Sports-related Mandibular Fractures in the Center of Italy: A Retrospective Study

The main causes of injuries to the lower and middle third of the facial skeleton are traffic accidents, accidental falls, assaults, and sport. Regarding sports-related maxillofacial trauma, an 8-year retrospective study was conducted at the Department of Oral and Maxillofacial Surgery of the Policlinico Umberto I in Rome, Italy. In all, 329 patients were included, of which we analyzed 35 patients with sports-related mandibular fractures. Specifically, we assessed the type of mandibular fracture reported, age, gender, number of fracture lines, association with other maxillofacial fractures, and treatment options. The causes of sports-related injuries are often multifactorial. Therefore, the aim of our study was to understand the correlation between the type of sport practiced and the most frequently reported pattern of mandibular fracture, highlighting how, depending on the sport, the mechanism of action is different and may correlate with a specific type of mandibular fracture.

Which sports have a higher risk of maxillofacial injuries?

OBJECTIVES

Sports etiology is one of the most common causes of maxillofacial injuries. This work aimed to provide an up-to-date review of sports-related maxillofacial injuries.

METHODS

An updated review was conducted on Pubmed and Google Scholar. No publication year and language restrictions were applied. Two different search strategies were performed, the first addressed which sports, generally associated with maxillofacial injuries, and the second search was conducted to determine the frequency of maxillofacial injuries associated with each sport individually.

RESULTS

The first search returned 26 articles distributed across different sports, from different countries, and with varied age distribution. The second search displayed 85 articles on individual sports group. Papers were rated and categorized according by the sport associated to the reported injury. A useful sports risk scale for maxillofacial injuries has been developed. Peculiar themes from all participating sports were evaluated. The use of protective equipment and other preventive measures were highlighted.

CONCLUSIONS

Some sports with ball and cycling can be considered riskier sports for maxillofacial injuries. Athlete education and the mandatory use of mouthguards, helmets, and eye protection, among other things, are crucial to prevent these injuries. Tailor-made mouthguards and protective masks, which are becoming cheaper, are in vogue. The Sports-related Maxillofacial Injuries Risk scale can be useful for athletes, athletic coaches, and maxillofacial surgeons.

Sports-based distribution of facial fractures - findings from a four-season country

OBJECTIVE

The aim of this study was to elucidate the relationship between injury mechanisms and sports-related facial fractures, and to evaluate the changes in incidence rates of facial fractures sustained in sports-related events in a 30-year period.

MATERIAL AND METHODS

This retrospective cohort study included all patients sports-related facial fractures admitted to a tertiary trauma centre during 2013-2018. Specific fracture types, sports, injury mechanisms as well as patient- and injury related variables are presented. The results underwent evaluated statistically with logistic regression analysis.

RESULTS

Facial fractures occurred most frequently while playing ice hockey and football. Unilateral zygomatic-maxillary-orbital and isolated mandibular fractures accounted for 74.2% of all fracture types. In total, 99 patients (46.5%) required surgical intervention for their facial injuries. About 12.7% of patients sustained associated injuries in addition to facial fractures. Overall, the number of sports-related facial fractures has increased during the last three decades mostly due to the surging rates of ice hockey- and football-related facial fractures.

CONCLUSIONS

Sport-related facial fractures have markedly increased in different sports disciplines during the past decades. The use of safety gear to protect the facial area should be enforced particularly in ice hockey.

Correlation Between Sports-Related Maxillofacial Injuries and Head Injuries: A Five-Year Retrospective Study

PURPOSE

As sports have become more diverse and demanding, the number of patients with a maxillofacial injury accompanied by a cranial injury or neurological symptoms has increased. This study examined the correlation between sports-related maxillofacial injuries and head injuries.

PATIENTS AND METHODS

Among the patients who visited the emergency department of Pusan National University Dental Hospital due to a maxillofacial injury from sporting activities between 2014 and 2018, those who additionally had head injuries were retrospectively examined. Sporting activities were classified according to the American Academy of Pediatrics classification, and severity of injuries was determined using the Facial Injury Severity Scale (FISS). Patients whose medical records showed neurological symptoms and who underwent brain computed tomography for concomitant head injury were selected. The association between each of these variables, including age and gender, was statistically analyzed.

RESULTS

A total of 95 patients were included in this study, most of whom were male teenagers, and cycling was the most common cause of injuries. The mean FISS score was 0.79. Brain computed tomography was conducted for 91 patients, and 28 patients reported neurological symptoms. Only 11 patients underwent advanced evaluation in the neurology or neurosurgery department. Most patients were diagnosed with contusion and concussion and were monitored without any treatment.

