Etiology And Incidence Of Maxillofacial Skeletal Injuries At ...

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239Pakistan Oral & Dental Journal Vol 34, No. 2 (June 2014)
Original article
1 Assistant Professor & Vice Principal, Head of Department of Oral
and Maxillofacial Surgery,Bibi Aseefa Dental College, Larkana,
Sindh. Email: elya_ilyas@yahoo.com
2 Assistant Professor, Department of Operative Dentistry, Institute
of Dentistry, Liaquat University of Medical & Health Sciences,
Jamshoro, Email: rajputfozia@yahoo.com Cell: 0300-3060358
3 Assistant Professor, Department of Oral Pathology, Bibi Aseefa
Dental College, Larkana, Sindh. Email: drsafia_omfs@yahoo.com
Cell Number: 0333-2685002
4 Assistant Professor, Department of Community Medicine Liaquat
University of Medical & Health Sciences, Jamshoro, Sindh.
Email: drgulzar@gmail.com Cell: 0333-2735948
Received for Publication: April 21, 2014
Revision Received: May 13, 2014
Revision Accepted: May 20, 2014
INTRODUCTION
Injuries to the maxillofacial region present one of
the most challenging problems for health care professionals worldwide. Particular interest was developed
by the high incidence and diversity of facial fractures.1
Fractures of the maxillofacial skeleton are invariably
associated with substantial morbidity, disfigurement,
functional deficit and high cost for treatment.2 The
causes differ among developing countries from those in
developed countries. In published studies from Nigeria,3
Libya,4 Europe5 and United States6 indicate that road
traffic accidents was the main cause of maxillofacial
injuries. Current studies show that interpersonal violence is leading source of facial fractures in developed
countries, where as road traffic accident remains major
etiology in underdeveloped countries.7 Socioeconomic
status, social education and behaviour, various cultural
thoughts, differences in sects and religions, industrialization, transportation, lack of driving skills, alcohol
consumption, and legislation, all may contribute in
establishing the prevalence of the various causes.4
According to anatomical site of distribution, mandible and zygomatic complex fractures are the most
prevalent sites and their occurrence varies with the
mechanism of injury and demographic factors.4
The coordinated and sequential collection of data
concerning chronological and demographic patterns of
maxillofacial injuries may help health care providers
to make a record of facial trauma. Ultimately an understanding of the cause, severity, and chronological
distribution of maxillofacial trauma permit clinical
ETIOLOGY AND INCIDENCE OF MAXILLOFACIAL SKELETAL INJURIES AT
TERTIARY CARE HOSPITAL, LARKANA, PAKISTAN
1MOHAMMAD ILYAS SHAIKH, BDS, FCPS
2FOZIA RAJPUT, BDS, MSc, FCPS
3SAFIA KHATOON, BDS, FCPS
4GULZAR USMAN, MBBS, MPH
ABSTRACT
The objective of this study was to determine the causes, incidence and distribution of maxillofacial
injuries. This was a descriptive study performed at the tertiary care hospital of Larkana (Accident &
Emergency Department of Chandka Medical College, Hospital and Outpatient’s Department of Bibi
Aseefa Dental College Hospital, Larkana) from 1st February 2011 to 30th August 2013.
Two hundred and eighty eight patients of maxillofacial injuries were included in this study
patients less than 11 years of age, suffering from neurological disorders and patients with isolated
cases of dental and nasal injuries or only with facial lacerations were excluded. Information and data
were collected from history, clinical examination and surgical preoperative records of each patient.
Results showed that the most common etiology was road traffic accident (170) 59%, interpersonal
violence (31) 10.76%, gunshot injuries (28) 9.7%, falls (19) 6.5% and others (40) 13.88%. The mandible was the most frequent bone fractured, which accounted for (148) 50.38% followed by zygomatic
complex (52) 18% and (24) 8.3% maxillary bone. Fracture in combination form involved (64) 22%.
It was concluded that road traffic accident was the most common etiological factor of maxillofacial skeletal trauma, while second most common cause was the interpersonal violence. Mandible was
the most commonly fractured bone.
Key Words: Maxillofacial skeletal trauma, fracture, road traffic accident.
240Pakistan Oral & Dental Journal Vol 34, No. 2 (June 2014)
Maxillofacial skeletal injuries
and research priorities to be established for effective
treatment and prevention of these injuries.5
First time this type of study was carried out at
peripheral areas of Sindh to highlight the main issues
regarding causes, type and pattern of maxillofacial
skeletal injuries in relation to age and gender.
The main aim of this study was to trace the full
profile of maxillofacial trauma victims, seen at emergency or outpatient’s department for understanding
the causes, incidence and temporal distribution of maxillofacial trauma which may help to establish clinical
priorities for the effective treatment and prevention of
these injuries.
