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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 3  |  Page : 182-186

Retrospective analysis on the incidence and pattern of facial bone fractures in a major trauma center of Eastern Uttar Pradesh


1 Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh; epartment of Dentistry, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, India
2 Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
3 Department of Prosthodontics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Submission15-Aug-2020
Date of Decision05-Jan-2021
Date of Acceptance22-Jan-2021
Date of Web Publication12-Jul-2021

Correspondence Address:
Nitesh Mishra
Kalpana Chawla Government Medical College and Hospital, Karnal - 132 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_132_20

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  Abstract 


Background: Maxillofacial trauma is one of the growing concerns in the field of health sector around the world. Fractures of the maxillofacial region often lead to considerable morbidity of esthetics and function. Aim: This study aims to establish the incidence and pattern of facial bone fractures as well as to present their etiology, frequency, and distribution among the cases reporting in the major trauma center of eastern Uttar Pradesh. Materials and Methods: The total number of patients included in this study was 575. The data were obtained from previous documented records. Proportions and relations of data are compared with the help of the Chi-square test. P < 0.05 suggests results are significant. Results: Of 575 patients, 376 patients had isolated fractures and 199 patients had mixed fractures. The mandible is the most commonly affected bone. The most commonly involved anatomical site was parasymphysis of the mandible (25.6% [202/790]), followed by zygomatic complex 14.9% (118/790). The mean age of patients was 28.92 years with a male predilection. The mean age for males and females was 29.44 years and 24.29 years, respectively. The most common age group involved in maxillofacial injury was 21–30. The correlation of anatomical sites of maxillofacial fractures according to age group was inferred to be statistically insignificant as P > 0.05. The most common mode of injury was inferred to be road traffic accidents (85.7% [493/575]). The correlation between anatomical site and mode of injuries was found to be statistically significant (P < 0.05). Conclusion: This study concludes that road traffic accident is the most common mode of injury and the most common bone involved is the mandible, with parasymphysis being the most affected anatomical site. The current study also demonstrates a significant correlation between the anatomical site of injury and the mode of injury.

Keywords: Maxillofacial trauma, mode of injury, retrospective study, road traffic accidents


How to cite this article:
Mishra N, Singh AK, Janani T, Sharma NK, Priya A. Retrospective analysis on the incidence and pattern of facial bone fractures in a major trauma center of Eastern Uttar Pradesh. Indian J Dent Sci 2021;13:182-6

How to cite this URL:
Mishra N, Singh AK, Janani T, Sharma NK, Priya A. Retrospective analysis on the incidence and pattern of facial bone fractures in a major trauma center of Eastern Uttar Pradesh. Indian J Dent Sci [serial online] 2021 [cited 2021 Sep 20];13:182-6. Available from: http://www.ijds.in/text.asp?2021/13/3/182/321169




  Introduction Top


Maxillofacial trauma is one of the growing concerns in the field of health sector around the world. Maxillofacial trauma poses a serious problem because of the proximity of this region to vital facial structures.[1] Fractures of the maxillofacial region often lead to considerable morbidity of esthetics and function. It may also lead to life-threatening complications when associated with head injury and cervical spine injury.[2] Incidence of maxillofacial fractures is governed by various factors such as age, sex, and socioeconomic status. Problems of illiteracy, violence, poor conditions of the road, driving under the influence of alcohol, and ignorance of wearing helmets and seat belts may add up to these factors of maxillofacial injury in developing countries. Most commonly maxillofacial fractures seen in developing countries are due to a road traffic accident.[3] According to the report given by WHO, road traffic accident is the reason for the death of one million people and injury to 15–20 million in a year.[4] Other reported causes of maxillofacial injury are physical assaults, fall from height, sports injury, self-fall, and injury inflicted due to suicide attempts.

Many studies report mandible fracture being the most common secondary to nasal fractures. Since the first written document on fractures of the mandible in 1650 BC in Egypt, there have been various studies and debates among maxillofacial surgeons, but a common consensus is not yet reached about the most frequent patterns.[5],[6] This high deviation from a fixed pattern is due to changing trends of the mode of injury and varied socioeconomic status among population.[7]

To control and effectively manage these injuries, studies regarding frequency, pattern, and distribution of maxillofacial fractures are very helpful. However, every study or research has its own limitations. This study aims to establish the incidence and pattern of facial bone fractures as well as to present their etiology, frequency, and distribution among the cases reporting in the major trauma center of eastern Uttar Pradesh.


  Materials and Methods Top


The study sample includes the maxillofacial trauma cases reporting to the emergency outdoor department of the trauma center of our institute. The trauma center is situated in the eastern region of Uttar Pradesh (India) and it has drainage from five adjacent states (UP, Bihar, Jharkhand, Chhattisgarh, and Madhya Pradesh) and one adjacent country Nepal. The records of all patients were searched which was available in the medical record department between the period of May 2016 and April 2019. All records of patients with maxillofacial injuries were evaluated. All patients having facial bone fractures and who had complete documentation were included in this study based on their clinical and radiological findings. The patients with associated head injury or other systemic injuries, either brought dead or deceased during primary management and the patients who left against medical advice cases were excluded from the study. The total number of patients satisfying the inclusion criteria was 575.

