Year : 2008 | Volume
: 19 | Issue : 4 | Page : 304--308
A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals of Mysore city
BR Chandra Shekar1, CVK Reddy2,
1 Department of Community Dentistry, Kamineni Institute Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Andhra Pradesh, India
2 Department of Community Dentistry, J S S Dental College and Hospital, S S Nagar, Mysore, Karnataka, India
B R Chandra Shekar
Department of Community Dentistry, Kamineni Institute Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Andhra Pradesh
Objectives: This study aims to provide a five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated during 1 st January 1998 and 31 st December 2002 in two hospitals of Mysore city; to determine the age and sex distribution, etiology, type of injury, day and time of accident, and the influence of alcohol and other drugs; andto suggest measures to prevent such injuries.
Materials and Methods: After obtaining permission from the concerned authorities, a pre-designed questionnaire was used to collect the necessary data from the two hospitals. The data was then computerized and statistical analysis was done using statistical package for the social sciences (SPSS) windows version 10.
Results: Road traffic accident (RTA) was the common cause for maxillofacial injuries. Men sustained more injuries compared to women. The injuries were mostly sustained in the age group of 11-40 years, constituting about 78% of all the injuries. Two wheelers were the most commonly involved compared to other vehicle types. Influence of alcohol at the time of injury was found in about 58% of the patients with maxillofacial injuries. The most number of accidents occurred in the weekends. Mandibular fractures were the most common.
Conclusion: RTAs are the most common cause for maxillofacial injuries. If RTAs are considered an epidemic of modern times, then prevention is its vaccine.
|How to cite this article:|
Chandra Shekar B R, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals of Mysore city.Indian J Dent Res 2008;19:304-308
|How to cite this URL:|
Chandra Shekar B R, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals of Mysore city. Indian J Dent Res [serial online] 2008 [cited 2021 Jun 15 ];19:304-308
Available from: https://www.ijdr.in/text.asp?2008/19/4/304/44532
Accidents constitute an important cause of preventable morbidity, mortality, and disability.  Accidents resulting in deaths and disabilities are responsible for considerable loss of man-hours and also pose a threat to social, economic, and cultural development of any country. The road traffic accidents (RTAs) are now considered a public health hazard of primary magnitude and are likely to increase in the coming years owing to the rapid increase in the automobile users. 
Accidents are definitely on the increase in India. The country has a world's highest fatality rate in RTAs, 20 times that of developed countries. In India, eight people get killed for every 100 vehicles, where as in developed countries like Britain, France, Germany, Italy, and USA, one person gets killed for every 1000 vehicles. ,
Facial fractures occur almost invariably in such accidents and they constitute quite a significant portion of the workload of the oral and maxillofacial surgeon. Studies in the past have revealed that the vast majority of facial fractures in peacetime result from RTAs, especially in developing countries where the tradition and enforcement of highway discipline are yet to be established.  Although trauma resulting from RTAs has been generally depicted as an affliction of the young adults, individuals of all age groups are involved.  Surveys conducted in some countries have shown alcohol as the direct cause in 30-50% of severe road accidents.  There is lack of population-based data on road traffic injuries in this part of the country, and there is large heterogeneity in the published data. This is an important research agenda for the country; hence, the present study was taken up as an attempt to provide a retrospective statistical analysis of patients treated for maxillofacial injuries and to determine the factors responsible for facial fractures, the age and sex distribution, the type of fracture, the time and day of accidents, and the influence of alcohol and other drugs in maxillofacial fractures.
To provide a five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated during 1 st January 1998 and 31 st December 2002 in two hospitals of Mysore city.
To determine the age and sex distribution, etiology, type of fracture, day and time of accident, and influence of alcohol and other drugs.
To suggest measures to prevent such injuries.
