Oral and Maxillofacial Injuries Clinical Trial
Official title:
Epidemiology of Oral and Maxillofacial Trauma in Province 2, Nepal
Trauma is one of the leading causes of death among people under 40 years of age, the causes
are numerous but the majorities are involved in road traffic accidents (RTA). The oral and
maxillofacial injuries are the common presentation of hospitals either as an isolated injury
( 50%) and rest 20-30% are associated with multiple injuries to the head, neck, chest,
abdomen and extremities. These injuries may cause serious functional, psychological,
physical, and cosmetic disabilities.
Maxillofacial fractures are a large public health problem with a significant negative impact
on an individual's overall health and even survival. 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. Also understanding
maxillofacial trauma helps to evaluate the behaviour patterns of people in different
countries and to establish effective prevention and treatment strategies.
To this end, numerous studies have been carried out to explore the epidemiological features
of maxillofacial fractures in different population groups. However, to best our knowledge,
there is a lack of research about maxillofacial injuries for this region. Hence the main
purpose of this study is to investigate the epidemiological characteristics of prevalence,
aetiology, sex and age distributions, fracture site, treatment pattern, associated injuries,
and complications of maxillofacial fractures treated at the National Medical College and
others Hospitals of Birgunj Metropolitan city over a 10-year period from June 2011 to June
2021. A specific form (oral and maxillofacial injury proforma) will be used to collect the
data from medical records of patients who had sustained oral and maxillofacial injuries and
admitted as well managed at the hospitals (National Medical College and Teaching Hospital,
Birganj health care, Gandak hospital, LS Neuro hospital. Birgunj). Subjects would be the
patients' data's/ medical records present in hospitals, Birganj. From the patient files or
medical records, following information will be gathered include demographics (e.g. age, sex),
the aetiology of injury, anatomic site of the fracture, time of hospital admission and
operation, presence and location of associated injuries, treatment pattern, length of
in-hospital stay, and complications.
Introduction:
Trauma-related injuries claimed approximately 5 million lives in the world in 2016; is one of
the leading causes of death among people in different age groups depending upon the causes of
injuries (WHO, 2018a). More than quarters (29%) of these deaths were due to a road traffic
accident. Low-income countries had the highest mortality rate due to a road traffic accident
with 29.4 deaths per 100 000 population (WHO, 2018b). Many factors affect mortality rate and
outcome after trauma (Kieser J et al 2002; Johnson J etal. 2012). Nature and severity of the
injuries on the body part are the main factors for mortality of injured person. Among the
mortality; fatality rate is 50 % within a few minutes of trauma due to damage to the brain or
spinal cord or heart or major vessel or organ. Another factor affecting mortality is the
standard of surgical care in the hospital; 30% die in the hospital a few hour injuries due to
hypoxia and haemorrhage (hypovolemic shock). Late mortality is seen within a day to a week in
hospital (20%) due to sepsis and multiorgan failure (Kovacs G, Sowers N., 2018; Prathigudupu
RS et al.,2018; ).
Oral and Maxillofacial trauma is a common presentation in Emergency departments (ED) of the
hospitals (Kieser J et al 2002; Wong NH etal 2012; Calderoni DR etal 2011; Katarzyna B etal
2010). Age of the patient, concomitant head injuries, airway obstruction, a pattern of facial
bone fracture and increased bleeding are some of the variables of increasing death rates
after maxillofacial trauma (Katarzyna B etal 2010; Kovacs G, Sowers N., 2018). Multiple body
part injuries are often associated with oral and maxillofacial injuries in severely injured
trauma patients(Kieser J et al, 2002; Wong NH etal, 2012; Calderoni DR etal, 2011; Katarzyna
B etal. 2010; Prathigudupu RS et al, 2018; Davies MJ et al 2012). The diagnosis, as well as
management of complicated facial fractures, is challenging even to the most experienced oral
and maxillofacial surgeons, while the presence of coexistent injuries and the complexity of
these injuries make it more difficult to consolidate experience and develop realistic
treatment protocols. Furthermore, the lack of sufficient specialist facial trauma units
results in unacceptable delays from referral to operation, complicating the management and
compromising the outcome. Coordination of trauma teams, emergency room physicians, and
surgical teams such as neurosurgeons, orthopaedic is vital for the early stabilization and
treatment of patients with facial bone fracture (Wong NH et al, 2012; Davies MJ et al, 2012;
Follmar KE et al,2007; Van Hout WM et al ,2013, Kostakis G et al, 2012). These injuries may
cause serious functional, psychological, physical, and cosmetic disabilities (Kim JW et al
2015; Zachariades N et al 1993) .
