Dr Manisha Chauhan Solanki (M.D.

S) Associate Professor Dept of Oral & Maxillofacial Surgery, Christian Dental College, Christian Medical College, Ludhiana, Punjab

Christian Dental College, Ludhiana, Punjab, India

Published in-- Gandhi S, Ranganathan LK, Solanki M, Mathew GC, Singh I, Bither S. Pattern of maxillofacial fractures at a tertiary hospital in northern India: a 4-year retrospective study of 718 patients. Dent Traumatol. 2011 Aug;27(4):257-62.

Ludhiana

Ludhiana, one of the old-established and biggest cities of Punjab, with a population that has increased during recent years to around 3.1 million, lies 300 km north-west of New Delhi and around 150 km from the border with Pakistan.

The etiology of maxillofacial injuries varies- From one country to another and Even within the same country

Depending on-- Prevailing socio-economic,

Cultural
Environmental factors

Developing business and road network

Emerging employment opportunities

Increase in per capita income and change in socioeconomic status

Increased movement by people

Increase in number of accidents and injuries

To know the pattern, incidence and etiology of maxillofacial injuries and to understand the changing trends.

To suggest measures to reduce injuries

All

patients who reported to emergency and

trauma centre of Christian Medical College and

Hospital, Ludhiana with maxillofacial fractures

from January 2006 to December 2009.

Patients who Expired before examination

Refused to undergo treatment Admitted and treated with soft tissue injuries

Readmitted with complications

Data was incomplete or non-available

A total of 1075 fractures were recorded in 718 patients . Data of 22 patients were incomplete and hence were not included.

Age Range
Mean age Male : Female

1year to 85 years
31.8 yrs 6.6:1

Study

Male : Female

Chandra Shekhar & Reddy (Mysore,

India)

4.7:1
3.2:1 8:1 6.6:1 3:1 6.6:1

Lee et al (Korea) Subhasraj et al (Chennai, India) Van Beek andMerkx (New Zealand) Bagheri et al (USA) Gandhi et al (Ludhiana, India)

Male predominance is because of the fact that

Mostly males are involved in outdoor activities while females are confined to household activities especially in the rural areas. Male drivers outnumber female drivers.

Most common cause for injuries Most common cause

Developed nations

Developing nations

Our study

Interpersonal Violence (IPV)

RTA

RTA

Second most common cause

Sports related injuries

IPV

Accidental fall

Hutchison IL, Magennis P, Shepherd JP, Brown AE.The BAOMS United Kingdom survey of facial injuries part 1: aetiology and the association with alcohol consumption. British Association of Oral and Maxillofacial Surgeons. Br J Oral Maxillofac Surg. 1998 Feb; 36(1):3-13. Hill CM, Burford K, Martin A, Thomas DW. A one year review of maxillofacial sports injuries treated at an accident and emergency department. Br J Oral Maxillofac Surg. 1998,36,44-47

Sports related injuries 1%

Work place injuries 1%

Injuries caused by animals 1%

IPV 9%
Accidental fall 16%

Road Traffic accident 72%

Various studies done in India from 1988-till date

Authors Sawhney and Ahuja (1988)1 Population Covered Urban & Rural Cause of Injuries RTA Percentage of patients 50%

Subhas Raj (2007)2

Chandra Shekhar and Reddy (2008) 3 Bither et al (2008) 4 Gandhi et al (2010)
5

Urban
Urban

RTA
RTA

61.3%
60.0%

Rural Urban & Rural

RTA RTA

42.9% 72.0%

1. Sawhney CP, Ahuja RB. Faciomaxillary fractures in north India. A statistical analysis and review of management. Br J Oral Maxillofac Surg 1988;26:4304.

2. Subhasraj K, Nandakumar C, Ravindran C. Review of maxillofacial injuries in Chennai, India: a st2748 cases. Br J Oral Maxillofac Surg 2007;45:6379. 3. Chandra Shekar BR, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals of Mysore city. Indian J Dent Res 2008;19:3048. 4. Bither S, Mahindra U, Halli R, Kini Y. Incidence and pattern of mandibular fractures in rural population: a review of 324 patients at a tertiary hospital in Loni, Maharashtra, India. Dent Traumatol 2008;24:46870.

There was no reported case of domestic violence in our study. Possible reasons Females usually report the cases of domestic violence as accidental fall.

Lesser nuclear families/ Joint families.

One case of a 12-year-old male child was reported, who suffered work place injury.
Despite a Government legislation against the child labour in India, such practices are common.

Poverty, illiteracy and lack of implementation of laws are the factors for the same

Facial fracture occurred most frequently in people in third decade of their life

Age and Sex wise distribution of maxillofacial injury patients

250

200

150

Male 100

Female

50

0 0-10 11_20 21-30 31-40 41-50 51-60 61-70 >70

Out of the total 718 patients, 184 patients [25.6%] had associated injuries
Other injuries 15%

Orthopaedic injury 29%

Head injury 56%

Patients with associated Injuries

Anatomical site of injuries

Isolated mandibular fractures

231

Isolated middle-third fractures Pan facial fractures

394
93

Distribution of Mandibular fractures

Dentoalveolar Symphysis Body Angle Ramus Condyle Total

RTA Accidental fall

23 6

158 52

35 5

62 18

2 0

38 26

318 107

IPV
Sports related injuries

5
1

15
4

4
1

7
0

1
0

3
0

35
6

Work place injuries

Injuries caused by animals Total

0
0

5
3

1
1

0
1

0
0

2
0

8
5

35

237

47

88

69

479

Distribution of Middle Third fractures

Dento- Nasal Zygomatic ZMC alveolar arch Le Fort I Le Fort II Le Fort III 23 3 0 0 Total

RTA Accident al fall IPV Sports related injuries Work place injuries Injuries caused by animals Total

35 12 4 0

115 22 30 2

22 3 0 0

140 17 13 0

52 7 1 0

77 8 1 0

464 72 49 2

52

172

25

172

60

88

27

596

Comparison of pattern of fracture

ZMC Subhasraj et al (Chennai, India) 36% Symphysi s 17.9% Nasal 8% Mandible 30.3% Middle Third 69.7%

Bakardjiev & Pechalova (Bulgaria)

Ugboko et al (Nigeria) Al Khateeb (UAE) Lee et al (Jeju, Korea)

16%

Not reported
23.1% 15.6% 2.2%

4%

74%

26%

15.2% 12.8% 15.2%

11% 18.1% 42.5%

64% 61.1% 7.9%

36% 38.9% 92.1%

Gandhi et al

28.9%

20%

28.9%

44.6%

55.4%

Low incidence of dentoalveolar fractures is probably due to the reason that such patients are usually treated at smaller hospitals and remain unreported. A total of 390 mandibular injuries (81.4%) and 290 middle third injuries (48.7%) were treated with open reduction and fixation. Increasing expertise of the surgeons in developing countries led to increased number of patients undergoing open reduction and fixation in the recent times than to past.

Strict implementation of road safety norms such as use of seat belts, wearing of helmets, use of air bags and speed limits.

Education of people about the road safety rules. Prevent drunken and underage driving.

Due to better socio-economic status of Indian population in the last two decades, pattern of maxillofacial injuries has changed as RTA has emerged as the major cause of maxillofacial injuries. Periodic verification of the aetiology of maxillofacial injuries helps us to recommend ways by which such injuries can be averted.

Proper education and strict implementation of road safety laws can reduce RTA, as all such injuries are accompanied by loss of working hours and increase in litigation. Hence, they also act as a deterrent to the rising economy of the country.