Cranio-maxillofacial trauma: a 10 year review of 9543 cases with 21 067 injuries

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Abstract

Introduction: Cranio-maxillofacial trauma management requires pertinent documentation. Using a large computerized database, injury surveillance and research data describe the whole spectrum of injuries. The goal of this study was to assess the effect of the five main causes of accidents resulting in facial injury on the severity of cranio-maxillofacial trauma.

Patients and Methods: During a period of 10 years (1991–2000) 9543 patients were admitted to the Department of Oral and Maxillofacial Surgery, University Hospital of Innsbruck with cranio-maxillofacial trauma. Data of patients were prospectively recorded including cause of injury, age and gender, type of injury, injury mechanisms, location and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures and concomitant injuries. Statistical analyses performed included descriptive analysis, chi square test, Fisher's exact test, and Mann–Whitney's U test. This was followed by logistic regression analyses for the three injury types to determine the impact of the five main causes on the type of injury at different ages in facial trauma patients.

Results: Five major categories/mechanisms of injury existed: in 3613 (38%) cases it was activity of daily life, in 2991 (31%) sports, 1170 (12%) violence, in 1116 (12%) traffic accidents, in 504 (5%) work accidents and in 149 (2%) other causes. A total of 3578 patients (37.5%) had 7061 facial bone fractures, 4763 patients (49.9%) suffered from 6237 dentoalveolar, and 5968 patients (62.5%) from 7769 soft tissue injuries. Gender distribution showed an overall male-to-female ratio of 2.1 to 1 and the mean age was 25.8±19.9 years; but both varied greatly depending on the injury mechanism (facial bone fractures: 35.4±19.5 years, higher risk for males; soft tissue injuries: 28.7±20.5, no gender preference; dentoalveolar trauma: 18±15.6, elevated risk for females). For patients sustaining facial trauma, logistic regression analyses revealed increased risks for facial bone fractures (225%), soft tissue lesions (58%) in patients involved in traffic accidents, and dental trauma (49%) during activities of daily life and play accidents. When compared with other causes, the probability of suffering soft tissue injuries and dental trauma, but not facial bone fractures, is higher in sports-related accidents, 12 and 16%, respectively.

Conclusion: This study differentiated between injury mechanisms in cranio-maxillofacial trauma. The specially trained surgeons treating cranio-maxillofacial trauma are the primary source of information for the public and legislators on implementing preventive measures for high-risk activities. In facial trauma, older persons are prone to bone fractures (increase of 4.4%/year of age) and soft tissue injuries (increase of 2%/year of age) while younger persons are more susceptible to dentoalveolar trauma (decrease of 4.5%/year of age).

Introduction

The management of cranio-maxillofacial trauma includes treatment of facial bone fractures, dentoalveolar trauma, and soft tissue injuries, as well as associated injuries, mainly of the head and neck (Hausamen, 2001). In the established hospital concept of 24-hour-trauma-service documentation of individual cases leads to the accumulation of large amounts of patient data over the years. The impact of the driving factors on direct and indirect costs of the sequelae of trauma therapy, as well as the epidemiology of facial trauma, need to be allocated to their cause (Hogg et al., 2000). Additionally, the success of treatment and implementation of preventive measures are more specifically dependent on epidemiological assessments (Mouzakes et al., 2001).

Cranio-maxillofacial injuries affect a significant proportion of trauma patients. They can occur in isolation, or in combination with other serious injuries, including cranial, spinal, upper and lower body injuries (Hussain et al., 1994; Oikarinen, 1995). The epidemiology of facial fractures varies in type, severity, and cause depending on the population studied (Haug et al., 1990; Girotto et al., 2001). The differences between populations in the causes of maxillofacial fractures may be the result of risk factors and cultural differences between countries but are more likely to be influenced by the injury severity.

An understanding of the cause, severity, and temporal distribution of maxillofacial trauma can assist in establishing clinical and research priorities for effective treatment and prevention of these injuries. Continuous long-term data collection on maxillofacial fractures is important because it allows the development and evaluation of preventative measures (Hogg et al., 2000). Prospective and retrospective data collection allows accurate detailed recording as well as regular data analysis. The Oral and Maxillofacial Trauma Registry at the University of Innsbruck, Austria was created in 1991 for this purpose. Its goal was to facilitate the awareness of injury, especially cranio-maxillofacial injury, in the Alps by identifying, describing, and quantifying trauma for use in planning and evaluation of preventative programmes, as well as legislative changes and cost/expenditure estimates.

Injury surveillance and research data at this centre reflect the whole spectrum of cranio-maxillofacial injuries; five main causes of injury were identified, namely work, traffic, assaults, sports and activities of daily life (ADL) (Gassner et al., 1999a–c).

Our goals were to enlarge facial trauma by evaluating data on patients with facial bone fractures, dentoalveolar trauma and soft tissue injuries, and to investigate the impact of the five main causes of facial injury. Furthermore, this study assesses the statistical patterns of cranio-maxillofacial trauma in relation to accident causes including the use of logistic regression analyses.

Section snippets

Patients And Methods

During the decade of January 1, 1991 to December 31, 2000, 9543 patients with cranio-maxillofacial trauma were registered at the Department of Oral and Maxillofacial Surgery in the University Hospital of Innsbruck. Data were collected including medical history, patient's symptoms, clinical signs and the radiological findings.

Frequency and type of injury (facial bone fractures, dentoalveolar trauma and soft tissue injuries), as well as age and gender distribution, monthly and yearly

Results

Altogether at total of 9543 patients sustained 21 067 cranio-maxillofacial injuries. Activities of daily life (ADL) and play accidents (3613) caused the majority of injuries (38%), followed by 2991 sports injuries (31%), 1170 assaults (12%), 1116 traffic accidents (12%), and 504 work-related accidents (5%). Less than 1.6% of all accidents (1 4 9) were due to other causes (Fig. 1). The main causes of sport accidents were skiing (950 patients, 31.8%), bicycling (707 patients, 23.6%) and soccer (240

DISCUSSION

Trauma is the leading cause of death in the first 40 years of life. In addition, traumatic injury has been identified as the leading cause of lost productivity, causing more loss of working years than heart disease and cancer combined. Fractures of the facial skeleton are a common component of multiple trauma resulting from motor vehicle crashes, and industrial accidents, but also from sports assaults and ADL accidents. Patients sustaining comminuted facial fractures present with poorer health

Conclusion

By analysing the main effects of the injury mechanisms in cranio-maxillofacial trauma, this study revealed an accumulating risk of 4.4% per year to sustain facial bone fractures and 2% for soft tissue injuries. Younger persons are more susceptible to dentoalveolar trauma demonstrating a decrease of 4.5% per year of age. The severity and complexity of facial trauma not only requires interdisciplinary co-operation in the care of these patients but also asks for continued information of the lay

Acknowledgements

This article is dedicated to Prof. Dr. Gabriel Röthler and Prof. Dr. Ernst Waldhart in recognition of their lifelong efforts in patient care, teaching, and research seeking progress in the care of patients with cranio-maxillofacial trauma at the Dept. of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.

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