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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 23-26

Ten-year review of facial bone fractures in rural population at a teaching institute in Central India (Maharashtra)


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 Submission30-May-2020
Date of Decision01-Jun-2020
Date of Acceptance01-Jun-2020
Date of Web Publication18-Jun-2020

Correspondence Address:
Harish Saluja
Department of Oral and Maxillofacial Surgery, Rural Dental College, Rahata, Loni, Ahmednagar - 413 736, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhnps.jhnps_22_20

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  Abstract 


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 Oct 22];8:23-6. Available from: https://www.jhnps.org/text.asp?2020/8/1/23/287151




  Introduction Top


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.[1],[2],[3],[4],[5],[6],[7]

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.[8] 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.[9],[10],[11] While data from developed Countries suggests assaults being the most frequent etiology of fractures.[12],[13]

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.[8]


  Materials and Methods Top


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 Top


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].
Table 1: Number of mandibular combination fractures

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Table 2: Number of midface combination fractures

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For combination of the mandible with midface, parasymphysis + ZMC has the highest number of combined injuries (2.01%) [Table 3].
Table 3: Number of mandibular and midface combination fractures

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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 Top


Trauma is the leading cause of death in the first 40 years of life.[8] 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.[14] 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.[9],[10],[11] 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.[15] 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.[9],[16],[17],[18] 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.[10],[11],[19],[20] 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.[16],[17],[18] Brasileiro and Passeri, 2006, reported 41.3% of mandibular fractures, 38.90% of ZMC fractures, and 6% maxillary fractures in their study.[14] Bakardjiev and Pechalova, 2007, reported 74% fractures of the mandible, 16% of the zygoma, 6% of the maxilla, and 4% of the nose.[21]

The anatomic distribution and incidence of mandibular fracture are widely variable. Many authors reported the angle as the most frequently affected site,[22] whereas others reported it as body[19] and parasymphysis.[8] 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%;[23] for Al Ahmed et al., it was 7.00%;[24] for Kadkhodaie, it was 75.00% (2005);[25] and for Brasileiro and Passeri, ZMC comprised 38.9%.[14]

Le Fort II was the third most common fracture comprising 4.07%. Ansari in his study stated it as 0.66%,[9] Kadkhodaie found it to be 2.80%,[25] Adebayo et al. found it to be 26.00%,[23] Al Ahmed et al. found it as 10.7%,[24] and Brasileiro and Passeri found it to be 1.40%.[14]

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%,[9] Kadkhodaie reported it as 1.10%,[25] Adebayo et al. reported it as 3.00%,[23] and Brasileiro and Passeri reported it as 0.60%.[14]

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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclosure

This material has never been published and is not currently under evaluation in any other peer reviewed publication.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.



 
  References Top

1.
Adi M, Ogden GR, Chisholm DM. An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985). Br J Oral Maxillofac Surg 1990;28:194-9.  Back to cited text no. 1
    
2.
Anderson L, Hultin M, Nordenram A, Ramstorm G. Jaw fractures in country of Stockholm (1978-1980): General survey. Int J Oral Surg 1984;13:194-9.  Back to cited text no. 2
    
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Hill CM, Crosher RF, Carroll MJ, Mason DA. Facial fractures-the results of a prospective four-year-study. J Maxillofac Surg 1984;12:267-70.  Back to cited text no. 3
    
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Mwaniki DL, Guthua SW. Occurrence and characteristics of mandibular fractures in Nairobi, Kenya. Br J Oral Maxillofac Surg 1990;28:200-2.  Back to cited text no. 4
    
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Thorn JJ, Møgeltoft M, Hansen PK. Incidence and aetiological pattern of jaw fractures in Greenland. Int J Oral Maxillofac Surg 1986;15:372-9.  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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Ansari MH. Maxillofacial fractures in Hamedan province, Iran: A retrospective study (1987-2001). J Craniomaxillofac Surg 2004;32:28-34.  Back to cited text no. 9
    
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Oji C. Jaw fractures in Enugu, Nigeria, 1985-95. Br J Oral Maxillofac Surg 1999;37:106-9.  Back to cited text no. 10
    
11.
Karyouti SM. Maxillofacial injuries at Jordan University Hospital. Int J Oral Maxillofac Surg 1987;16:262-5.  Back to cited text no. 11
    
12.
Iida S, Hassfeld S, Reuther T, Schweigert H, Hagg C, Klein J, et al. Maxillofacial fractures resulting from falls. J Cranio Maxillofac Surg 2003;31:278-83.  Back to cited text no. 12
    
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Laski R, Ziccardi VB, Broder H, Janal M. Facial trauma: A reoccurrence disease? The potential role of disease prevention. J Oral Maxillofac Surg 2004;62:685-8.  Back to cited text no. 13
    
14.
Brasileiro BF, Passeri LA. Epidemiological analysis of maxillofacial fractures in Brazil: A 5-year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:28-34.  Back to cited text no. 14
    
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Fasola AO, Obiechina AE, Arotiba JT. Incidence and pattern of maxillofacial fractures in the elderly. Int J Oral Maxillofac Surg 2003;32:206-8.  Back to cited text no. 15
    
16.
Hogg NJ, Stewart TC, Armstrong JE, Giroti MJ: Epidemiolgy of maxillofacial injuries at trauma hospitals in Ontario, Canada, between 1992 and 1997. J Trauma 2000;49:435-42.  Back to cited text no. 16
    
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Boole JR, Holtel M, Amoroso P, Yore M. 5196 mandible fractures among 4381 active duty army soldiers, 1980 to 1998. Laryngoscope 2001;111:1691-6.  Back to cited text no. 17
    
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Le BT, Dierks EJ, Ueeck BA, Homer LD, Potter BF. Maxillofacial injuries associated with domestic violence. J Oral Maxillofac Surg 2001;59:1277-83.  Back to cited text no. 18
    
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Tanaka N, Tomitsuka K, Shionoya K, Andou H, Kimijima Y, Tashiro T, et al. Aetiology of maxillofacial fracture. Br J Oral Maxillofac Surg 1994;32:19-23.  Back to cited text no. 19
    
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Iida S, Kogo M, Sugiura T, Mima T, Matsuya T. Retrospective analysis of 1502 patients with facial fractures. Int J Oral Maxillofac Surg 2001;30:286-90.  Back to cited text no. 20
    
21.
Bakardjiev A, Pechalova P. Maxillofacial fractures in Southern Bulgeria- A retrospective study of 1706 cases. J Cranio Maxillofac Surg 2007;35:147-50.  Back to cited text no. 21
    
22.
Ogundare BO, Bornick A, Bayley N. Pattern of mandibular fracturs in an urban major trauma center. J Oral Maxillofac Surg 2003; 61:713-8.  Back to cited text no. 22
    
23.
Adebayo ET, Ajike OS, Adekeye EO. Analysis of the pattern of maxillofacial fractures in Kaduna, Nigeria. Br J Oral Maxillofac Surg 2003;41:396-400.  Back to cited text no. 23
    
24.
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. 24
    
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Kadkhodaie MH. Three-year review of facial fractures at a teaching hospital in Northern Iran. Br J Oral Maxillofac Surg 2006;44:229-31.  Back to cited text no. 25
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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