The epidemiology of oral and maxillofacial trauma varies from one geographical region to
another and even within the same region depending on the many risk factors such as
demographic, socioeconomic, cultural, personal behaviour, mental status and environmental
factors ( Mathog RH et al, 2000; Fasola AO et al, 2003;Branas CC et al, 2004; Li Z and Li ZB,
2008 ). The common causes worldwide are road traffic accidents (20-83%) (Lee JH et al, 2010;
Karagozoglu KH et al, 2012; Walker TW et al 2013; Forouzanfar T et al. 2013; Mijiti A et al,
2014;Jung CP et al, 2016 ); assault( 18- 79%) (Ugboko VI et al 1998; Laskin DM and Best AM,
2000; Olasoji HO et al, 2002; Adebayo ET et al ,2003; Al Ahmed HE et al, 2004; Brasileiro BF
et al, 2006; Lee K, 2009a; Lee KH, 2009b; Mijiti A et al, 2014), falls( 10-17% ) (Shankar AN
et al, 2012; Van den Bergh B et al 2012; Salentijn EG et al, 2013; Mijiti A et al, 2014),
sport injuries (3-7% ) (Bamjee Y et al, 1996; Qudah MA et al, 2002; Al-Khateeb T et al 2007;
Bakardjiev A et al, 2007; de Matos FP et al 2010) , hit by moving object ( 5- 15%) (Sakr K,
Farag IA et al 2006; Subhashraj K et al, 2007; Thorén H et al, 2010; Chrcanovic BR et al,
2012), bicycle accident ( 2-28% ) (Gomes PP et al, 2006; Kotecha S et al, 2008; Lee JH et al,
2010; Forouzanfar T et al, 2013) , work-related accident (1.7-7% ) (Gassner R et al 2003;
Qing-Bin Z et al, 2013) and miscellaneous ( 1.3 %) include pathological fractures, blast
injuries, animal attack accident, tooth extraction, and unknown etiology.
Facial bone fractures are a large public health problem with a significant negative impact on
an individual's overall health and even survival (Kim JW et al , 2015; Kovacs G, Sowers N,
2018; Prathigudupu RS et al, 2018) . Addressing socio-cultural issues, reviewing and
improving road safety legislation, enforcing infrastructure and vehicle standards, and
improving post-crash care remain critical to preventing avoidable deaths and disabilities
caused by road crashes - which continue to be a major public health challenge ( Mathog RH et
al, 2010; Kim JW et al, 2015). Despite the legislative changes and preventative measures
involving seatbelt and airbag use, as well as the reduction of drinking and driving, road
traffic accidents are still the major cause of facial fractures in many developing countries.
This part of the country ( Provinces 2), is the second most populous province of the country
Nepal, located in the central south of the country spans over 9,661 km2 (3,730 sq mi), with a
5,404,145 population of (according to the CBS 2015 year census). Majority of people are poor
(48%), illiterates 32% overall and major source of income is agriculture and foreign worker
(Wikipedia, 2019). It borders with Bihar states of India. Among the many factors social and
cultural similarity, the people of Bihar is presented in this regional hospital for
treatment. The road, a major means of transportation here but the condition of the road is
very bad.
The main purpose of this study is to investigate the epidemiological characteristics of
prevalence, aetiology, sex and age distributions, fracture site, treatment pattern,
associated injuries, and complications of maxillofacial fractures treated at the National
Medical College and others Hospitals of Birgunj Metropolitan city over a 10-year period from
June 2011 to June
Statement of the Problem and Rationale / Justification:
A clearer understanding of the demographic patterns of maxillofacial injuries will assist
health care providers as they plan and manage the treatment of traumatic maxillofacial
injuries (Al Ahmed et al., 2004; Lee K, 2009; Mijiti A et al., 2014). Such epidemiological
information can also be used to guide the future funding of public health programs geared
towards prevention.
Understanding maxillofacial trauma helps to evaluate the behaviour patterns of people in
different countries and to establish effective prevention and treatment strategies (Maliska
et al., 2009; Katarzyna B, Piotr A 2010).
Understanding 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 (Gassner et al., 2003; Qing-Bin Z et al., 2013).
To this end, numerous studies have been carried out to explore the epidemiological features
of maxillofacial fractures in different population groups (Ugboko VI et al., 1998; Kieser J
et al., 2002; Olasoji HO et al., 2002; Qudah MA et al., 2002; Fasola AO et al., 2003; Al
Ahmed HE et al., 2004; Ansari MH., 2004; Gomes PP et al., 2006; Sakr K et al., 2006;
Al-Khateeb T et al., 2017; Bakardjiev A et al., 2007; Lee JH et al., 2010; Walker TW et al.,
2012; Forouzanfar T et al., 2013; Qing-Bin Z et al., 2013; Van Hout WM et al., 2013; Mijiti A
et al., 2014; Jung CP et al., 2016; Nogami S et al., 2019). However, to best our knowledge,
there is a lack of reports detailing the causes, incidence, and treatment pattern of
maxillofacial injuries, and no study has been published about oral and maxillofacial injuries
analysis for this region.
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