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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 4  |  Page : 107-110

Trends in the patterns of maxillofacial fractures in Kolkata


1 Medical Officer, West Bengal Dental Services, Lucknow, Uttar Pradesh, India
2 Consultant Maxillofacial Surgeon, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
3 Senior Resident, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
4 PGT-3, SPPGIDMS, Lucknow, Uttar Pradesh, India

Date of Submission28-Aug-2020
Date of Acceptance15-Sep-2020
Date of Web Publication29-Dec-2020

Correspondence Address:
Dr. Dhritiman Pathak
Moore Avenue Housing Estate 159 N.S.C. Bose Road, Kolkata - 700 040, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_40_20

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  Abstract 


Background:- The maxillofacial skeleton is commonly fractured due to its prominent position. Maxillofacial fractures lead to cosmetic disfigurement as well as problems in oral functioning.
Aim: The aim of this study was to determine the incidence, etiology, mode, and the pattern of fractures in the maxillofacial region.
Methods: A retrospective study of maxillofacial injuries at ESIC Medical College and Hospital, Joka (Kolkata) between Feb 2018 to April 2019 was conducted and data extracted from patients who were either treated in emergency room or in outpatient department.
Results and Conclusion: The study concluded that better road safety laws need to be enforced along with the improvement of the education and socio-economic setup.

Keywords: Kolkata, maxillofacial fracture, road traffic accidents


How to cite this article:
Das G, Pathak D, Shukla B, Shukla R, Patel D, Mondal K. Trends in the patterns of maxillofacial fractures in Kolkata. Int J Prev Clin Dent Res 2020;7:107-10

How to cite this URL:
Das G, Pathak D, Shukla B, Shukla R, Patel D, Mondal K. Trends in the patterns of maxillofacial fractures in Kolkata. Int J Prev Clin Dent Res [serial online] 2020 [cited 2021 Jan 24];7:107-10. Available from: https://www.ijpcdr.org/text.asp?2020/7/4/107/305287




  Introduction Top


Accidents constitute an important cause of preventable morbidity, mortality, and disability. Road traffic accidents (RTAs) are now considered a public health hazard (Annually, over 1 million people die and over 25 million are injured or permanently disable). Fractures of the facial skeleton are common following RTAs, assault, falls, and sporting injuries.[1] Numerous reports on the incidence and treatment of maxillofacial injuries are available. However, knowledge is limited on the patterns of maxillofacial injuries.[2],[3] The aim of this study was to determine the incidence, etiology, mode, and the pattern of fractures in the maxillofacial region.


  Materials and Methods Top


A retrospective study of maxillofacial injuries at ESIC Medical College and Hospital, Joka (Kolkata) between February 2018 and April 2019 was conducted for the first time, and data extracted from patients who were either treated in the emergency room or in the outpatient department. This data were analyzed for age, gender, etiology occupation, type of vehicle, anatomic location of hard tissue and soft tissue injuries, other associated injuries, and mode and location of accident.


  Results Top


Out of 109 patients, 81 (74.3%) were male and rest 28 (25.7%) were female. The male-female ratio was 3:1. The majority of RTA victims were between the age group 20–29 years 48 (44.03%) followed by 30–39 years 27 (24.8%), while the minority was 50 years or above 6 (5.5%). The mean age of the patients was 24.07 years.

The majority 37 (33.9%) of accidents was due to violation of traffic rules followed by alcohol intoxication and substance abuse like amphetamines 28 (25.7%). Twenty (18.4%) were due to unsafe driving (over speeding, inexperienced, and reckless driving) and 7 (6.4%) RTAs were due to poor vehicle conditions. Out of 109 patients, majority of them were students 31 (28.4%), followed by laborers 19 (17.4%), service employees 11 (10.1%), self-employed individuals 15 (13.8%), and housewives 18 (16.5%). Meanwhile, 6 (5.5%) patients were retired from their jobs, and minority 9 (8.3%) were unemployed. Out of 109 patients, motorized 2 wheelers are 51 (46.8%), followed by motorized light 4 wheelers are 26 (23.9%) [Table 1]. Out of 109 patients, majority of them 59 (54.12%) were injured during noncollision accidents, mainly skidding of the vehicles hitting face first on the road. 26 (23.9%) were injured during head-on collision with other vehicles, road dividers, trees, and animals. 12 (11%) during the side on collision, while 12 (11%) patients were injured when hit from behind. Majority of RTAs 74 (67.9%) took place in urban areas, followed by 32 (29.4%) in rural areas and least 3 (2.7%) on highways.
Table 1: Type of vehicle

