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