Sequelae of Major Trauma Patients with Maxillofacial Fractures.

OBJECTIVES: Sequelae after maxillofacial fractures are frequent and may affect the patient's quality of life. This study examined sequelae associated with maxillofacial fractures of severely traumatized patients focusing mainly on nerve injuries. METHODS: A retrospective study including trauma patients with relevant facial fractures admitted to our Trauma Center in the period 2011-2016. Presence of posttraumatic maxillofacial sequelae was identified by examining the medical records of the included patients. Focusing on facial sensory deficits and facial nerve paralysis, but also comprising data on diplopia, blindness, malocclusion, trismus, eye globe malposition, flattening of the malar, facial contour changes, and wound infections. RESULTS: Two-hundred-seventy-five severely traumatized patients were included, comprising 201 men (73%), with a median age of 40 years and ISS of 20. 163 (59%) patients only had assessments within 3 months from trauma of which 79 patients (48.5%) had facial complications at initial examination, mostly malocclusion and trismus. Most patients in this group had no or only minor sequelae at their last clinical assessment, mainly being sensory deficits. 112 (41%) patients had assessments both within and beyond 3 months of which 73 patients (65.2%) had facial complications at initial examination, while 91 patients (81%) had reported sequelae within 3 months decreasing to 47 patients (42%) at their last clinical assessment beyond 3 months from trauma, mostly sensory deficits. An improvement of most sequelae was observed. CONCLUSION: Objective sequelae were found to be quite common after maxillofacial fractures in severely traumatized patients, especially sensory deficits. However, most of the addressed sequelae seemed to improve over time.

Psychological Impact on Maxillofacial Trauma Patients - An Observational Study.

Facial disfigurement due to trauma is very common as the face is a prominent part of the body and is susceptible to injuries. A protocol for the diagnosis and intervention for psychological problems of trauma patients should be implemented in the Indian hospitals as they lack policies for assessing the mental status of such patients. This study was conducted to analyze and determine the psychological implications and need for mental health services of maxillofacial trauma patients. Fifty patients with maxillofacial trauma above 18 years of age were included in this study. The assessment was done using the Hospital Anxiety and Depression Scale (HADS) and Trauma Screening Questionnaire (TSQ), which are considered as the standard tools for assessment of psychological disorders post-trauma. We observed psychological stress in 84% of the patients at the baseline, which reduced to 24% after one month at the first follow-up visit and further reduced to 22% at the second follow-up visit. The reduction in the percentage from the first to the second follow-up visit was less significant. However, the change in HADS and TSQ scores was found to be significant, suggesting that the intensity of trauma decreases with the time-lapse. Anxiety, depression, and post-traumatic stress are prevalent in patients with maxillofacial trauma, which may lead to impaired day-to-day life. Our results suggest that there is a need for psychological care in patients with maxillofacial trauma.

Self-esteem following maxillofacial and orthopedic injuries: preliminary observations in sub-Saharan Africans.

BACKGROUND: The face is a vital component of one's personality and body image while extremities are important in function (mobility, routine daily activities). Recovery and rehabilitation from acquired maxillofacial and orthopedic traumas are psychological in nature. METHODS: This was a prospective study of recruited subjects in a Nigerian University teaching hospital. A total of 160 participants (80 with maxillofacial injuries and 80 with orthopedic injuries) had repeated review assessments within 1 week of arrival in the hospital (time 1), 4-8 weeks after initial contact (time 2), and 10-12 weeks thereafter (time 3), using Rosenberg's Self-Esteem Questionnaire. RESULTS: Thirty-three (41.3%) participants in the maxillofacial injured and 12 (15.0%) in the orthopedic injured subjects scored between 0 and 14 at time 1. At time 2, 39 (51.3%) subjects in the maxillofacial fracture group and 20 (29.0%) in the orthopedic injured group scored between 0 and 14, while at time 3, 7 (9.2%) in the maxillofacial fracture group and 1 (1.5%) in the orthopedic injured group scored between 0 and 14. There was a statistical significant difference between the two groups when compared at times 1, 2, and 3 with p < 0.001, p = 0.006, and p = 0.041 respectively. Subjects with maxillofacial fracture consistently had lower self-esteem compared to subjects with orthopedic injured for times 1, 2, and 3. CONCLUSIONS: Self-esteem may be reduced following maxillofacial injuries; therefore, measures should be taken by surgeons to minimize the risk of facial scarring by careful handling of tissues. Also, management of these injuries should integrate multidisciplinary care that will address psychological needs of patients. TRIAL REGISTRATION: Not applicable.

