Public Health
- Theses and Dissertations
The causes of maxillofacial fractures treated at Christchurch Hospital
from 1996-2006
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.
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