth. The aim of this study was to identify risk factors and protective elements for facial injuries in car accidents.

METHODS

We analysed the technical and clinical data of patients with facial injuries caused by car accidents over a 16-year period (2000-2016) and investigated the following factors: sitting position, sex, age, accident time, use of a seatbelt, deployment of the front airbag, direction of impact, speed at the time of collision, and occurrence and location of facial injuries.

RESULTS

Of the 1291 patients involved in car accidents who were included in our study, 291 (22.5%) had suffered facial injuries. We found a significant association between occurrence of facial injuries and sex, speed at the time of collision, impact from the back, seatbelt usage, and deployment of the front airbag. In accidents occurring at speeds over 40 km/h, automobile security measures had no significant influence on the occurrence of facial injuries in drivers and front-seat passengers. In accidents occurring at speeds between 0 and 20 km/h, seatbelt usage (without airbag deployment) solely showed a significant protective influence against the occurrence of facial injuries (odd ratio [OR], 0.130; confidence interval [CI], 0.038-0.451). In contrast, patients who were in accidents at speeds between 21 and 40 km/h suffered significantly fewer facial injuries when wearing a seatbelt with the front airbag being deployed (OR, 0.245; CI, 0.091-0.665) or undeployed (OR, 0.216; CI, 0.084-0.561).

CONCLUSION

Male sex and a high speed at the time of collision are significant risk factors for the occurrence of facial injuries. The security measurements evaluated in this study only exerted a protective influence at low speeds (below 40 km/h). This indicates a possible weakness of these security systems with regard to preventing facial injuries. Engineers could benefit from these findings and improve the efficiency of existing security measures and eventually help decrease the incidence of facial injuries.