|Year : 2020 | Volume
| Issue : 2 | Page : 87-90
Pattern and Etiology of Maxillofacial Trauma among Sudanese Population
Mashail Mahmoud Hamid1, Azkar Jabir1, Ahmed Fathi1, Arwa Mohieeldin1, Marwa Mahmoud Hamid2
1 Department of Oral and Maxillofacial Surgery, Pedodontics and Preventive Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
2 Department of Orthodontics, Pedodontics and Preventive Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
|Date of Submission||16-Jul-2020|
|Date of Decision||20-Jul-2020|
|Date of Acceptance||21-Jul-2020|
|Date of Web Publication||8-Dec-2020|
Marwa Mahmoud Hamid
Al Qasr Ave, Medical Campus, University of Khartoum, P. O. Box 11115, Khartoum
Source of Support: None, Conflict of Interest: None
Background: Maxillofacial trauma has the potential to cause disfigurement and loss of function. It can be fatal by causing severe bleeding or interference with the airway. Objectives: The objectives of this study were to assess the etiology, site, timing, age, and gender predilection of maxillofacial trauma in a sample of Sudanese patients. Materials and Methods: This was a prospective descriptive-analytical hospital-based study. The records of 96 trauma patients who attended Khartoum Dental Teaching Hospital from February to April 2017 were investigated for the following information: the etiology of the trauma, site of the fracture, time of the injury as well as the patients’ age and gender. Data were analyzed using the Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY USA). Results: During the study period, 96 patients with 204 fractures were treated. 82.3% of the patients were males. The age group between 13 and 23 years showed the highest rate of incidence of maxillofacial trauma. The most common cause of the trauma was assault (36.5%) in males and falls in females (47.1%). Dentoalveolar fractures were the most common site of fractures (25.6%) followed by condylar fractures (14%). The majority of the injuries (34.4%) took place during the day between 1 pm and 6 pm. Conclusions: Causes and patterns of maxillofacial trauma vary greatly from one region to another. This can remarkably aid in raising public awareness and establishing specific prevention and treatment programs.
Keywords: Maxillofacial, Sudanese, trauma
|How to cite this article:|
Hamid MM, Jabir A, Fathi A, Mohieeldin A, Hamid MM. Pattern and Etiology of Maxillofacial Trauma among Sudanese Population. J Head Neck Physicians Surg 2020;8:87-90
|How to cite this URL:|
Hamid MM, Jabir A, Fathi A, Mohieeldin A, Hamid MM. Pattern and Etiology of Maxillofacial Trauma among Sudanese Population. J Head Neck Physicians Surg [serial online] 2020 [cited 2021 Jan 18];8:87-90. Available from: https://www.jhnps.org/text.asp?2020/8/2/87/302628
| Introduction|| |
In surgical terms, trauma may be defined as a physical force that results in injury. Maxillofacial injury specifically denotes trauma to the middle third of the facial skeleton and/or mandible including soft-tissue injury. Maxillofacial trauma constitutes a substantial proportion of traumas; in general, this is primarily because this region is the most exposed part of the body and the most prone to injury.
Maxillofacial injury can occur in isolation or may be associated with multiple injuries to other regions, such as the abdomen, chest, spine, and extremities,, along with psychological trauma., Road traffic accidents (RTAs), interpersonal violence, and falls are often reported as causes of maxillofacial trauma. Other causes include sports-related injuries, occupational hazards, and rarely, blast injuries., However, epidemiology, etiology, and severity of maxillofacial trauma vary remarkably depending on the population studied.,,,
Regional-based assessment of the etiology and maxillofacial trauma patterns can aid the health-care providers to identify the risk factors for trauma and formulate appropriate plans to reduce the incidence of maxillofacial trauma as well as providing proper management.
