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ORIGINAL RESEARCH Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 2  |  Page : 109-111
Maxillofacial intervention in trauma patients aged 60 years and older


Department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Medical College and Research Institute (Deemed University), Porur, Chennai - 600 116, Tamil Nadu, India

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Date of Submission31-Oct-2006
Date of Decision06-Jan-2007
Date of Acceptance08-Jan-2007
 

   Abstract 

The purpose of this study was to evaluate the incidence of trauma victims of age 60 years and older who required maxillofacial intervention. The study analyses the pattern of injuries and the various factors that predict the treatment plan of these patients. A retrospective study was carried out in 1820 trauma patients who reported to the Sri. Ramachandra Dental College and Hospital and required maxillofacial intervention, over a period of 5 years (October 2000 and September 2005). Of the total trauma victims, 185 patients were found to be aged 60 years more. In the majority of the patients, the injury was due to road traffic accidents (79.4%). Males (72.4%) sustained more injuries than females (27.6%). Soft tissue injuries were seen in 49.1% of the patients, while 14% had mandibular fractures. People in their early 60s were injured more often than their older counterparts. The findings of this study highlight the present situation with regard to maxillofacial trauma in patients aged 60 years and older and its management in this part of the country.

Keywords: Elderly, intervention, mandibular, maxillofacial trauma

How to cite this article:
Subhashraj K, Ravindran C. Maxillofacial intervention in trauma patients aged 60 years and older. Indian J Dent Res 2008;19:109-11

How to cite this URL:
Subhashraj K, Ravindran C. Maxillofacial intervention in trauma patients aged 60 years and older. Indian J Dent Res [serial online] 2008 [cited 2019 Sep 22];19:109-11. Available from: http://www.ijdr.in/text.asp?2008/19/2/109/40463
It had been showed that the elderly people experience the same injuries as those who are younger in age, but the spectrum of injury, gender dominance, duration of injury, and outcome differ tremendously. [1],[2] The combination of soft tissue injury to the chin region and mandibular fracture have been correlated with cervical spine fracture. The incidence and pattern of maxillofacial trauma had been well studied in the past. Studies related to specific bones have also been carried out. The prevalence of maxillofacial trauma in children and young adults have been well documented. [3],[4],[5] However, very little information is available regarding the study of maxillofacial trauma in the elderly population. Studies had been done in various countries on the pattern of trauma in elderly patients, [4],[6] but very few studies have been done in Asian countries.

The purpose of this study was to systematically analyze the trauma pattern in patients aged 60 years or more, who required maxillofacial intervention at Chennai, India. Unlike developed countries, in India, the health care system is poorly organized. Treatment given to the elderly is often decided by the concerned family's financial situation rather than the physiological need. Oreskorich [4] showed that there is no necessity to treat severely injured elderly patients any differently from their younger counterparts, which implies that the increased trauma care cost is also justified for severely injured elderly.


   Materials and Methods Top


Records of patients who reported at the casualty and at the Department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital, Chennai, India, were reviewed. Patients aged 60 years and older who were treated for maxillofacial injuries during a period of 5 years (from October 2000 to September 2005) were included in this study. This hospital serves as a tertiary care center and is one of the major health care providers for the residents of Chennai.

Over this period, of 1820 patients with maxillofacial injuries seen in the emergency department and in the Department of Maxillofacial Surgery, a total of 185 patients were found to be in the age-group of 60 years and older. The following parameters were evaluated: age, sex, site of trauma, cause of injury, past medical history, associated injuries, treatment modalities, and complications, as well as the monthly, weekly, and daily variations. The etiology of injury was classified as follows: road traffic accidents, falls, assault, and others like occupation-related accidents.

The types of injuries were grouped as soft tissue injuries, maxillary fractures, mandibular fractures, zygomaticomaxillary complex fractures, nasal bone fractures, dentoalveolar fractures, and cranial bone fractures.