The data were obtained from previous documented records. The data included the patient's age, gender, mode of injury, and the anatomical site of fractures. The data collected are summarized and the results are represented in the form of graphs and tables and their proportions and relations are compared with the help of the Chi-square test. P < 0.05 suggests results are significant. Statistical analysis was done using SPSS version 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp) at the level of significance set at P = 0.05.


  Results Top


Frequency of maxillofacial fractures

A total of 575 patients suffered maxillofacial trauma for 3 years and a total of 790 anatomical sites involved in fractures. Of 575 patients, 376 patients had isolated fractures and 199 patients had mixed fractures [Table 1]. Mandible and zygomatic were the most commonly affected bone. Most commonly involved anatomical site was parasymphysis of the mandible (25.6%, [202/790]), followed by zygomatic complex (14.9%, [118/790]), angle of the mandible (13.8%, [109/790]), condyle of the mandible (11.3% [89/790]), the body of the mandible (10.5% [83/790]), and symphysis of the mandible and Lefort 2 of the maxilla with 5.1% (41/790) each, and the rest other anatomical sites were Lefort 1 of the maxilla, Lefort 3 of the maxilla, nasal bone, orbital floor, body of zygoma, coronoid of mandible, naso-orbito-ethmoid complex, zygomatic arch, frontal bone, and dentoalveolar region of the maxilla and mandible [Table 2].
Table 1: Distribution of type of fractures

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Table 2: Distribution of maxillofacial injuries in study subjects

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Distribution of maxillofacial injuries according to age and gender

In the current study, 575 patients were examined following inclusion criteria, of which 517 were male (90%) and 58 were female (10%). The mean age of patients was 28.92 years with a male predilection. The mean age for males and females was 29.44 years and 24.29 years, respectively [Table 3]. The most common age group involved in maxillofacial injury was 21–30 followed by 11–20. All anatomical sites such as condyle, angle, parasymphysis, and zygomatic complex were common in the third decade of life [Table 4]. The correlation of anatomical sites of maxillofacial fractures according to age group was done with the help of Chi-square test and it was inferred to be statistically insignificant as P > 0.05.
Table 3: Distribution of gender and age of patients with maxillofacial fractures

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Table 4: Distribution of anatomical site of maxillofacial injuries according to age groups

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Distribution of maxillofacial injuries according to the mode of injury

The most common mode of injury was inferred to be road traffic accidents (85.7% [493/575]). Other modes of injuries were fall from height, physical assault, and sports injury which were depicted as 9.5% (55/575), 4% (23/575), and 0.3% (2/575), respectively. Self-fall and gunshot injury represent the same percentage of 0.2% (1/575) [Table 5]. Fractures of the region of the mandible (condyle, angle, coronoid, symphysis, parasymphysis, and body) were mostly associated with road traffic accidents and falls from height [Table 6]. Zygomatic complex fractures were mainly associated with road traffic accidents. Fractures of the nasal bone and orbital floor were associated with sports injury and assaults. Naso-orbito-ethmoid complex fractures are mainly associated with road traffic accidents. Hence, the correlation was done between the anatomical site and mode of injuries with the help of Chi-square statistical analysis, and the results were found to be significant (P < 0.05).
Table 5: Distribution of study subjects according to the mode of injury

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Table 6: Distribution of anatomical site of maxillofacial injuries according to the mode of injuries

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  Discussion Top


The pattern, incidence, and changing trends in maxillofacial trauma often attract researchers because it may lead to severe functional and esthetic morbidity. Various studies depicting the epidemiology of maxillofacial injuries have been published. This study presents the analysis from a major trauma center of the eastern region of Uttar Pradesh state which drains the patients from five adjacent states and one neighboring country.

Etiology and pattern of maxillofacial injuries are different for developing and developed countries and various factors such as socioeconomic status, illiteracy, substance abuse, lack of employment, and demographic location are responsible for it.[8] Most of the patients in this study group represented the rural population. The urban population was little and mainly due to the presence of industries. Due to the presence of obvious socioeconomic status of the representative population and presence of illiteracy, the incidence of maxillofacial injury due to road traffic accidents is more. Most of the cases were associated with two-wheelers like motorcycles or scooters. Another major reason could be the lack of proper traffic regulations in rural regions like not using safety measures like helmets and seat belts. Physical assault is also considered as one of the major etiology in maxillofacial trauma and it is often attributed to lack of employment, illiteracy and substance abuse like alcohol. In this study, the most common mode of maxillofacial injury was found to be road traffic accidents (85.7%) which is in agreement with many studies.[3],[8],[9],[10],[11] and not in line with the study of Brucoli et al.[12] This finding enlightens us about the seriousness of traffic rules. Correlation between the anatomical site of fracture and mode of injury was found to be significant in our study. Fractures of the region of the mandible (condyle, angle, coronoid, symphysis, parasymphysis, and body) were mostly associated with road traffic accidents and falls from height. Fracture of the mandible often occurs when a person falls or slips from a two-wheeler or when there is a sudden deceleration of bike due to collision imparting direct blow to the mandible.[9] Zygomatic complex and maxillary fractures were mainly associated with road traffic accidents because crashing or smashing of one vehicle into another leads to the transfer of whole force and momentum right on to the whole face. This can cause the involvement of various regions of facial bones.[9] These theories can justify a significant correlation between anatomical sites and mode of injury.

