|Year : 2020 | Volume
| Issue : 1 | Page : 23-26
Ten-year review of facial bone fractures in rural population at a teaching institute in Central India (Maharashtra)
Harish Saluja1, Shivani Sachdeva2, Seemit Shah1, Anuj Dadhich1, Mukund Singh3, Sumeet Mishra4
1 Department of Oral and Maxillofacial Surgery, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
2 Department of Periodontics, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
3 Department of Conservative Dentistry, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
4 Department of Orthodontics, Rural Dental College, Loni, Ahmednagar, Maharashtra, India
|Date of Submission||30-May-2020|
|Date of Decision||01-Jun-2020|
|Date of Acceptance||01-Jun-2020|
|Date of Web Publication||18-Jun-2020|
Department of Oral and Maxillofacial Surgery, Rural Dental College, Rahata, Loni, Ahmednagar - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Objective: The purpose of this study was to review the incidence and characteristics of maxillofacial fractures in Loni (rural population) and compare them with the existing literature. Materials and Methods: A retrospective study of patients' records and radiographs was reviewed during the 10-year period between 2007 and 2017. Statistical analysis was carried out according to age, gender, cause of accident, and fracture site. Results: A total of 1943 cases with 2470 injuries were reviewed during the 10-year period. The age of patients ranged from 0 to 70 years. The ratio of men to women was 3.5:1. Most fractures were caused by road traffic accident (44.12%), followed by fall (26.76%), assault (25.06%), and animal injuries (4.06%). The prevalent anatomic regions of isolated fractures were the mandible (50.64%), followed by Zygomatic complex (ZMC) (9.26%), Le Fort II (4.07%), Le Fort I (3.50%), orbital floor (3.07%), Le Fort III (2.23%), dentoalveolar (1.39%), zygomatic arch (1.13%), and nasal bone (0.77%). In combination fractures, the most common were the midface combinations (12.55%), followed by mandibular and midface combinations (6.13%), mandibular combination fractures (3.25%), and midface and frontal bone fractures (1.444%). Conclusion: The findings of this study compared with similar studies reported in literature support the view that the cause and incidence of maxillofacial injuries vary from one country to another. Animal injury was one of the causes for maxillofacial trauma because of rural location of our center.
Keywords: Facial bone, fracture, incidence, maxillofacial injuries, trauma:
|How to cite this article:|
Saluja H, Sachdeva S, Shah S, Dadhich A, Singh M, Mishra S. Ten-year review of facial bone fractures in rural population at a teaching institute in Central India (Maharashtra). J Head Neck Physicians Surg 2020;8:23-6
|How to cite this URL:|
Saluja H, Sachdeva S, Shah S, Dadhich A, Singh M, Mishra S. Ten-year review of facial bone fractures in rural population at a teaching institute in Central India (Maharashtra). J Head Neck Physicians Surg [serial online] 2020 [cited 2020 Sep 20];8:23-6. Available from: http://www.jhnps.org/text.asp?2020/8/1/23/287151
| Introduction|| |
Maxillofacial injuries affect a significant proportion of trauma patients worldwide and are associated with severe morbidity, loss of function, and esthetic concern. A number of literatures are published on the incidence and pattern of maxillofacial fractures. However, the epidemiological data vary from country to country because of social, cultural, and environmental factors and also depending on the population studied.,,,,,,
The census 2001 in India revealed that out of the total population of 1027 million, about 285 million live in urban areas and 742 million in rural areas. Thus, 72% of population live in a rural area. According to reports of developing nations, road traffic accidents (RTAs) are the main cause of maxillofacial fractures.,, While data from developed Countries suggests assaults being the most frequent etiology of fractures.,
Social problem of illiteracy, domestic violence, deteriorating infrastructure, driving under the influence of alcohol, noncompliance with crash helmet, and seat belt legislation contribute to the maxillofacial fractures.
| Materials and Methods|| |
A retrospective review of patient records of 1943 patients was analyzed during the period of 2007 and 2017. Data concerning age, gender, etiology, and anatomic site were collected. The fractures were classified according to the maxillary midface system of Le Fort and the mandibular and zygomatic complex system of Killey. If more than one facial bone fracture occurred in a single patient, it was classified as a combination fracture. Frequency and type of injury were analyzed.
| Results|| |
During the 10-year study period, 1943 patients were attended at the department of oral and maxillofacial surgery, Loni. The age of the patients ranged from 0 to 70 years. The largest demographic group included was the one between 21 and 30 years of age accounting for 45.24% of the total number of patients. Males were more frequently injured than the females. The ratio of male to female patients was 3.5:1. The most common cause of injury was RTA comprising 44.12%, followed by fall (26.76%), assault (25.06%), and animal injuries (4.06%).
Isolated mandibular fractures were the most common (50.64%) among which parasymphysis fracture has the highest incidence, followed by ZMC (9.26%), Le Fort II (4.07%), Le Fort I (3.50%), orbital floor (3.07%), Le Fort III (2.23%), dentoalveolar (1.39%), zygomatic arch (1.13%), and nasal bone (0.77%).