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Among 109 patients had suffered facial bone fracture. Majority of them 24 (22.01%) had fractured parasymphysis followed by condyle 12 (11%) then zygomatic complex 10 (9.1%). 15 (13.8%) and 12 (11%) patients had an angle of mandible and body of mandible fractures [Table 2]. All of the 109 (100%) patients had suffered minimal soft tissue injury around the maxillofacial region. 18 (16.5%) patients had suffered crush and blunt injury, while 15 (13.8%) patients had abrasion and bruises [Table 3]. Out of 109 patients, 61 (55.96%) had suffered an isolated maxillofacial injury and 23 (21.10%) patients had neurologic injuries, which included head/brain injury.
Table 2: Hard tissue injury

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Table 3: Soft tissue injury

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  Discussion Top


More than 50 million people suffer nonfatal injuries, with many incurring a disability as a result of their injury. Road traffic crashes are the seventh-leading cause of death by 2030. There are considerable economic losses to individuals, their families and the whole nation as a result of road traffic injuries. Road traffic crashes cost most countries 3% of their GDP.[4],[5]

In previous studies, there is a higher frequency of maxillofacial injuries among males. These is because males are comparatively more involved in various activities. Singaram et al.[3] found that the male population was four times more likely to be the victims of RTAs than the female counterpart, which is similar to the finding of this study. Lone et al.[4] reported males being more commonly involved in RTAs than females in the ratio of 4.5:1, which is relatively higher than what the ratio in this study is. However, Ghosh[5] found that accident rates were nine times higher in males than in females. This ratio was very high compared to that of this study. In the present study, the highest number of RTA victims (44%) was found to be between the age group of 20–29 years. High risk-taking behavior like immature, inexperienced, and rash driving during this phase is one of the main reasons behind it. Al Ahmed et al.[6] in their study found that individuals between 20 and 29 years of age sustained the most maxillofacial fractures, which correspond to the results of the present study. However, Giri et al.[7] observed the maximum incidence of mandibular fractures in individuals during third decade followed by second and fourth decades of their lives, which is contradictory to the present study in where individuals in their second decade were the most common victims followed by third decade.[8],[9]

Violation of traffic rules was the major reason behind the highest number of accidents (33.9%) followed by alcohol intoxication and substance abuse (25.7%). Unsafe driving, poor vehicle condition, pedestrian on-road and poor infrastructure were responsible for 18.4%, 6.4%, 10.1%, and 5.5% of accidents, respectively. Rowe and Killey[8] found drunk-driving, lack of regards to traffic laws, over-speeding, overloading, poor road conditions, and poor vehicular conditions implicated for high number of RTAs among which lack of regards to traffic laws accounted for nearly three-quarters of the cases. An increase in speed multiplies the risk of accident and severity of injury during accident. A vehicle moving on high speed will have a greater impact during the crash and hence will cause more injuries. According to Waylen and McKenna,[9] alcohol greatly increased the probability of having a car accident and the severity of its consequences.[10],[11],[12] Espada et al.[13] added that the occupant of a vehicle is three times more likely to die of a fatal injury after a car accident if having consumed alcohol compared to being sober. For every increase of 0.05 blood alcohol concentration, the risk of accident doubles.[13],[14]

In this study, students were found to constitute the largest group (28.4%) involved in RTAs, followed by laborers, service employees, and self-employed individuals in descending order. A similar finding was seen by Mehta[12] in his study. The present study showed that motorized two-wheeler vehicles (motorcycle, scooter, and moped) were more prone to RTAs, which was followed by motorized light four-wheeler vehicles such as car, jeep, and van. Corresponding results were reported by Biswas et al.,[13] Kiran et al.[14] and Patil et al.[15] The vulnerability of two-wheelers may caused due to reckless driving, less enclosed protection of two wheelers than other vehicles and as a whole,it is the commonest mode of transportation.

