Kai H Lee 2009
[MMedSc, in conjunction with Dept of Surgery]
Abstract
Objective
To explore and analyse the common causes of maxillofacial fractures, focusing on the characteristics of patients, fracture location and surgical management of these injuries treated at the Oral and Maxillofacial Surgery unit at the Christchurch Hospital over an eleven year period (January 1996 to December 2006).
Background
Maxillofacial fractures commonly present to the emergency department. These injuries are associated with significant morbidity including serious functional and cosmetic deficits to the patients and frequently require hospitalisation and surgery. International evidence suggests that the main causes include interpersonal violence (IPV), fall, sports and motor vehicle accidents (MVA). The relative frequencies of these causes may be changing over the last decade and this change appears to be associated with variations in patient demographics, fractures pattern and surgical treatments.
Methods
A retrospective database of patients presenting to the Oral and Maxillofacial Surgery unit at Christchurch Hospital during an 11-year period was reviewed. Variables examined include demographics, location of fractures, mode of injury, alcohol involvement and treatment delivered.
Results
A total of 2581 patients were treated during the study period with maxillofacial fractures. The patient age ranged from 1 to 95 years with a mean age of 32 years; 81% were males. Patients in the 16-30 year age group accounted for 53% of all patients, with males in this year group accounting for 47%. There was a 20% increase in the number of fractures between the two halves of the study.
IPV was the main cause of facial fractures during the study period (44%), followed by sport, accidental falls and MVA. Mandibular fractures were noted in 1045 patients (41%), followed by zygoma fracture (37%) and the orbital wall (22%). Le Fort fractures were noted in 4% of patients. Alcohol involvement was noted in 49% of all patients. Alcohol involvement was most frequently observed in the 16-30 year old group (32% of all patients), followed by the 31-45 year old group (11%). IPV-related patients were responsible for 78% of alcohol-related fractures.
Fifty nine percent of patients required hospitalisation following their injuries; 32% of patients were in the 16-30 year old group. Fifty one percent of patients required active treatment, with 37% of patients requiring open reduction with internal fixation.
Males in the younger age groups were particularly susceptible to IPV while older patients were more likely to suffer fall-related facial fractures. Multiple fractures were more likely seen in MVA and isolated fractures more common in IPV. Patients who suffered MVA were more likely to be hospitalised and requiring surgery while patients with fall-related fractures were least likely to be hospitalised and requiring surgery. The majority of patients with IPV-related facial fractures had alcohol involvement in this study. Alcohol-related fractures were associated with an increase in the incidence of hospitalisation and surgery.
Conclusion
IPV has continued to be the main cause of maxillofacial fractures in this study. Young male adults presenting after IPV made up a large proportion of patients. The mandible and zygoma were the most frequent sites of injury. Maxillofacial fractures frequently require hospitalisation and surgical intervention.