   Results Top


Of the total 185 patients, 134 were male (72.4%) and 51 were female (27.6%). The male to female ratio was 2.6:1 [Table - 1]. Patients' ages ranged from 60 to 89 years. The majority of the patients were in the 60-65 years age-group (40%). The average age of the sample was 64.3 years. The average male age was 67.1 years and the average female age was 61.9 years.

On an average, each patient sustained 1.26 fractures. The distribution patterns found in these patients were as follows: soft tissue injuries (49.1%), mandibular fractures (14%), zygomaticomaxillary complex fractures (12.4%), maxillary fractures (7.5%), nasal bone fractures (7%), cranial bone fractures (4.8%), and dentoalveolar fractures (4.8%) [Table - 2]. Out of 91 patients who had soft tissue injuries, 86 were treated by primary closure of the lacerations under local anesthesia (95.5%). Five patients had to be taken to the operation theatre for general anesthesia before suturing as they had extensive facial lacerations (4.5%). Out of the total 185 patients, 94 had bony injuries, 91 had only soft tissue injuries, and 56 patients had both.

The majority of the injuries were due to road traffic accidents (79.4%), followed by falls (8.5%), assault (6.4%), and others (5.3%). Out of 112 patients who sustained road traffic accidents, 81 were male and 31 were female. Of the 25 assault victims, 11 were male and 14 were female. Pedestrian accidents, occupation-related accidents, etc., accounted for 10.8% [Table - 3]. A significant past medical history was noted in 78.9% of the patients, which included diabetes; cardiovascular, respiratory, gastrointestinal, and neurological diseases; osteoporosis; and joint disorders [Table - 4].

Patients who had maxillofacial injuries were treated by either open reduction or internal fixation and closure, depending on the fracture site and the general condition of the patient. The closed reduction technique includes arch bar wiring, eyelet wiring, maxillomandibular wiring, suspension wiring, splints, etc. Open reduction was used in 28.8% of patients, 26.9% were treated with closed reduction, and 44.2% did not undergo any treatment. Seven patients had postoperative complications (3.7%). The complications were all infections following treatment with open reduction and internal fixation. The highest incidence of patients was seen during the month of October and on Saturdays.


   Discussion Top


Ageing of the population is a product of demographic transition. The phenomenon of population ageing is noticeable in most societies all over the world. In industrialized societies, most people can now expect to live on to old age. In developing societies, though the average life expectancy is less, a small proportion of the massive populations survive into old age. Although studies have shown that people in the second and third decades of their lives are more commonly involved in road traffic accidents, there is a steady increase in such trauma in the geriatric population. [1],[3],[5],[7]

In India, the retirement age for the people working in government concerns is 60 years. Similarly, private companies rarely retain or employ people who are older than 60 years. Because of domestic pressures and to relieve their own feelings of insecurity, people in their early 60s continue to be socially active and, hence, are susceptible to accidents like their younger counterparts.

A prevalence rate of 10.1% was found for maxillofacial injuries in our study, which is similar to the values of 5-29% found in developed countries. [8] It is not surprising to see a male dominance in the incidence of trauma because, after 50 years of age, the fairer sex in this country spend the larger part of their time within their homes, taking care of the household.

Shaim et al . [9] showed that in 70% of patients with maxillofacial trauma, the cause of injury was transport related. In our study, road traffic accidents were the commonest cause of maxillofacial trauma in adults older than 60 years (79.4%). In India, the motorcycle still remains a common and economical mode of transport for the majority of the population. Due to slower reflexes and impairment of vision and hearing, the elderly are more liable to get involved in accidents. This differs from the data obtained from some developed countries, where falls were the commonest cause of injury in the elderly. [2],[4],[6]

Iida et al . [10] found that falls accounted for 25% of the total cases. More severe injuries tend to be seen in the patients who have fallen from greater heights and when there are associated acute medical disorders. In our study, falls were the cause of maxillofacial trauma in 8.5% of the patients. The various factors which predispose to falls include sensory impairment, neuromuscular disorders, unstable gait, dementia, acute illness, postural hypertension, and medications like benzodiazepines. [11]

Among the 185 patients with maxillofacial fractures, the mandible was found to be more commonly involved than the midface. This is contrast to the study of Goldschmidt et al ., [2] where injuries to the middle third of the face were encountered more commonly. Mandibular fractures were treated either by open reduction and internal fixation or by closed reduction, depending upon the displacement of the fracture segments, the dentition, and the general condition of the patient. However, they were conservatively managed, whenever there was not much functional and structural deficit.

