GET THE APP

Demographic Study of Maxillofacial Injury in Multiple Trauma Patients
Emergency Medicine: Open Access

Emergency Medicine: Open Access
Open Access

ISSN: 2165-7548

Research Article - (2016) Volume 6, Issue 6

Demographic Study of Maxillofacial Injury in Multiple Trauma Patients

Samad Shams Vahdati, Alireza Ala*, Reihaneh Falaki, Roshan Fahimi, Afshin Safapour and Arezou Ettehadi
Emergency Medicine Research Team, Tabriz University of Medical Sciences, Iran
*Corresponding Author: Alireza Ala, Emergency Medicine Research Team, Tabriz University of Medical Sciences, Iran, Tel: +984133352078 Email:

Abstract

Introduction: Maxillofacial injuries may appear to be minor and small, can quickly progress and become lifethreatening and lead to brain damage. Incidence, etiology and epidemiology of maxillofacial injuries and facial fractures are different in various areas with different cultures, socio-economic states. The aim of this study is to investigate the etiology, location, and severity of damage and demography of patients with facial fractures and injuries (maxillofacial) in multiple trauma patients. Material and Method: In this cross-sectional study, all of the patients with maxillofacial fractures who were admitted to Imam Reza trauma centre of Tabriz enrolled between April 2015-2016 were evaluated. All fractures were identified, and demographic information, including age, gender, type of injury, the presence or absence of safety data were collected and analysed by the IBM® SPSS® software release 16.0.0. Results: 83 patients of our study (75.9%) were male (M: F=3:1). The average age of patients was 34.1 ± 5.83 years. Most of the events took place in August (21.7%) and in summer (42.16%). The average numbers of fractures in patients were 1.73. Car collision accounts for 33.7%, falling trauma for 21.7% and car to motorcycle for 15.7% of accidents. Only 3 of the patients in the present study had the safety factors. In the study of fracture types in the target population, orbital rim fracture was in 55.42% of patients and zygoma fracture was in 34.93% of them. Le Fort fracture type II was the most common one with a frequency of 7.22%. Conclusion: The results of this study indicate further relation between maxillofacial fractures and traffic accidents especially during the holiday season and lack of safety equipment.

Keywords: Maxillofacial injuries; Alcohol; Trauma

Introduction

An ATLS (Advanced Trauma Life Support) protocol was published in 1987 for the first time and was accepted as a gold standard method of dealing with traumatic patients in the emergency. However it lacks the protocols for the method and location of maxillofacial injuries. Although injuries related to superior of clavicle seem minor and small but they are progressive and life-threatening [1-4]. Maxillofacial injuries are usually happening with brain injuries simultaneously [4]. Incidence and etiology of maxillofacial injuries and fractures of different regions of face bones are different. Culture, socioeconomic differences and awareness of driving rules and drinking alcohol are very important. A report from various parts of Turkey declares several etiologies [5-8]. According to the studies from developed countries, injuries leading to maxillofacial fracture are usually due to car accidents, pedestrian accident, sports, and work accidents. This epidemiology in developing countries is mostly related to road accidents, violence, and fighting [9-15]. Maxillofacial injuries can also occur isolated, but most of the time it comes with high energy trauma. These injuries could also be sever and life threatening and sometimes needing multiple services approach [16]. Several reports from different countries have been published based on maxillofacial fractures with analysis and discussion on various occasions [17-26]. Kind of trauma, its severity, and injuries with maxillofacial fractures help us to deal and handle them the best way. There are only a few general studies discussing this important [10,27-32]. In this study, we want to investigate etiology, area and severity of injuries and demographic characteristics of fractures and maxillofacial fractures in multi traumatic patients.

Methods and Materials

All patients from March 2014 till March 2015 with complain of multi trauma referred to trauma centre in the north west of Iran (Imam Reza Hospital In Tabriz) with diagnosis of maxillofacial fractures are studied. In radiology and CT scan, type of fracture is detected and age, sex, kind of trauma, existence of safety, factor are inserted to data collection form which are designed. Patients whose information was not available, uncompleted, lack of patients consent were not investigated in our study.

Results

The average age of the patients in our study is 31.4 ± 15.83 years. 63 patients (75.9%) were male and 20 cases (24.1%) were female. 42.16% of the patients (35 cases) in the summer, 23 cases (27.71%)in the spring, 222 cases (26.5%) in the autumn and only 3 cases (3.61%) in the winter were referred to the hospital.