In the present study, fractures involving the lower jaw was significantly more common than fractures in the other regions of the face. In fact, more than half of the maxillofacial fractures (87%) were that of mandible, followed by midface, dentoalveolus, and nasal bone. These findings are supported by studies conducted by Lone et al.,[4] Ortakoğlu et al.[16] and Qudah and Bataineh[17] who have also found mandible to be fractured comparatively higher in RTAs than other bones of the maxillofacial region. Parasymphysis was the most common site (22%) in mandible followed by the angle (13.76%), body and condyle (11%), whereas zygomatic complex region (9.1%) was the most common site of fracture in the midface as per this study. Le Fort III, coronoid, and symphysis were the least affected regions of the maxillofacial region in descending order.[18] Subhashraj et al.,[18] Agrawal et al.[19] and Lone et al.[4] also found that parasymphyseal region was more commonly involved in patients with mandibular fractures.

The studies by Khateeb and Abdullah[20] have found zygomatic complex as the most common middle third fracture, which is coinciding with the results of this study. In the present study, multiple superficial injuries of soft tissue in the maxillofacial region were common (36.7%). These injuries were a combination of lacerations, abrasion, bruises, crush, and blunt injuries. Any single type of superficial soft-tissue injury sustained was also noticed, such as isolated laceration (33%), abrasion and bruises (16.5%) then crush/blunt injuries (13.8%).[21],[22],[23] Teshome et al.[24] found that almost half of the maxillofacial injuries (49.4%) in their study subjects were only soft-tissue injuries; laceration, contusion, and abrasions. Jha et al.[2] reported of multiple superficial injuries to be most common, followed by lacerations, abrasion, and crush injuries, which is similar to that of this study. In contrast, Singh et al.[22] found the facial region to be most susceptible to laceration and abrasion than multiple superficial injuries. Maxillofacial injuries, in general, may occur in isolation or can have other associated injuries. Udeabor et al.[23] and Subhashraj et al. [18] reported 83.2% and 68.01% of associated injuries in their study population, respectively.


  Conclusion Top


RTAs are the leading cause of maxillofacial injuries in developing nations. This is largely due to the fact that strict enforcement of traffic rules is still lacking while huge burden of outdated old vehicles continues to rise. Males of younger age groups are more prone to these injuries, which sometimes may cause permanent functional impairment and deformity that leads to national loss in terms of workforce. Public health program will provide knowledge on traffic rules and motivation to follow them. Increasing public awareness towards voluntarily taking safety measures like the use of protective gears in the form of helmets and seatbelts for their own safety rather than just obeying the rules can reduce most of the injuries. Its time for people to realize the effects of alcohol intoxication, substance abuse, and the use of mobile phones while driving. There are various factors behind RTAs, and the ever increasing cases of maxillofacial injuries related to it suggest the need from concerned authorities to deal with them promptly and appropriately.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Lone P, Singh AP, Kour I, Kumar M. A 2-year retrospective analysis of facial injuries in patients treated at department of oral and maxillofacial surgery, IGGDC, Jammu, India. Natl J Maxillofac Surg 2014;5:149-52.  Back to cited text no. 4
[PUBMED]  [Full text]  
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Giri KY, Singh AP, Dandriyal R, Indra N, Rastogi S, Mall SK, et al. Incidence and pattern of mandibular fractures in Rohilkhand region, Uttar Pradesh state, India: A retrospective study. J Oral Biol Craniofac Res 2015;5:140-5.  Back to cited text no. 7
    
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Biswas S, Naiya S, Ghosal A, Basu G. An epidemiological study on road traffic accident in urban West-Bengal. J Evol Med Dent Sci 2015;4:10533-8.  Back to cited text no. 13
    
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