CONCLUSIONS

Higher FISS values did not reflect the severity of maxillofacial and head injury. In this study, there were some patients with cranial fracture and cerebral hemorrhage with mild neurosurgical symptoms of facial trauma. Although the incidence of head trauma is not high, the necessity of wearing protective equipment cannot be overemphasized because severe trauma is permanent. Neurological signs and symptoms of patients with maxillofacial trauma should not be overlooked and require a thorough evaluation.

Midface Including Le Fort Level Injuries

Le Fort fractures occur at uniform weak areas in the midface often due to blunt impact to the face. Sporting injuries are a common cause of facial trauma; however, use of protective equipment has reduced the number of sports-related injuries. All patients with traumatic injuries should be evaluated using Advanced Trauma Life Support protocol. Le Fort fractures can contribute to airway obstruction, and urgent intubation may be indicated. Surgery is indicated for most displaced Le Fort fractures to restore function and facial harmony. To facilitate reduction, the original occlusive relationship should be restored by placing the patient in MMF.

Facial Trauma Patterns Among Young Athletes

Study Design

Retrospective case series review.

Objective

Participation in athletics is common in high school and college students and presents an increased risk of injury in this age-group. Previous studies have included National Collegiate Athletic Association athletes but not high school athletes. Here we report the trends of maxillofacial injuries in high school students.

Methods

Patients presenting to a level 1 trauma center with maxillofacial injuries were identified by chart query with associated International Classification of Diseases, 10th Revision codes for facial fractures between October 2015 and October 2017. Data collected included age, sport, fracture type, need for surgery, associated concussion, and time to return to play were measured. New York State Public High School Athletic Association regional high school sports participation data from 2016 to 2018 were used to calculate incidence.

Results

A total of 33 patients aged 13 to 19 years were identified. Baseball, basketball, and lacrosse were most frequently associated with maxillofacial trauma. Annual incidence rates for mandible fractures in high school athletes were 0.037%, 0.012%, and 0.01% for lacrosse, baseball, and basketball, respectively. Annual fracture incidence rates for midface fractures in high school athletes were 0.17%, 0.018%, and 0.01% for baseball, lacrosse, and basketball, respectively.

Conclusion

Maxillofacial fractures are uncommon injuries among athletes but present with serious implications including surgical correction. Baseball was strongly associated with midface fractures despite being considered a noncontact sport. Improved facial protection across all sports will be imperative at reducing the incidences of these injuries.

Level of Evidence

Level 4.

Study of Pediatric Operative Recreational Trauma: A Retrospective Analysis of Pediatric Sports-Related Facial Fractures

BACKGROUND

In the United States, most school-aged children participate in some form of organized sports. Despite the advantages to social and physical development that organized sports may have, these activities also place a significant number of America's youth at risk for facial injuries. Pediatric facial fractures resulting from sports trauma are well documented within pediatric literature. Despite knowledge of the importance of safety equipment, there is a continued need for increased awareness about fracture patterns resulting from sports injuries to develop better strategies for their prevention.

METHODS

A retrospective review of all pediatric patients (age <18) who presented to Children's Memorial Hermann Hospital as a level 1 trauma between January 2006 and December 2015 with radiologically confirmed facial fractures was performed. Data regarding patient demographic information, mechanism of injury, facial fracture location, associated injuries, hospital course, and need for surgical intervention was collected.

RESULTS

Of the 1274 patients reviewed, 135 (10.59%) were found to have facial fractures resulting from sports trauma and were included in our cohort. The median age was 14 with 77.8% of the cohort being male. The most common fractures identified were orbital (n = 75), mandibular (n = 42), nasal (n = 27), maxilla (n = 26). Fractures were more frequently related to involvement in baseball/softball and bicycling n = 46 and n = 31 respectively. Eighty-two (60.74%) patients required admission, 6 requiring ICU level care, 70 (51.85%) were found to require surgery. There were 14 patients who were found to have a concomitant skull fracture and 6 with TBI. There were no fatalities in this cohort of patients.

CONCLUSION

Pediatric facial fractures occur in the same anatomic locations as adult facial fractures. However, their frequency, severity, and treatment vary because of important anatomical and developmental differences in these populations. Despite available knowledge on this subject and increased use of protective equipment, pediatric facial fractures continue to occur with similar distribution as historically described. While sports participation confers numerous benefits, it is vital that we continue researching pediatric facial trauma and associated fractures to develop protective equipment and protocols to mitigate the risks of these activities.