The aim of this study was to assess the patterns and etiology of maxillofacial trauma in patients admitted at Khartoum Dental Teaching Hospital (KDTH), Khartoum, Sudan, over a 3 months’ period, with special attention to age, gender, and timing of the maxillofacial injuries.
| Materials and Methods|| |
From February to April 2017, 96 Sudanese patients with maxillofacial trauma were admitted to KDTH. The following data were collected directly from the patients’ medical records: patient’s age, gender, fracture site, cause of the trauma, and time of the day during which the injury had occurred. Ethical approval was obtained from the Ethics Research Committee to conduct this research.
| Results|| |
The present study was conducted on 96 patients, and among them, 79 were male (82.3%) and 17 were female (17.7%), with a male: female ratio of 4.6:1 [Figure 1]. The majority of the patients (39.6%) belonged to the age group between 13 and 23 years [Figure 2]. The total number of fractures recorded was 204, among which dentoalveolar fracture was the most common pattern (25.6%) followed by condylar fracture (14%) and parasymphyseal fracture (12.8%) [Figure 3]. The maximum prevalence of injuries recorded was due to assault (36.5%) [Figure 4]. Over one-third of the incidences (34.4%) took place during the day, between 1 pm and 6 pm [Figure 5]. Certain associations between age, gender, and cause of the injury were observed [Figure 6] and [Figure 7].
| Discussion|| |
Trauma, in general, and maxillofacial trauma, in specific, can be life-threatening. Moreover, traumatic injuries have been recognized as the leading cause of lost productivity and reduced human workforce more than heart disease and cancer combined.
This study was conducted in KDTH. The deteriorated health system and lack of facilities in states’ hospitals have made (KDTH) the main maxillofacial trauma center in Sudan. Trauma patients are referred from all over the country to KDTH to receive treatment. In this study, men were found to be at a higher risk of maxillofacial trauma than females with a 4.6:1 male-to-female ratio. This is a universal finding agreed on in many previous studies on different populations such as Saudi Arabia, the United Arab Emirates, Jordan, the United States, Europe, Nepal, Ghana, Nigeria, and many others.,,,,,, The fact that males are more prone to injuries than women can be attributed to their earlier and frequent engagement in violent behavior, vehicular travel, and sports activity when compared to women.
Regarding age distribution, it was evident that the age group between 13 and 23 years recorded the highest incidence of trauma (39.6%) followed by 24–34 years (26%). This might be because this period of an individual’s life is the period of the most social activity and interaction. This again was similar to previous findings in the literature.,,, However, Smith et al. reported a higher age for maxillofacial trauma in the United States (45 years).
In Sudan, as in many other developing countries, violent behavior and assault were the leading cause of maxillofacial trauma (36.5%) followed by RTAs (35.4%). On the contrary, RTA as a cause of maxillofacial trauma predominated in developed countries, for example, the United States, where the incidence of RTA inflicted injuries was 47%. A similar finding was observed in Holland., A multicenter prospective study in Europe revealed that assault and RTA alternated as the most common etiological factors of maxillofacial trauma. Such information is extremely important in assisting authorities in raising public awareness toward legislation on violence and traffic safety measures such as seat belts and wearing helmet, especially when riding two-wheeled vehicles.
Certain associations were observed between age, gender, and cause of the trauma [Figure 6] and [Figure 7]. In the younger age group (2–12 years), falls were the major cause of trauma, whereas in 13–23 and 24–34 years’ age groups, RTA predominated. On the other hand, in patients older than 35 years, assaults were the most common cause of trauma. In addition, it was found that in the males’ group, assaults and RTA were the main etiological factors, whereas in the females’ group, falls were the primary cause of maxillofacial trauma. This might be due to males being more confrontational and more likely to be involved in physical violence than females.
The bone most frequently associated with fracture was the dentoalveolar (25.6%) followed by the condyles (14%), whereas the least affected bones were the orbital and nasal bone (1.8% and 1.3%, respectively). These findings oppose Arangio et al. results in Italy where they found that the zygomatic bone was the most commonly involved in maxillofacial trauma accounting for 34% of total injuries, whereas alveolar bone fractures only represented 2%. Another contradictory result was obtained by Smith et al. in the United States where they found that orbital bone fracture followed by maxillary fractures scored the highest incidences of maxillofacial trauma (32% and 26%, respectively).
Day hours from 1 pm to 6 pm recorded the highest rate of injuries (34.4%) followed by the period from 7 pm to midnight (31.2%). This could be attributed to the general rhythm of Khartoum residents where most activities and social interactions take place during the day and early night hours.
| Conclusions|| |
In the present study, maxillofacial trauma patients who attended KDTH from February to April 2017 were mostly males. Younger patients (13–23 years old) were commonly involved. The major cause of trauma was assault in males and falls in females. Dentoalveolar bone was the most frequently involved bone in maxillofacial trauma. Moreover, over one-third of the injuries took place between 1 pm and 6 pm. These findings, hopefully, could result in a serious reflection on prevention plans and implementation of new solid strategies to reduce the direct cost of trauma treatments and indirect expenditures on its consequences.