For more than one mandibular fracture, parasymphysis + angle fracture has the highest incidence, followed by parasymphysis + body [Table 1], while among multiple midface fractures, zygomatic complex fracture + Le Fort II fractures have the highest incidence [Table 2].
For combination of the mandible with midface, parasymphysis + ZMC has the highest number of combined injuries (2.01%) [Table 3].
Frontal bone was most commonly involved in patients having Le Fort III fractures.
Only 11 (0.57%) patients out of 1943 were affected by panfacial injuries.
| Discussion|| |
Trauma is the leading cause of death in the first 40 years of life. Many articles pertaining to the incidence and pattern of trauma have been published.
Epidemiological surveys tend to vary with geographic region, socioeconomic status, culture, religion, and duration during which the study is carried. The main causes worldwide are RTA, assaults, falls, sports-related injury, and animal injuries. This study identified RTA as the most common cause of injury. Earlier studies also support the same.,, From economic point of view, the major mode of transportation in a rural area is bicycle and motorbike which increases the risk of injury. Even though now a days traffic rules & regulations like use of seat belt, helmets are being enforced, but still road traffic accidents (RTA) are still number one cause of maxillofacial fractures. Since our institution is a tertiary care center and also located on national highway and close to religious place, the number of casualties reporting is more. Domestic violence has also contributed to a number of casualties. The cause for it is the rising unemployment along with narcotic and alcohol abuse. Prevention in this area is a social responsibility as it is the third leading cause in maxillofacial injuries according to our study. Animal injuries are more common in rural areas as they are used for agricultural as well as dairy purposes.
In this study male-to-female ratio of 3.5:1 was seen. The male predominance is a relatively consistent finding in all studies.,,, The main reason for this in rural population of India is that the females are generally at home and look for the household work while the males look out for the outdoor work. This is due to the cultural trends all over the country in the rural population.
The age group of 21–30 years showed increased evidence of injuries, followed by 31–40 years of age. This is in consistent with other studies.,,, Men aged between 21 and 40 years represent a group with intense social interaction, making them more susceptible to transport accidents and interpersonal violence, consequently leading to higher rates of maxillofacial fractures.
Mandibular fractures were more common than any other facial bone fractures comprising 39.85%. This is due to the direction and quantity of force the mandible is exposed to.,, Brasileiro and Passeri, 2006, reported 41.3% of mandibular fractures, 38.90% of ZMC fractures, and 6% maxillary fractures in their study. Bakardjiev and Pechalova, 2007, reported 74% fractures of the mandible, 16% of the zygoma, 6% of the maxilla, and 4% of the nose.
The anatomic distribution and incidence of mandibular fracture are widely variable. Many authors reported the angle as the most frequently affected site, whereas others reported it as body and parasymphysis. In this study, the parasymphysis was the most frequently affected site.
According to this study, ZMC fractures comprised 9.26% of the total maxillofacial injuries, but there are other studies indicative of a variety of values. A study by Adebayo et al. showed an incidence of 44%; for Al Ahmed et al., it was 7.00%; for Kadkhodaie, it was 75.00% (2005); and for Brasileiro and Passeri, ZMC comprised 38.9%.
Le Fort II was the third most common fracture comprising 4.07%. Ansari in his study stated it as 0.66%, Kadkhodaie found it to be 2.80%, Adebayo et al. found it to be 26.00%, Al Ahmed et al. found it as 10.7%, and Brasileiro and Passeri found it to be 1.40%.
Le Fort I comprised 3.50%. Other studies by Ansari found it as 0.48%; Kadkhodaie found it as 2.30%; Adebayo et al. found it as 11.00%; Gassner, Tuli, Hachl, Rudisch, and Ulmer found it as 2.10%; Al Ahmed et al. found it as 29.40%; and Brasileiro and Passeri found it to be 2.20%.
Le Fort III comprised 2.23% according to our study, whereas other studies by Ansari reported it to be as 7.84%, Kadkhodaie reported it as 1.10%, Adebayo et al. reported it as 3.00%, and Brasileiro and Passeri reported it as 0.60%.
The fractures of the nasal bone comprised 0.77%. Other studies by Ansari reported it as 9.43%, Adebayo et al. reported it as 11.00%, Al Ahmed et al. reported it as 0.60%, and Brasileiro and Passeri reported it to be 22.20%.
In combination fractures, the most common were the midface combinations (12.55%), followed by mandibular and midface combinations (6.13%), mandibular combination fractures (3.25%), and midface and frontal bone fractures (1.444%).
| Conclusion|| |
The findings of this study, compared with similar studies reported in literature, support the view that the cause and incidence of maxillofacial injuries vary from one country to another. We speculate that improving the condition of the roads, driving skills, and raising the traffic sense of the general public through campaigns will help to reduce the number of injuries.
It is hoped that assessments such as the one presented here will be valuable to government agencies and health-care professionals involved in planning future programs to serve rural people more efficiently and more effectively.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
This material has never been published and is not currently under evaluation in any other peer reviewed publication.
The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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[Table 1], [Table 2], [Table 3]