It is reasonable to assume that the capacity for self-regeneration and healing in bone and other tissues declines over the years. Unlike the developed countries, India does not have a good social security system. The elderly have to take care of themselves, personally and financially. The management of trauma in the geriatric population is more dependent on psychosocial conditions than physiological considerations.

Educational programs for the geriatric population about the need for home safety inspections, modifying medications known to adversely affect balance, gait training, and improving any correctable sensory deficits may reduce the incidence of falls. Identifying and reporting individuals who are unfit drivers may potentially reduce motor crashes; this includes persons with visual or hearing deficits, dementia, or disabling musculoskeletal disorders, as well as those using medications that decrease driving skills. In an effort to refresh skills and update traffic knowledge, driver education courses for adults over 55 years can be undertaken, as is done in the United States. There should be efforts to implement measures such as prolongation of stop light times to accommodate the decreased rate of walking of the elderly, modification of road and crosswalk signs, tighter speed limit enforcement, and safety education for senior citizens.

 
   References Top

1.van Beek GJ, Merkx CA. Changes in the pattern of fractures of the maxillofacial skeleton. Int J Oral Maxillofac Surg 1999;28:424-8.  Back to cited text no. 1  [PUBMED]  
2.Goldschmidt MI, Castiglione CL, Assael LA, Lilt MD. Craniomaxillofacial trauma in the elderly. J Oral Maxillofac Surg 1995;53:1145-9.  Back to cited text no. 2    
3.Hussain K, Wijetunge DB, Grubnic S, Jackson IT. A comprehensive analysis of craniofacial trauma. J Trauma 1994;36:34-47.  Back to cited text no. 3  [PUBMED]  
4.Oreskorich MR, Howard JD, Copan MK, Carrico CJ. Geriatric trauma: Injury patterns and outcome. J Trauma 1984;24:565-72.  Back to cited text no. 4    
5.Ugboko VI, Odusamye SA, Fagade OO. Maxillofacial fractures in a semi urban Nigerian teaching hospital. Int J Oral Maxillofac Surg 1998;27:286-9.  Back to cited text no. 5    
6.Falcone PA, Haedicke GJ, Brooks G, Sullivan PK. Maxillofacial fractures in the elderly: A comparative study. Plast Reconst Surg 1990;86:443-8.  Back to cited text no. 6  [PUBMED]  
7.Fasola AO, Nyako EA, Obiechina, Arotiba JT. Trends in the characteristics of maxillofacial fractures in Nigeria. Int J Oral Maxillofac Surg 2003;61:1140-3.  Back to cited text no. 7    
8.Vetter JD, Topazian RG, Goldberg MH, Smith DG. Facial fractures occurring in a medium sized metropolitan area: Recent trends. Int J Oral Maxillofac Surg 1994;20:214-6.  Back to cited text no. 8    
9.Shahim FN, Cameron P, McNeil JJ. Maxillofacial trauma in major trauma patients. Aust Dent J 2006;51:225-30.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Iida S, Hassfeld S, Reuther T, Schweigert HG, Haag C, Kleim J, et al . Maxillofacial fractures resulting from falls. J Craniomaxillfac Surg 2003;31:278-83.  Back to cited text no. 10    
11.Fonseca RJ, Walker RV. Oral and maxillofacial trauma, 2 nd ed. WB Saunders Company: 1997. p. 1045-55.  Back to cited text no. 11    

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Correspondence Address:
K Subhashraj
Department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Medical College and Research Institute (Deemed University), Porur, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.40463

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    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]

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