According to the reasons of maxillofacial injuries, 28 cases of our study (33.7%) with car crash with car, 18 cases (21.7% falling from height, 13 cases (15.7%) car crash with motorcycle accident, 10 cases (12%) overturning motorcycle (or) bike, 7 cases (8.4%) car crash with pedestrian, 5 cases (6%) car overturning, 2 cases (2.4%) with car crash with motorcycle accident were arrived at the hospital (Figure 1).

emergency-medicine-reasons

Figure 1: According to the reasons of maxillofacial injuries.

The amount of fractures of traumatic patients in 43 cases one fracture, in 21 cases (25%) two fractures, in 14 cases (17%) three fractures, in 4 cases (5%) four fractures and in one of them five fractures has been reported. The average amount of fractures in each patient was 1.73.

Type of trauma in the patients of our study were respectively in 46 cases (55.42%) fracture in rime of orbit, in 29 cases (34.93%) fracture in zygoma, in 27 cases (32.53%) fracture in maxilla, in 26 cases (31.32%) fracture in nasal bone, 11 cases (13.25%) fracture in mandible and 8 cases (9.63%) Le Fort fractures were reported. The most common type of Le Fort fracture was type 2 with frequency of 7.22%. Le Fort fracture type 1 and 3 both with the frequency of 1.2% were the least frequent types of fracture (Figures 2 and 3).

emergency-medicine-trauma

Figure 2: Type of trauma in the patients of our study was respectively in 46 cases.

emergency-medicine-location

Figure 3: Location of trauma.

Discussion

In Gassner et al. [10] study the average age was 25.8 years. In Hogg et al. [33] study 2969 patients were studied with the average age of 25 years. In Alvi et al. [1] study the average age of the patients with maxillofacial injuries was 35.4 years. Shahim et al. [34] study determind the average age was 15-24 years. The most common age range in Ogundare et al. [35] study was 25-34 years. In fact the most common prevalence of age in maxillofacial fracture was in third decade of life.

75.9% of cases in our study were male whereas 24.1% were female (sex ratio: 3:1). Gassner et al. [10] study from 1990 till 2000 with the sex ratio of 2:1, Hogg et al. [33] study from 1991 till 1997 in Ontario Canada sex ratio was 3:1. Although almost in all studies dominant sex of maxillofacial fracture patients are male but there are significantly different from some other studies.

Most of maxillofacial fractures happen in the summer (42.16%) and spring (27.7%) in our study. These results reflect the increase of accidents in holiday seasons of the year. In Gassner et al. [10] study frequency of maxillofacial fracture was higher in the summer. In Hogg et al. [33] study fractures happened at the weekends (51%) in the summer most often. In Ogundare et al. [35] in a 10 year study most fractures were in the summer (31%). These studies are representing that most of the maxillofacial fractures are happening in the summer, this is because of increasing using of automobile transportation in holidays.

In evaluation of the etiology of maxillofacial fracture, 33.7% car crash, 21.7% falling from height, 15.75% car accident with motorcycle, 12% motorcycle or bike rollover, 8.4% car accident with pedestrian, 6% car rollover and 2.4% car crash with bike were reported. None of the fractures was reported because of violence or sports trauma. In Gassner et al. [10] study daily activities (38%), sports (31%), car accidents (12%), fighting (12%), in Hogg et al. [33] study vehicle accidents (70%), falling (12%), in Ogundare et al. [35] study from 1990 to 2000 in Colombia hospital, fighting (79%) were reported.

Car accidents are the most important reason of maxillofacial fractures. Although in developed countries by increasing safety of roads and vehicles, and compliance of traffic rules, by reducing traffic accidents, violence and sports are mostly leading to fracture. Type of trauma in the patients 55.4% fracture in rime of orbit, 34.93% in zygoma, 32.53% in maxilla, 31.32% in nasal bone, 13.25% in mandible, 9.63% Le Fort fracture were reported. The most common type of Le Fort fracture was type 2 (72.2%). In a ten years study of Gassner et al. [10] most fractures were included of fracture of mid face (72.5%), mandible (24.3%). Fracture of orbit in 22.3% was in the floor of it, and common Le Fort fracture was type 2 (45). Maximum fracture of Hogg et al. [33] study in maxilla (23%), and in orbit (22%), in Bakardjiev et al. [12] study in Bulgaria fracture of mandible (74%), and zygoma (16%), in Alvi et al. [1] study orbit fracture (24.2%) and maxilla fracture (22%), in Shahim et al. [34] study fracture of maxilla (22.3%) and orbit (21.4%) and in Ogundare et al. [35] study from 1990 to 1000 in Colombia hospital, fracture of mandible (36%) were reported. In our study similar to others, fracture of maxilla, superior orbit and mandible were reported the most common fractures in maxillofacial traumatic patients [36].

