Incidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study

Introduction: The aim of the present study was to evaluate the incidence, aetiology and patterns of maxillofacial injuries in a tertiary trauma hospital in Nepal. Methods: A retrospective analysis of all the maxillofacial trauma patients operated at the Department of Plastic, Cosmetic and Maxillofacial Surgery, B and B Hospital, Lalitpur, Nepal between 1st March, 2015 and 31st December, 2020 was performed. Data were collected for each patient in regards to age, gender, cause and nature and type of the injury and the treatment provided. Results: Among 409 patients operated in this period for maxillofacial injuries, 83% (n=356) were male and 17% (n=73) were female. Patients in the second and third decade of life were found to be more prone to sustain maxillofacial injuries. Road traffic accident was the most frequent cause (n=331; 77%) followed by physical assault (n=46; 10.7%) and falls (n=42; 9.7%). Mandible was the most commonly fractured bone (n=125; 26.5%). Fracture of parasymphysis, combined symphysis and condyle fracture and parasymphysis and angle fracture were the most common patterns of mandible fracture. Conclusions: The major cause of maxillofacial injuries among patients operated in our hospital was road traffic accident which directly reflects the poor traffic system and improperly planned roads. ABSTRACT


INTRODUCTION
Maxillofacial injuries constitute a significant portion of the overall traumatology.Management of injuries in the maxillofacial region presents one of the most difficult challenges for the healthcare professionals worldwide as these are invariably associated with substantial morbidity, disfigurement and functional deficit. 1 This in turn may have a negative influence on the quality of life of the victims. 2 The incidence of maxillofacial fractures varies widely between different countries. 3The main causes worldwide are road traffic accidents (RTAs), physical assaults, falls and sports injuries. 4,57][8] Therefore, we aim to evaluate the incidence, aetiology and pattern of maxillofacial injuries in a tertiary trauma hospital in Nepal through this retrospective study.
Incidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study...

METHODS
A retrospective analysis of all the patients operated for maxillofacial injuries at the Department of Plastic, Cosmetic and Maxillofacial Surgery, B and B Hospital, Lalitpur, Nepal between 1 st March, 2015 and 31 st December, 2020 was performed.The data such as age, gender, cause and pattern/site of injury and treatment performed were derived from the medical records of the hospital.This study was approved by the Institutional Review Board/Ethical Committee of the hospital.
Cause of injury was grouped into the following categories:

RESULTS
Between 1 st March, 2015 and 31 December, 2020, a total of 429 patients had been treated surgically for maxillofacial injuries.Of the total patients, 356 (83%) were male and 73 (17%) were female with malefemale ratio of about 5:1.(Table 1) The peak incidence of the injury was seen in the age group of 15-24 years (n=156; 36.3%)followed by 25-34 years (n=145; 33.7%) with lesser incidence above 55 years of age.31 (7.2%) of the total patients were below the age of 14 years.(Table 2  DA: dentoalveolar; ZMC: zygomatic complex

DISCUSSION
Maxillofacial fractures have been reported to represent 7.4 -8.7% of the medical care provided in emergency centres. 9Factors such as the geographic location, population density, economic status and cultural differences have a significant impact on etiology and injury patterns of epidemiological investigations. 10,11To our knowledge, only few studies have been published regarding the incidence, etiology and patterns of maxillofacial injuries in Nepal.
In this study, 83% of the patients were male and 17% were female.The higher incidence of maxillofacial injuries among men is a universal finding in all other studies.The study by Bali et al. 12 showed similar results (81.08% male and 18.92% female).A study by Arangio et al. 13 also showed the same results (83% male and 17% female).
The highest incidence of maxillofacial injuries were found in the age groups of 15-24 and 25-34 years which is similar to previous published reports in many countries. 14,15A study by Arangio et al. in the province of Latina, Italy 13 showed that the incidence of maxillofacial injury was highest among the 18-39 year age group.People are usually very active in the second and third decade of life.[18] Aetiology: Our study showed that the most common cause of maxillofacial injury is the RTA (77%) which is in accordance with many other studies.The studies by Kanala et al. in Vijayawada, India 14 and Subhashraj et al. in Chennai, India 15 showed the RTAs as the most common cause (70% and 62% respectively).Another study by Arangio et al. in Italy 13 also showed that the most number of maxillofacial injuries (33.7%) were caused by RTAs which is lower than in our study.The higher percentage of RTAs in Nepal might be due to the lack of strict traffic rules and lack of separate lane for pedestrians.However, we have seen a reduction in the number of high-velocity maxillofacial injuries due to RTAs in the recent years following the imposition of strict restriction on drinking and driving in Nepal.In developed countries, RTAs are contributing less than physical assaults to the cause of maxillofacial injuries.
A study by Schneider et al. in Germany 19 showed that a significant percentage (45.2%) of the maxillofacial fractures was caused by interpersonal violence which is in contrary to the results of our study.
Site and type of fracture: Many studies have reported zygomatic complex fractures as the most common type of fracture in the maxillofacial region. 13,19.In contrast to these studies, mandible was the most commonly fractured bone (26.5%) though only slightly more than zygomatic complex fracture (23.8%) in our study.Studies by Manodh et al. 1 and Kanala et al 14 also showed that mandible was the most commonly fractured bone in maxillofacial region (59.2% and 47% respectively).
5][16] The most common types of combined fractures according to our study are the combined parasymphysis and angle fracture (12.8%) and symphysis and condyle fracture (12.8%).However, studies by Subhashraj et al. 15 and Bart van den Bergh et al. 10 showed that the usual combination of mandible fractures was the parasymphysis and condyle fractures and body and condyle fractures respectively.
Management: In our institution, ORIF using miniplates is the preferred method of treatment for maxillofacial fractures.Closed reduction is mostly restricted to nasal bone fractures, zygomatic arch fractures and mandibular condylar head fractures.

CONCLUSIONS
This study has demonstrated that the major cause of maxillofacial injury treated in our institution is the road traffic accident.Male patients in the second and third decade of life are more prone to sustain maxillofacial injuries.Mandible and zygomatic complex fractures are the most common maxillofacial fractures.Most of these fractures are treated by ORIF with plates and screws.
of maxillofacial fractures from the years 2010 to 2013 in Mecklenburg-Western Pomerania, Germany: A retrospective study of 409 patients.J Cranio-Maxillofac Surg.2015 Dec;43 (10):1948-51. [PubMed] Maxillomandibular fixation using arch bars is performed only in cases of complex mandibular fractures and panfacial fractures for aiding in ORIF.Comminuted mandibular condylar head fractures NMJ I VOL 06 I NO.02 I ISSUE 12 I Jul-Dec, 2023 Incidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study... are treated with maxillomandibular elastic traction using arch bars.

Table 3 )Table 3 :
Cause of maxillofacial injuriesIncidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study...
NMJ I VOL 06 I NO.02 I ISSUE 12 I Jul-Dec, 2023

Table 4 .
Type of injuries

Table 6 )
Incidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study...