Materials and Methods
A preformed pro forma was used to collect the data for this retrospective statistical analysis. After obtaining permission from the concerned hospital authorities, the hospital records of all the patients admitted and treated for maxillofacial injuries in K.R Hospital (Govt.) and J.S.S.Hospital (Private), Mysore, during 1 st January 1998 and 31 st December 2002 were checked. The information pertaining to the age and sex distribution, etiology of fracture, type of fracture, day and time of accident, associated head injuries, influence of alcohol and other drugs in these injuries, the type of treatment, etc. were entered in the preformed pro forma. The data was then computerized and subjected to statistical analysis, using SPSS windows version 10.0. The various statistical parameters used were mean, standard deviation, and chi-square test. The statistical significance was fixed at 0.05.
A total of 546 patients were admitted to the two hospitals for maxillofacial injuries during 1 st January 1998 and 31 st December 2002. Men sustained significantly more maxillofacial injuries compared to women, with an overall male to female ratio being 4.7:1 [Pie diagram 1]-[SUPPORTING:1]. The age range of the patients treated for maxillofacial injuries in these two hospitals during the five-year period was 3-90 years. Those in the age group of 11-40 years constituted the major proportion (78.3%) of these maxillofacial injuries [Bar diagram 1]-[SUPPORTING:2]. Of the 8 causes for sustaining maxillofacial fractures, RTAs were the most common (61.3%), followed by fights and assaults (16.3%) [Bar diagram 2]-[SUPPORTING:3]. Among RTAs, two wheelers were the most commonly involved (80.5%), followed by others (8.9%) [Bar diagram 3]-[SUPPORTING:4]. The fracture of the lower one third or mandibular fracture was the most common constituting about 60.4% of the maxillofacial injuries, followed by middle third fracture (39.6%) [Pie diagram 2]-[SUPPORTING:5]. Subcondylor fracture was the most common (36.7%) lower third fractures [Pie diagram 3]-[SUPPORTING:6], and nasal bone fracture was the most common of the middle third fractures (55.9%) [Bar diagram 4]-[SUPPORTING:7]. Fifty-eight point eight percent of the total patients with maxillofacial injuries were under alcoholic influence at the time of injury [Pie diagram 4]-[SUPPORTING:8]. Of 291 RTAs involving alcoholics, 210 accidents (72.1%) occurred on saturdays [Table 1]. Among the alcoholics involved in RTAs, 283 accidents (97.2%) occurred between 6 p.m. and 12 a.m., the peak being between 7.30-9.30 p.m. Among the nonalcoholics involved in RTAs, the highest number of accidents occurred between 12-6 p.m. [Table 2]. About 78.2% of the patients treated for maxillofacial injuries had closed reduction with arch bar fixation, and for the rest 21.8% open reduction with miniplate fixation was the treatment choice [Pie diagram 5]-[SUPPORTING:9].
The higher frequency of maxillofacial injuries among men compared to women in the present study may be attributed to the fact that the females, most often, are confined to housework and they drive vehicles less frequently, and more carefully than males; Also, the fact that women occasionally participate in trading or farming and are less exposed to accidents in fights, industrial works, and sports. The finding was consistent with the findings of the studies by El-Sheikh et al., and others. ,,,,,,,,,,,,,,, Trauma is now considered a problem of young people, which may be because of their aggressive nature and careless driving on roads. The age group of 21-30 years also coincides with the period when young men and women complete their post secondary education and make numerous journeys in search of employment. This suggests that proper education to these groups may reduce their involvement in such accidents which is in accordance with the findings of studies by El-Sheikh et al.,  and others. ,,,,,,, The increasing number of RTAs in developing countries like India may be attributed to many factors like sharing of roadways by pedestrians and animals with fast-moving and slow-moving vehicles, with almost no segregation of pedestrians from wheeled traffic; the large numbers of old and poorly maintained vehicles on road; large numbers of motorcycles, scooters, and mopeds;, low driving standards; large numbers of overloaded buses; widespread disregard for traffic rules; defective roads; poor street lighting; and defective layout of cross roads and speed breakers.  In addition, the increasing volume of traffic as a result of economic expansion and rapid increase in the density of urban population may also be the factors responsible for increasing RTAs in recent times. The increasing fights and assaults in the recent times can be attributed to increasing interpersonal violence with alcohol consumption, and unemployment. El-Sheikh et al.,  Ugboko et al., Erol et al., Ansari et al., and Costa Ferreira Pedro et al., in their studies found that RTAs as the major cause of maxillofacial injuries. The results were consistent with findings of other studies conducted by Ortakoglu et al., Dinesh Mohan,  Jagnoor,  Subashraj et al.,  and Garg et al. The two wheelers in comparison with the cars are unstable and provide little protection to their riders in accidents. This may be the possible explanation for the increasing frequency of RTAs involving the two wheelers. The escalating cost of vehicle