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.
| References|| |
Thomas DW, Hill CM. Etiology and changing patterns of maxillofacial trauma. In: Ward Booth P, editor. Maxillofacial Surgery. 1st
ed., Vol. 1. London: Churchill Livingstone; 1999. p. 1-10.
Weihsin H, Thadani S, Agrawal M, Tailor S, Sood R, Langalia A, et al
. Causes and incidence of maxillofacial injuries in India: 12-year retrospective study of 4437 patients in a tertiary hospital in Gujarat. Br J Oral Maxillofac Surg 2014;52:693-6.
Akama MK, Chindia ML, Macigo FG, Guthua SW. Pattern of maxillofacial and associated injuries in road traffic accidents. East Afr Med J 2007;84:287-95.
Morris LM, Kellman RM. Complications in facial trauma. Facial Plast Surg Clin North Am 2013;21:605-7.
De Sousa A. Psychological issues in oral and maxillofacial reconstructive surgery. Br J Oral Maxillofac Surg 2008;46:661-4.
Glynn SM, Shetty V, Elliot-Brown K, Leathers R, Belin TR, Wang J. Chronic posttraumatic stress disorder after facial injury: A 1-year prospective cohort study. J Trauma 2007;62:410-8.
Erol B, Tanrikulu R, Görgün B. Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901 patients (25-year experience). J Craniomaxillofac Surg 2004;32:308-13.
Gassner R, Tuli T, Hächl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: A 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 2003;31:51-61.
Laski R, Ziccardi VB, Broder HL, Janal M. Facial trauma: A recurrent disease? The potential role of disease prevention. J Oral Maxillofac Surg 2004;62:685-8.
Bormann KH, Wild S, Gellrich NC, Kokemüller H, Stühmer C, Schmelzeisen R, et al
. Five-year retrospective study of mandibular fractures in Freiburg, Germany: Incidence, etiology, treatment, and complications. J Oral Maxillofac Surg 2009;67:1251-5.
Girotto JA, MacKenzie E, Fowler C, Redett R, Robertson B, Manson PN. Long-term physical impairment and functional outcomes after complex facial fractures. Plast Reconstr Surg 2001;108:312-27.
Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 1990;48:926-32.
Khadka R, Chaurasia NK. Four years prospective study of the maxillofacial trauma at a tertiary center in Western Nepal. J Orofac Sci 2014;6:78-1. [Full text]
Almasri M. Severity and causality of maxillofacial trauma in the Southern region of Saudi Arabia. Saudi Dent J 2013;25:107-10.
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.
Bataineh AB. Etiology and incidence of maxillofacial fractures in the north of Jordan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:31-5.
Boffano P, Roccia F, Zavattero E, Dediol E, Uglešić V, Kovačič Ž, et al
. European maxillofacial trauma (EURMAT) project: A multicentre and prospective study. J Craniomaxillofac Surg 2015;43:62-70.
Parkins G, Boamah MO, Avogo D, Ndanu T, Nuamah IK. Maxillofacial and concomitant injuries in multiple injured patients at Korle Bu Teaching Hospital, Ghana. West Afr J Med 2014;33:51-5.
Adeyemo WL, Ladeinde AL, Ogunlewe MO, James O. Trends and characteristics of oral and maxillofacial injuries in Nigeria: A review of the literature. Head Face Med 2005;1:7.
Smith H, Peek-Asa C, Nesheim D, Nish A, Normandin P, Sahr S. Etiology, diagnosis, and characteristics of facial fracture at a midwestern level I trauma center. J Trauma Nurs 2012;19:57-65.
van den Bergh B, Karagozoglu KH, Heymans MW, Forouzanfar T. Aetiology and incidence of maxillofacial trauma in Amsterdam: A retrospective analysis of 579 patients. J Craniomaxillofac Surg 2012;40:e165-9.
Arangio P, Vellone V, Torre U, Calafati V, Capriotti M, Cascone P. Maxillofacial fractures in the province of Latina, Lazio, Italy: Review of 400 injuries and 83 cases. J Craniomaxillofac Surg 2014;42:583-7.
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