Unfortunately head and neck is the most damaged organ in trauma after limbs in multiple trauma [37] specially in motorcycle riders who is young and male and most of the time did not obey to use protective instruments has head and face trauma [38].

By using ultrasonography for finding free fluid in abdomen and pneumothorax and hemotoraxs in chest, may be it can useful for midface bones to use it in bedside [39-41].

Conclusion

The most common age of maxillofacial injury is the third decade of life. The sex ratio of male to female is 3:1. It happens in holiday seasons of the year most often (spring and summer). Car accident is the most common reason for facial injuries and fractures. There were not cases of violance and trauma due to sports activity. Regarding to the type of trauma, the most common regions of fracture are respectively rime of orbit fracture and zygoma fracture. The most common type of Le Fort fracture was type 2. Many patients of our study with maxillofacial fractures have not complied safety tips like using helmet and safety belts.

References

  1. Alvi A, Doherty T, Lewen G (2003) Facial fractures and concomitant injuries in trauma patients. Laryngoscope 113: 102-106.
  2. Cannell H, Paterson A, Loukota R (1996) Maxillofacial injuries in multiply injured patients. Br J Oral Maxillofac Surg 34: 303-308.
  3. Perry M, Dancey A, Mireskandari K, Oakley P, Davies S, et al. (2005) Emergency care in facial trauma--a maxillofacial and ophthalmic perspective. Injury 36: 875-896.
  4. Perry M (2008) Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 1: Dilemmas in the management of the multiply injured patient with coexisting facial injuries. Int J Oral Maxillofac Surg 37: 209-214.
  5. Brooks A, Holroyd B, Riley B (2004) Missed injury in major trauma patients. Injury 35: 407-410.
  6. Buduhan G, McRitchie DI (2000) Missed injuries in patients with multiple trauma. J Trauma 49: 600-605.
  7. Aksoy E, Unlü E, Sensöz O (2002) A retrospective study on epidemiology and treatment of maxillofacial fractures. J Craniofac Surg 13: 772-775.
  8. Erol B, Tanrikulu R, Görgün B (2004) Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901patients (25-year experience). J Craniomaxillofac Surg 32: 308-313.
  9. Lee JH, Cho BK, Park WJ (2010) A 4-year retrospective study of facial fractures on Jeju, Korea. J Craniomaxillofac Surg 38: 192-196.
  10. Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H (2003) Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 31: 51-61.
  11. van den Bergh B, Karagozoglu KH, Heymans MW, Forouzanfar T (2012) Aetiology and incidence of maxillofacial trauma in Amsterdam: a retrospective analysis of 579 patients. J Craniomaxillofac Surg 40: e165-e169.
  12. Bakardjiev A, Pechalova P (2007) Maxillofacial fractures in Southern Bulgaria–a retrospective study of 1706 cases. J Craniomaxillofac Surg 35: 147-150.
  13. Iida S, Kogo M, Sugiura T, Mima T, Matsuya T (2001) Retrospective analysis of 1502 patients with facial fractures. Int J Oral Maxillofac Surg 30: 286-290.
  14. Ramli R, Rahman NA, Rahman RA, Hussaini HM, Hamid AL (2011) A retrospective study of oral and maxillofacial injuries in Seremban Hospital, Malaysia. Dent Traumatol 27: 122-126.
  15. Motamedi MH (2003) An assessment of maxillofacial fractures: a 5-year study of 237 patients. J Oral Maxillofac Surg 61: 61-64.
  16. Haug RH, Prather J, Indresano AT (1990) An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 48: 926-932.
  17. Erdmann D, Follmar KE, DeBruijn M, Bruno AD, Jung SH, et al. (2008) A retrospective analysis of facial fracture etiologies. Ann Plast Surg 60: 398-403.
  18. Al Ahmed HE, Jaber MA, Abu Fanas SH, Karas M (2004) The pattern of maxillofacial fractures in Sharjah, United Arab Emirates: a review of 230 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98: 166-170.
  19. Brasileiro BF, Passeri LA (2006) Epidemiological analysis of maxillofacial fractures in Brazil: a 5-year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102: 28-34.