spare parts has compelled the vehicle owners to seek substandard alternatives, thereby compromising the safety of the vehicle as well the rider or the passengers in case of heavy vehicles. The majority of commercial vehicle drivers are illiterate and may not be able to read and properly interpret the simple road signs. This may be the reason for higher involvement of buses and trucks in comparison with the cars as was found in the studies by Veeresha et al.,  Subashraj et al.,  and Garg et al. A study by T et al.,  has found 'falls' as the main cause for maxillofacial injuries whereas a study by others  has revealed daily activities and sports as the main cause. The studies conducted by Kontio et al and others  have found fights and assaults as the main cause for maxillofacial injuries. The review of all these studies clearly suggests that the causes for maxillofacial injuries vary from one country to another. The higher involvement of mandible may be attributed to its prominence and also to its exposed anatomical position on the face. Most of the victims of RTAs will try to avoid their head against injury at the time of accidents. Thus, in the process of avoiding their head, may receive maximum impact to the mandible. This can also be a factor responsible for the higher involvement of mandible compared to other facial bones in the maxillofacial injuries. The enforcement of certain strict laws to make it mandatory, the use of seat belts in cars and the use of total head guard (with chin protector) rather than the conventional helmets can reduce most of the mandibular and middle third fractures of the face. The importance of the use of helmets should be taught to the public, so that they willingly go about using it for their own safety rather than just to obey the orders. The studies conducted by Ugboko et al.,  Veeresha et al.,  Motamedi,  Ortakoglu et al.,  and Qudah Mansour et al.,  have also found mandibular fracture to be the most common maxillofacial injury. The force of a blow is transferred from the chin along the mandible to the condyle often causing fractures in the neck, which is one of the weak anatomical locations within the mandible. The long roots of canines, presence of third molars, and also the abrupt change in the direction between the large, strong body of the mandible and the thin ascending ramus make the parasymphysis and the angle region, the other two weak anatomical sites susceptible for fractures as found in the studies by Veeresha et al.,  Motamedi,  MH et al.,  Costa Ferreira Pedro et al., Sakr et al.,  Lida et al.,  and Ortakoglu et al. The involvement of nasal bone in most of the middle third fractures may be attributed to its prominent location on the face and relative structural weakness as was reported in the studies of Le et al.,  and Veeresha et al. The studies by Al Khateeb et al.,  have found zygomatic complex as the most common site of middle face injury which is not coinciding with the results of this study. The alcohol consumption is considered a part of the life style of the present generation and the proportion of youth with this habit is increasing with the time. Alcohol impairs driving ability and increases the risk of an accident as well as its consequences. Drugs such as barbiturates, amphetamines, and cannabis impair one's ability to drive safely. Alcoholics become more violent and this may be reason for higher incidence of fight and assault related maxillofacial injuries among male alcoholics as was found in the study by Lee et al.  The concerned authorities should consider banning of alcohol and such drugs as was suggested by Le et al. The weekend parties and the excessive use of alcohol among the youth in the name of parties may be responsible for this high incidence of accident related maxillofacial injuries on saturdays. Therefore, there is a need to stress the importance of common restraint devices and good road habits at least during this high-risk period to reduce the incidence of maxillofacial fractures due to the RTAs. Our results are in acccordance with that of Gilthorpe ,  Subashraj et al.,  Dinesh Mohan,  Jagnoor,  Fasola AO,  and Risto Kontio et al. A study by Khateeb et al.,  has found that most number of injuries tend to occur in the month of January, whereas a study by Risto Kontio et al.,  has found June through August as the months of maximum maxillofacial injuries. The timing of accidents among the nonalcoholics coincided with the peak traffic hours [Table 2]. The timing of accidents among alcoholics coincided with the time when most of the alcoholics return home, and also there will be moderate traffic during this time and results were in agreement with results of study by Veeresha et al. Majority of the patients treated in these hospitals had closed reduction with arch bar fixation as the treatment and few patients were treated with open reduction and miniplate fixation, which is consistent with the studies conducted by Erol et al.,  Ansari et al.,  Ortakoglu et al.,  and Qudah Mansour et al. Plating with intermaxillary fixation was the most commonly opted treatment procedure in the study by Khateeb et al. The treatment chosen may differ as there are many factors like cost of treatment, affordability by the patient, feasibility in the hospital, doctor's decision and skill, patient's willingness to avail the treatment advised - all of which may vary from one country to another.