Pattern of Traumatic Dental Injuries Among Adults

Background

The etiology, presentation and management of traumatic dental injuries (TDIs) vary significantly between the adult and the younger population. Most epidemiological studies on TDIs have focused on the pediatric age group. This study aims to report and compare the distributions of TDIs among adults in a sub-population in India.

Methods

This prospective observational study was performed on 1562 consecutively selected patients (1218 males and 344 females) from a university dental hospital in India, between July 2014 and June 2018. The clinical examinations were performed by a single trained and calibrated endodontist. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the World Health Organization's (WHO’s) classification. Periapical and panoramic radiographs were taken for all the subjects.

Results

A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years, were examined during the study period. The total number of teeth with TDIs was 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fractures (male=31.0% and female=36.6%). Avulsion injuries are more likely to be seen by a dentist within 1 hour post-trauma. About two-third of the TDIs were caused by road traffic accidents (RTAs) followed by falls in about 20% of the patients.

Conclusion

Uncomplicated crown fracture was the most commonly observed type of TDI, and RTAs were the primary cause of TDI.

Determinants for traumatic orofacial injuries in sport: Extrinsic factors in a scoping review

BACKGROUND/AIM

Sports practices carry a risk for orofacial injuries and, to avoid them, preventive measures are necessary. The aim of this study was to investigate a web of extrinsic determinants for orofacial trauma in sports.

MATERIALS AND METHODS

Through a scoping review, eight extrinsic risk factors for sports-related orofacial trauma emerged from the thematic analysis. These were sports modality, sports philosophy, competition rules, level of competition, accessory equipment, environmental conditions, acting regimen, pitch conditions, and human resources. The data collection was conducted on seven databases, using terms based on health science descriptors and keywords related to orofacial trauma and sports.

RESULTS

From the 1155 articles found, 157 were selected based on eligibility criteria and classified according to the mentioned factors. After the full reading of the articles, the most cited risk factor was sports modality while acting regimen and environmental factors were the least mentioned. Therefore, a scheme following the web of determinants was constructed with the purpose of establishing a risk profile, which was based on the interactions between the determinants and on the frequency that they were mentioned as contributors to injury. From this, it was observed that each traumatic event is possibly a result of the interrelationships among the eight suggested determinants.

CONCLUSION

Sports modality was the most cited extrinsic determinant observed in the literature, while environmental conditions and acting regimen were the least cited. In addition, more than establishing the determinants, it is necessary to comprehend how they relate, once preventive strategies should intercede on these relations, to help reduce sports injuries.

Sports-Related Oral and Maxillofacial Injuries: A 5-Year Retrospective Study, Pusan National University Dental Hospital

PURPOSE

The incidence of sports trauma is gradually increasing, and its importance is therefore also increasing. The present study was conducted to analyze the types, proportions, and tendencies of sports trauma associated with the oral and maxillofacial regions.

PATIENTS AND METHODS

Patients who visited the Emergency Department of Pusan National University Dental Hospital between 2014 and 2018 for more than 5 years were surveyed through retrospective epidemiologic investigations. Type of sports was classified according to American Academy of Pediatrics classification. For statistical analysis, age and gender distribution, cause of trauma, and annual trends data were collected.

RESULTS

Of the 517 patients, most of the patients were teenagers (27.9%), followed by those younger than 10 years (23.2%) (χ² = 22.897; P = .002), and noncontact sports, which is cycling, was the most common (43.5%) cause for trauma in both adult and children groups (χ² = 91.824; P < .001). The most common sports associated with contact sports, limited-contact sports, and noncontact sports were football (47.7%), baseball (50.0%), and cycling (74.8%), respectively. The causes for trauma injury were as follows: contact sports, other person's body (53.4%); limited-contact sports, other objects (60.9%); and noncontact sports, slip down (77.4%) (χ² = 298.901; P < .001). The prevalence and incidence of sports injuries increase every year, and the proportion of injured patients in May was the highest (χ² = 52.360; P = .181). The high percentage of traumatic sports demonstrated statistically significant trends (χ² = 43.073; P = .002). Kickboard injuries showed a rapid increase recently (P for linear trend = .045), whereas other sports showed no significant trends.

CONCLUSIONS

Considering the increasing incidence of sports-related injuries, oral and maxillofacial surgeons should be more concerned with maxillofacial trauma during sports.