Middle East Journal of Family Medicine

Muntaha Y.Jerius MD
King Hussain Medical center
Out patient Department
Royal Medical Services
Amman-Jordan

Correspondence to:
Muntaha Y.Jerius
P.O.Box 921004
Amman 11192
Jordan
E-mail: dr.muntaha@hotmail.com

ABSTRACT

Objective: To describe the cases of maxillofacial injuries that attended the Emergency Department at Queen Alia Military Hospital.

Methods: A descriptive study of 85 cases representing patients with maxillofacial injuries who attended the emergency department at Queen Alia military hospital during a 3 year period (January 2002 till January 2005) were analyzed in relation to age, gender, cause of injury and need for referral to other specialties for better management.

Results: Out of the total 85 cases that were reviewed, there were 65 (76.4%) males and 20 (23.6%) females. The mean age of the patients was (24.5) and their age range was between (3-50) years. The majority of the maxillofacial injuries were due to car accidents 69 (81.17%). Regarding the need for referral, 14 (16.4%) cases had associated serious head and eye injuries, therefore they were referred to Neurosurgery and Ophthalmology Departments. The majority of cases 71 (83.6%) had maxillary and mandibular fractures, which required referral to the department of maxillofacial surgery.

Conclusion: The number of documented cases of maxillofacial injuries during the study period may reflect under-reporting of the problem. This may necessitate the need for an obligatory special form to be used at the Emergency Department to overcome this problem.

Keywords: Oral Injuries, Maxillofacial injuries, Mandibular fracture.

Maxillofacial trauma is presented in Accident and Emergency Department of the hospital either as isolated injury or part of multiple injuries to the head, neck, chest and abdomen⁽¹⁾. The etiology of these injuries is variable from one country to another and even within the same country depending on prevailing socioeconomic cultural and environmental factors⁽²⁾. These injuries not only affect the function of the patient but also cause serious psychological, physical and cosmetic disabilities. Most of our patients were involved in road traffic accidents⁽²⁾, while in developed countries like the United Kingdom it was found that violence is the commonest cause of maxillofacial injuries, while car accident injuries were declining, maybe because of improvement in car design and safety equipment and rapid management of the patients⁽⁵⁾. Epidemiologically, studies of maxillofacial trauma have classically shown that young adults are the main victims^(3,4,5). The aim of this study was to investigate the incidence, etiology, management, age and sex distribution of maxillofacial injuries.

This descriptive study was conducted at Emergency Department at Queen Alia Military Hospital during a 3year period from January 2002 till January 2005. The data were collected by reviewing 85 medical records representing patients with maxillofacial injuries who attended the Emergency department at that period, analyzed in relation to age, sex, cause of injury and need for referral to other specialties for better management. The management started with (ATLS) Advanced Trauma Life Support including the maintenance of airway control of bleeding, antibiotic coverage and head elevation. Regular mouthwash was advised. In all cases plain x-rays and CT scan were obtained when possible. Patients who needed surgical intervention were referred for admission to be managed accordingly.

Out of the total 85 cases that were reviewed, there were 65 (76.4%) males and 20 (23.5%) females.
More than 90% were between the age of 5 years and 35 years, mean age was (24.5). 69 cases (81%) were due to car accidents and the rest were either due to quarrels or other types of trauma as seen in Table 1 and Table 2.

Regarding the need for referral, 14 (16.4%) cases wereassociated with serious head and eye injuries; therefore they were referred to neurosurgery and ophthalmology departments, and the rest were referred to the oral and maxillofacial surgery department for further management.
The mandible was the most common site of injury in about 69% followed by maxilla which represents 14% of the cases, then the other bones as shown in Table 3.

Maxillofacial injury is injury to the facial soft tissues, facial bones and associated specialized soft tissue within the head and neck as a result of wounding or external violence. Regarding the etiology of maxillofacial injuries, in this descriptive study road traffic accidents were the cause of 81% of the injuries which agrees with other studies done by S.shahid Hussain⁽¹⁾ and Ansari MH⁽⁸⁾ and comparable to two other studies done in Jordan by Qudah MA et al and Jasser K^(7,11). In contrast, studies in developed countries reported that violence is the main cause of maxillofacial injuries which was found by Ogundar BO et al, Laski R et al and BuchananJ et al^(3,4,6),as well as in the UK, as reported by Tefler M et al⁽¹³⁾. Males were involved more than females, which can be justified by the fact that men are working outdoors more than women, especially in this society. Some results about male predominance were reported in other studies in Pakistan and Jordan as well as in developed countries^(3,4,13). The pattern of maxillofacial injury varies with the severity of trauma. The most common bone to be injured is the mandible, in about 69% of the cases, maybe because it is the most prominent bone in the face, compared with the middle third of the face. This was followed by the maxilla in 14% of the cases. These observations are parallel to those of other studies. Another study in Jordan reported 75% of the cases as mandibular injury⁽¹¹⁾ so as in Ansari MH study who recorded 52% of the injuries are in the mandible(8). The severity of injury varies from simple soft tissue laceration to more complicated fractures of the maxillofacial bones. Some patients have associated other injuries so they need to be treated by active participation by neurosurgeon or ophthalmologist or orthopedic surgeon^(1,9).

Young people were the main victims in this study compared with other studies maybe because they are the most active age group physically^{(2,3,9,10,12)}.

The oral and maxillofacial surgeon is an essential part of comprehensive Accident and Emergency Services in the management of these injuries, both primary and secondary. In the more severe injuries, the OMF Surgeon works in close collaboration with many other specialists, in particular neurosurgical and ophthalmologic colleagues. Most of the patients in our study had associated injuries treated concomitantly. Facial wounds and lacerations were closed primarily; bone injuries like mandible and zygomatic arch fractures were treated by reduction, fixation and elevation accordingly. Patients having an element of head injury were observed and treated by the neurosurgeon. an intra-oral approach was used to prevent facial scarring.

The number of documented cases of maxillofacial injuries during the study period may reflect under-reporting. This may necessitate the need for an obligatory special form to be used at the Emergency Department to overcome this problem.

Maxillofacial injuries may cause serious cosmetic and functional deformities; patients with these injuries are candidates for a number of operations. We conclude that early intervention including reduction, stabilization of fractures as well as bone or cartilage grafting will reduce the time of healing and number of surgeries done.

The oral and maxillofacial surgeon is an essential part of comprehensive Accident and Emergency Services in the management of these injuries, both primary and secondary.