Summary and Conclusion
Fractured mandible and middle third of the face in younger age groups may sometimes lead to almost permanent deformity. If RTA is considered an epidemic of modern times, then prevention is its vaccine. This can be accomplished by educating the general public, particularly the vulnerable age group (15-45 years) about road safety measures. Road safety is a result of deliberate effort on the part of the government and the nongovernment alike. These sectors should acknowledge road safety to be an important and valuable public good and should develop policies and programs to support and maintain it. These groups can host various events related to road safety like the launching of new legislation, conducting conferences and seminars, organizing national charity sports event for road safety, arranging radio or television talks, street demonstrations, fairs, walks, marathons, photographs, or other type of art exhibitions or similar events. The increasing number of RTA related maxillofacial injuries suggests the need for immediate attention from the concerned authorities.
The study had some limitations. The number of hospitals considered was small andthe data for the statistical analysis were obtained from the hospital records, where much of the valuable information on the occupation, literacy status, the use of preventive devices like the helmets, seat belts, etc. at the time of injury werenot available. Hence, further studies specifically the prospective studies are required to support and validate the findings of this study. Also, there should be uniform and standardized pro forma throughout the country to record all the relevant information in cases of road traffic injuries.
Our profound thanks to Dr. Shobha Sridhar, Associate Professor, Department of Community Dentistry, Shyamala Reddy Dental College and Hospital, Bangalore and Dr. Veeresh D J, Associate Professor, Department of Community Dentistry, PMN Dental College and Hospital, Bagalkot for their continuous supervision for the academic excellence and help during the preparation for this article.
|1||Mahajan BK. Non- communicable diseases. Textbook of preventive and social medicine. 1st ed 1991. p. 264-5.|
|2||Veeresha KL, Shankararadhya MR. Analysis of fractured mandible and fractured middle third of the face in road traffic accidents. J Indian Dent Assoc 1987;59:150-3.|
|3||Park K. Epidemiology of chronic non-communicable diseases. Textbook of preventive and social medicine. 17th ed. 2005. p. 303-7|
|4||World Health Organization. World health day theme-2004. Available from: http://www.worldhealthorganization. [cited in 2004]. |
|5||Ugboko VI, Odusanya SA, Fagade OO. Maxillo-facial fractures in a semi-urban Nigerian teaching hospital: A review of 442 cases. Int J Oral Maxillofac Surg 1998;27:286-9.|
|6||Fasola AO, Obiechina AE, Arotiba JT. Incidence and pattern of maxillo-facial fractures in the elderly. Int J Oral Maxillofac Surg 2003;32:206-8.|
|7||El-Sheikh MH, Bhoyar SC, Emsalam RA. Mandibular fractures in Benghazi Libya: A retrosoective analysis. J Indian Dent Assoc 1992;63:367-70.|
|8||Kieser J, Stephenson S, Liston PN, Tong DC, Langley JD. Serious facial fractures in New Zealand from 1979-1998. Int J Oral Maxillofac Surg 2002;31:206-9.|
|9||Subashraj K, Nandakumar N, Ravichandran C. Review of maxillofacial injuries in Chennai, India: A study of 2748 cases. Br J Oral Maxillofac Surg 2007;45:637-9.|