  20. Cheema SA, Amin F (2006) Incidence and causes of maxillofacial skeletal injuries at the Mayo Hospital in Lahore, Pakistan. Br J Oral Maxillofac Surg 44: 232-234.
  21. Ellis E, Moos KF, el-Attar A (1985) Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol 59: 120-129.
  22. Abbas I, Ali K, Mirza YB (2003) Spectrum of mandibular fractures at a tertiary care dental hospital in Lahore. J Ayub Med Coll Abbottabad 15: 12-14.
  23. Bataineh AB (1998) Etiology and incidence of maxillofacial fractures in the north of Jordan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86: 31-35.
  24. Iida S, Matsuya T (2002) Paediatric maxillofacial fractures: their aetiological characters and fracture patterns. J Craniomaxillofac Surg 30: 237-241.
  25. Tung TC, Tseng WS, Chen CT, Lai JP, Chen YR (2000) Acute life-threatening injuries in facial fracture patients: a review of 1,025 patients. J Trauma 49: 420-424.
  26. Bagheri SC, Holmgren E, Kademani D, Hommer L, Bell RB, et al. (2005) Comparison of the severity of bilateral Le Fort injuries in isolated midface trauma. J Oral Maxillofac Surg 63: 1123-1129.
  27. Gomes PP, Passeri LA, Barbosa JR (2006) A 5-year retrospective study of zygomatico-orbital complex and zygomatic arch fractures in Sao Paulo State, Brazil. J Oral Maxillofac Surg 64: 63-67.
  28. Eski M, Sahin I, Deveci M, Turegun M, Isik S, et al. (2006) A retrospective analysis of 101 zygomatico-orbital fractures. J Craniofac Surg 17: 1059-1064.
  29. Mohajerani SH, Asghari S (2011) Pattern of mid-facial fractures in Tehran, Iran. Dent Traumatol 27: 131-134.
  30. Sargent LA Fernandez JG (2012) Incidence and management of zygomatic fractures at a level I trauma center. Ann Plast Surg 68: 472-476.
  31. Rosado P, de Vicente JC (2012) Retrospective analysis of 314 orbital fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 113: 168-171.
  32. Salentijn EG, van den Bergh B, Forouzanfar T (2013) A ten-year analysis of midfacial fractures. J Craniomaxillofac Surg 41: 630-636.
  33. Hogg NJ, Stewart TC, Armstrong JE, Girotti MJ (2000) Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada, between 1992 and 1997. J Trauma 49: 425-32.
  34. Shahim FN, Cameron P, McNeil JJ (2006) Maxillofacial trauma in major trauma patients. Aust Dent J 51: 225-230.
  35. Ogundare BO, Bonnick A, Bayley N (2003) Pattern of mandibular fractures in an urban major trauma center. J Oral Maxillofac Surg 61: 713-718.
  36. Vahdati SS, GhafarZad A, Rahmani F, Panahi F, Rad AO (2014) Patterns of road traffic accidents in north west of Iran during 2013 New Year Holidays: complications and casualties. Bull Emerg Trauma 2: 82-85.
  37. Ramouz A, Hosseini M, Vahdati SS (2016) Epidemiology of head and neck fractures caused by motorcycle accidents. Iranian Journal of Emergency Medicine 3: 23-27.
  38. Haghighi SH, Adimi I, Vahdati SS, Khiavi RS (2014) Ultrasonographic diagnosis of suspected hemopneumothorax in trauma patients. Trauma Mon 19: e17498.
  39. Tajoddini S, Vahdati SS (2013) Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency physicians and radiologists. Eur J Trauma Emerg Surg 39: 9-13.
  40. Ala AR, Pouraghaei M, Vahdati SS, Taghizadieh A, Moharamzadeh P, et al. (2016) Diagnostic Accuracy of Focused Assessment With Sonography for Trauma in the Emergency Department. Trauma Mon 21: e21122.
  41. Kim CH, Shin SD, Song KJ, Park CB (2012) Diagnostic accuracy of focused assessment with sonography for trauma (FAST) examinations performed by emergency medical technicians. Prehosp Emerg Care 16: 400-406.
Citation: Vahdati SS, Ala A, Falaki R, Fahimi R, Safapour A, et al. (2016) Demographic Study of Maxillofacial Injury in Multiple Trauma Patients. Emerg Med (Los Angel) 6: 343.

Copyright: © 2016 Vahdati SS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License; which permits unrestricted use; distribution; and reproduction in any medium; provided the original author and source are credited.