METHODOLOGY
Two hundred and eighty-eight patients with maxillofacial skeletal injuries were seen in the tertiary care
hospital of Larkana (Accident & Emergency Department
of Chandka Medical College Hospital and Outpatient’s
Department of Bibi Aseefa Dental College Hospital,
Larkana), from 1st February 2011 to 30th August
2013. Patients who sustained maxillofacial skeletal
injuries were included where as patients less than 11
years of age, neurological disorders and patients with
isolated cases of dental and nasal injuries or only with
facial lacerations were excluded. Information and data
were collected from clinical examination and surgical
preoperative records of each patient.
The obtained data included:
• Patient’s demographic details including age, gender
and race
• Etiology with respect to age group
• Fracture site with respect to age group
SPSS version 16.0 was used to analyze the collected
data.
RESULTS
Two hundred eighty-eight patients with maxillofacial skeletal injuries formed the study group. Male
were dominant with 81% (n-233) while 19% (n-55)
were females Fig 1. Most effects patients were in second to third decades. Road traffic accidents were the
most common cause (n-170) 59%. Furthermore motor
cyclists and walkers were the top victims. Interpersonal violence (n-31) 10.76% was on second, followed
by gunshot injuries (n-28) 9.7%, falls (n-19) 6.5% and
others (n-40) 13.88% as mentioned in Table 1. Mandible
was involved in 50.38% cases followed by zygomatic
complex (n- 52) 18% and (n-24) 8.3% maxillary bone.
Fracture in combination form involved (n- 64) 22% Table
2. Patients with significant proportion had fractures
in combination form.
Fig 1: Sample size and gender distribution
TABLE 1: ETIOLOGY OF MAXILLOFACIAL
SKELETAL INJURIES
S.
No.
Etiology No. of
patients
Percentage
1. Road traffic accidents (n-170) 59%
2. Interpersonal violence (n-31) 10.76%
3. Gunshot injuries (n-28) 9.7%
4. Falls (n-19) 6.5%
5. Others (n-40) 13.88%
TABLE 2: DISTRIBUTION ON THE BASIS OF
BONE INVOLVED (n=288)
S.
No.
Bone involved No. of
patients
Percentage
1. Mandible (n=148) 50.38%
2. Zygomatic bone (n= 52) 18%
3. Maxillary bone (n=24) 8.3%
4. Panfacial fractures (n-64) 22%
DISCUSSION
Maxillofacial trauma is usually caused by a known
and relatively constant set of etiological factors.8 Recent
studies and surveys show that causes and incidence
of maxillofacial trauma tend to vary with geographic
region, road safety regulation, culture, social education
and behaviours.9
In the current study population, 2nd to 3rd decade
male gender was predominance. This finding is almost
similar to the previous published studies.10,11,12 This
could be because this is a male dominating society
where males are mostly involved in outside activities,
and more exposed to such accidents as compared to females. Moreover the study was conducted in interior of
241Pakistan Oral & Dental Journal Vol 34, No. 2 (June 2014)
Maxillofacial skeletal injuries
Sindh province where the culture and social behaviours
restricts the females to domestic activities.
In contrast to this study, 90% male population was
the victim of maxillofacial trauma in Zimbabwe13 which
is again explaining the male dominancy.
In this study, road traffic accidents, especially
motorcyclists were the most common victims 59%. This
could be because in our setup, motor bikes are usually
provided to youngsters, and they use motorbikes rather
carelessly. Other study from Pakistan showed similar
results (57%).14 Similar results were shown in studies
from India (62%)15 and 52.2% Jordan16, whereas in a
study from England, only 24.7% patients were registered with maxillofacial trauma due to road traffic
accidents,17 they were using the seat belts, and were
following traffic rules and regulations that decreased
the ratio of injuries.
Second most common etiological factor noted in the
present study was the interpersonal violence 10.76%
Table 1. Current study was conducted in Larkana and
its neighbouring small cities of interior Sindh located
near the peripheral cities of Balochistan, in these areas
tribal fighting is common.
Mandible was the most common site involved
50.38% followed by zygomatic complex in this study.
Similarly, Cheema18 and Ahmed et al19 found 51%
mandibular bone involvement which is almost equal
to the results of this study.
In contrast to the present study, Rana14 found 75.6%
mandibular bone involvement which is quite higher
percentage. In addition the involvement of site and
occurrence varies with the mechanism of injury and
gender and age, for instance in road traffic accidents,
the most prevalent site is mandibular body and condyle20 while in younger age group, condylar fractures
are more common. In the current study it was the body
of the mandible, opposite to the findings by Motamedi
MH21 who found condylar region as the more prevalent
site.
CONCLUSION
Motor vehicle accidents due to the condition of the
roads, driving skills and violation of traffic rules was
the main factor responsible for maxillofacial injuries,
which can be overcome by putting sufficient stress on
the use of seat belts and head gears in case of motorcycles and strict enforcement of traffic rules.
Following the comparison of the obtained data with
literature, it can be stated that causes and incidence
would vary from one country to another still vary from
rural to urban or from area to area.
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