|10||Mohan D. The road ahead. Traffic injuries and fatalities in India. TRIPP transportation research and injury prevention program. WHO collaboration center. |
|11||Jagnoor. Road traffic injury prevention: A public health chanllenge. Indian J Community Med 2006;31:129-31.|
|12||Yoffe T, Shohat I, Shoshani Y, Taicher S. Etiology of maxillofacial trauma: A 10-year survey at the Chaim Sheba Medical Center, Tel-Hashomer. Harefuah 2008;147:192-6,280.|
|13||Motamedi M. An assessment of maxillofacial fractures: a 5-year study of 237 patients. J Oral Maxillofac Surg 2003;61:61-4.|
|14||Gassner R, Tuli T, Hδchl O, Rudisch A, Ulmer HJ. Cranio-maxillofacial trauma: A 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 2003;31:51-61.|
|15||Kontio R, Suuronen R, Ponkkonen H, Lindqvist C, Laine P. Have the causes of maxillofacial fractures changed over the last 16 years in Finland? An epidemiological study of 725 fractures. Dent Traumatol 2005;21:14-9.|
|16||Erol B, Tanrikulu R, GφrgŁn B. Maxillofacial fractures: Analysis of demographic distribution and treatment in 2901 patients (25-year experience). J Craniomaxillofac Surg 2004;32:308-13.|
|17||Ansari MH. Maxillofacial fractures in Hamedan province, Iran: A retrospective study (1987-2001). J Craniomaxillofac Surg 2004;32:28-34.|
|18||Ferreira Pedro C, Josι Manuel A, Silva Pedro M, Jorge Manuel R, Miguel PC, Alvaro CS, et al . Retrospective study of 1251 maxillofacial fractures in children and adolescents. Plast Reconstr Surg 2005;115:1500-8.|
|19||Sakr K, Farag I, Zeitoun I. Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt. Br J Oral Maxillofac Surg 2006;44:107-11.|
|20||Bakardjiev A, Pechalova P. Maxillofacial fractures in Southern Bulgaria: A retrospective study of 1706 cases. J Craniomaxillofac Surg 2007;35:147-50.|
|21||Al-Khateeb T, Abdullah FM. Craniomaxillofacial injuries in the United Arab Emirates: A retrospective study. J Oral Maxillofac Surg 2007;65:1094-101.|
|22||Shahim FN, Cameron P, McNeil JJ. Maxillofacial trauma in major trauma patients. Aust Dent J 2006;51:225-30. |
|23||Jha N, Srinivasa DK, Roy G, Jagadish S. Injury pattern among road traffic accident cases: A study from South India. Indian J Community Med 2003;28:2. |
|24||Sathiyasekaran BW. Accident trauma: A descriptive Hospital Study. J R Soc Health 1991;111:10-1.|
|25||Garg N, Hyder AA. Road traffic injuries in India: A review of the literature. Scand J Public Health 2006;34:100-9.|
|26||Ortakoglu, Kerim, Gunaydin, Yilmaz, Aydintuq, Yavuz Sinan, et al . An analysis of maxillofacial fractures: A 5 year survey of 157 patients. Military Med 2004;169:723-727.|
|27||Mansour Q, Anwar B. A retrospective study of selected oral and maxillofacial fractures in a group of Jordanian children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:310-4.|
|28||Lida S. Retrospective analysis of 1502 patient's facial fractures. Int J Oral Maxillofac Surg 2001;30:286-90.|
|29||Le BT, Dierks EJ, Brett A. Maxillofacial injuries associated with domestic violence in Portland. J Oral Maxillofac Surg 2001;59:1277-83.|
|30||Lee KH, Snape L. Role of alcohol in maxillofacial fractures. N Z Med J 2008;121:15-23.|
|31||Gilthorpe MS. Variations in admissions to hospital for head injury and assault to the head part-1: Age and gender. Br J Oral Maxillofac Surg 1999;37:294-300.|