Evaluation of Depression Associated With Post-Traumatic Stress Disorder After Maxillofacial Injuries-A Prospective Study.

PURPOSE: Maxillofacial injuries can result in psychological derangement, leading to post-traumatic stress disorder (PTSD), which is characterized by continual re-experiencing of any traumatic event in addition to numerous systemic complications. The objective of this study was to assess the incidence and severity of "PTSD-related depression" in patients with maxillofacial injuries and to identify the risk factors involved. MATERIALS AND METHODS: This prospective study involved 88 patients with maxillofacial trauma who had only cosmetic deficits (group A), only functional deficits (group B), or cosmetic and functional deficits (group C). The psychological status of all patients was assessed before and after surgery using Zung's Self-Rating Depression Scale. Remission time also was analyzed. Data were analyzed with SPSS 22.0 using parametric methods. Comparison of mean values among groups was performed using 1-way analysis of variance followed by Tukey honest significance difference post hoc tests for multiple pairwise comparisons. To compare proportions, the χ2 test was applied. RESULTS: The number of patients in groups A, B, and C was 11, 34 and 43, respectively. In the immediate post-trauma stage, all patients in group A showed severe depression; the percentages of patients with severe depression in groups B and C were 8.8 and 81.4%, respectively, which was statistically relevant. Depression scores of patients of all groups decreased gradually in the postsurgical phase. Patients with cosmetic defects consistently recorded higher depression scores at all intervals. The time taken for recovery from depression (remission time) was shorter for patients with only functional deficits (group B). CONCLUSION: Patients with maxillofacial injuries are prone to PTSD-related depression from functional and cosmetic deficits. The objectives of trauma management must be aimed at restoring pre-trauma form and function of the maxillofacial skeleton and the patient's psychological status.

[Influential factors analysis of positive psychology in patients with oral and maxillofacial trauma].

PURPOSE: To investigate the positive psychological reaction of patients with oral and maxillofacial trauma and related factors. METHODS: One hundred and five hospitalized patients with oral and maxillofacial trauma were investigated by self-designed general data questionnaire, positive psychological scale posttraumatic growth evaluation of quantitative PTG, and self-image questionnaire. SPSS 18.0 software package was used to analyze the data. RESULTS: Positive psychological score of the patients was 56.01±17.322, and self-image average score was 51.33±7.306. There were significant differences between male and female patients after trauma in new possibilities, personal power, self transformation and personal feeling (P<0.05); there was no significant difference between different ages in positive psychological reaction.With the improvement of educational level of patients, better personal power (P=0.031) and self transformation (P=0.01), and more positive psychological reaction were observed; Posttraumatic positive psychology of patients was negatively correlated with self-image score (r=-0.318, P<0.001). CONCLUSIONS: The male patients with oral and maxillofacial trauma have more positive attitude than female. With the improvement of educational level, more positive psychological reaction was documented in term of personal strength, self-transformation,but no obvious change in relationship with others, new possibilities and personal feeling. The better self image, the more positive psychological reaction was displayed.

Depression and anxiety disorders in a sample of facial trauma: A study from Iran

BACKGROUND: Various studies have shown that such patients are susceptible to psychological problems and poor quality of life. The aim of the present study was to evaluate and compare the prevalence of depression and anxiety disorders and quality of life in a group of facial trauma. MATERIAL AND METHODS: In the present cross-sectional study Hospital Anxiety and Depression Scale (HADS) and Oral Health Impact (OHIP-14) questionnaires were used. In this study, fifty subjects were selected from the patients with maxillofacial traumas based on the judgment of the physicians, referring to hospitals in Kerman and Rafsanjan during 2012-2013. In addition, 50 patients referring to the Dental School for tooth extraction, with no maxillofacial traumas, were included. SPSS 13.5 was used for statistical analysis with two-sample t-test, Mantel Haenszel technique, Pearson's correlation coefficient and chi-squared test. RESULTS: Seven patients with maxillofacial traumas were depressed based on HADS depression scale, with 5 other borderline cases. However, patients referring for surgery or tooth extraction only 2 were depressed and 1 patient was a borderline case. The results showed that patients with maxillofacial traumas had higher rates of depression and anxiety, with significant differences between this group and the other group (P=0.01). The results of the present study showed a significant prelateship between depression severity and confounding factors. The mean of OHIP-14 parameters were 35.51 ±5.2 and 22.3±2.4 in facial trauma and dental surgery groups, respectively, with statistically significant differences (P=0.01). CONCLUSIONS: The results of the present study showed depression and anxiety disorders in patients with maxillofacial trauma. The results showed a higher rate of anxiety and anxiety in patients with maxillofacial traumas compared to the control group