In this study, the most commonly mandible is involved, with parasymphysis (25.6%) being the most affected site followed by zygomatic complex (14.9%). This finding is consistent with many studies.[3],[8],[10] The mandible is most commonly affected as it has few bony support, more obvious location, and more mobility as compared to other facial bones.[13] However, Patel et al. reported orbital fractures as the most common injury (57%), Brucoli et al.[12] reported zygomatic complex being most common and also inconsistent with the finding of Al-Hassani et al.[14] In this study, of 575 patients, 376 patients had isolated fractures and 199 patients had mixed fractures. Site of fractures and whether a fracture is isolated or mixed usually show direction and impact of force applied to the facial bone.[6]

In this study, the incidence of maxillofacial injury has male predilection with a ratio of 9:1 (male: female) which is consistent with findings of Abhinav et al.[10] Higher incidence of maxillofacial injury in males in this study group due to presence of more rural population where males are mostly involved in outdoor work and females are confined to their household work. This finding is consistent with most studies.[3],[8],[10]

The mean age group that was affected was 21–30 years and this finding is consistent with many other epidemiological studies[15],[16],[17] and a prospective study by Agnihotri et al.[11] and study by Prasad et al.[9] This age group is most affected because the population in this age group is young, energetic, self-dependent, and socially excited. The habit of alcohol also makes this group prone to injury.[9] The second age group that was affected is 11–20. The low occurrence of fractures in the pediatric population may be due to the more flexible bone and resistance due to tooth buds.[18],[19]


  Conclusion Top


This retrospective study concludes that road traffic accident is the most common mode of injury and the most common bone involved is the mandible, with parasymphysis being the most affected anatomical site. It also concludes that the young population is most frequently affected. Illiteracy, socioeconomic factors, lack of knowledge of traffic rules, and alcohol abuse are the most suggested reasons for these injuries. The current study also demonstrates a significant correlation between the anatomical site of injury and the mode of injury. Thus, this study intends to provide a general scenario of maxillofacial injuries within the population and to give a helping guide to implement awareness programs among the population which may help in the prevention of maxillofacial trauma and minimizes mortality and morbidity within the community.

Limitations of the study

Error in data by improper documentation, missing information, and bias in selection are the considerable limitation of this study as it is a retrospective study. Another limitation of this study is it is a single institution-based study, so external validity is limited. Such kind of limitations can be reduced with the help of prospective studies and further investigation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Al Ahmed HE, Jaber MA, Abu Fanas SH, Karas M. The pattern of maxillofacial fractures in Sharjah, United Arab Emirates: A review of 230 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:166-70.  Back to cited text no. 6
    
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Bither S, Mahindra U, Halli R, Kini Y. Incidence and pattern of mandibular fractures in rural population: A review of 324 patients at a tertiary hospital in Loni, Maharashtra, India. Dent Traumatol 2008;24:468-70.  Back to cited text no. 8
    
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Prasad C, Narayanan MB, Parimala V, Vijjaykanth M. Prevalence and pattern of maxillofacial trauma in North Chennai: A retrospective study. J Indian Assoc Public Health Dent 2018;16:303-7.  Back to cited text no. 9
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Agnihotri A, Galfat D, Agnihotri D. Incidence and pattern of maxillofacial trauma due to road traffic accidents: A prospective study. J Maxillofac Oral Surg 2014;13:184-8.  Back to cited text no. 11
    
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Brucoli M, Boffano P, Romeo I, Corio C, Benech A, Ruslin M, et al. Epidemiology of maxillofacial trauma in the elderly: A European multicenter study. J Stomatol Oral Maxillofac Surg. 2020;121:330-338. doi: 10.1016/j.jormas.2019.09.002.  Back to cited text no. 12
    
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Al-Hassani A, Ahmad K, El-Menyar A, Abutaka A, Mekkodathil A, Peralta R, et al. Prevalence and patterns of maxillofacial trauma: a retrospective descriptive study. Eur J Trauma Emerg Surg. 2019. [doi: 10.1007/s00068-019-01174-6] Epub ahead of print.  Back to cited text no. 14
    
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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