Management of Self-Harm Injuries in the Maxillofacial Region: A Report of 2 Cases and Review of the Literature.

Clinicians face numerous challenges when managing psychiatric patients who self-inflict injuries within the maxillofacial region. In addition to a complex clinical examination, there are both surgical and psychiatric factors to consider, such as the risk of damaging vital structures, the exacerbation of the patient's psychiatric status, and the long-term psychosocial and esthetic sequelae. We present 2 cases of adolescents who repeatedly self-inflicted wounds and/or inserted foreign bodies (FBs) into the face, scalp, and neck. The different treatment modalities were based on full evaluation of the patient's clinical, medical, and diagnostic test findings coupled with a psychiatric assessment. The decision for conservative management or surgical intervention was made according to the presence and location of the FBs, degree of hemorrhage, signs and symptoms of infection, and unpleasant scars that could lead to long-term psychological impairment. In most cases, the FBs were removed and the wounds were toileted and closed under local or general anesthesia. We advocate a holistic approach via a multidisciplinary team, which is deemed essential to provide the highest quality of care for patients to reduce the risk of further relapses. Lastly, a satisfactory esthetic outcome is always paramount to achieve long-term psychological and physical welfare.

Microstructural Change and Cognitive Alteration in Maxillofacial Trauma and Mild Traumatic Brain Injury: A Diffusion Tensor Imaging Study.

PURPOSE: The aim of the present study was to establish the incidence of maxillofacial (MF) injury accompanying mild traumatic brain injury (mTBI) and the associated neurocognitive deficits and white matter changes. MATERIALS AND METHODS: A prospective review of 41 patients with mTBI and maxillofacial injury (with or without intracranial lesion) due to motor vehicle accidents who had admission computed tomography (CT), neurocognitive evaluation, and quantitative diffusion tensor imaging available was performed during admission and at 6 months of follow-up. Descriptive statistics were used for the demographic data, and a paired t test and repeated measure analysis of variance were used to establish the intergroup differences and susceptibility. RESULTS: The included patients were relatively young adults, with a mean age of 27.3 ± 8.8 years and 11.3 ± 2.1 years of education. Of the 41 patients, 20 (48.8%) had maxillofacial injuries involving the soft tissue and muscles, 18 (43.9%) had facial bone fractures, and 3 (7.3%) had mixed injuries. Of the 41 patients with MF injuries, 28 (68.3%) had intracranial abnormalities found on the admission CT scan. Executive function and attention were significantly altered across the time points, with patients with both MF injury and an intracranial lesion doing poorly at baseline but with improvement 6 months later. In contrast, the patients with no visible intracranial lesion but with MF injuries remained impaired, with signs of a slowed recovery. The fractional anisotropy of the genu of the corpus callosum, anterior limb of the internal capsule, and cingulum for patients with MF injuries but without an intracranial lesion showed trends of reduced integrity over time. CONCLUSIONS: The presence of MF injury without any intracranial traumatic lesions in patients with mTBI increases the risk of short- and long-term neurocognitive derangement compared with patients with mTBI, MF injury, and intracranial traumatic lesions.

Traumatismos maxilofaciais como marcadores de violência urbana em Belo Horizonte-MG: uma análise epidemiológica e socioespacial / Maxillofacial injury as markers of urban violence in Belo Horizonte û Brasil: an epidemiological and socio-spatial analysis

A violência urbana no Brasil é uma questão de saúde pública. Ela está presente no cotidiano de cada brasileiro, produzindo um grande número de vítimas, sequelas físicas e emocionais. O traumatismo maxilofacial é um tipo de traumatismo específico que atinge as regiões da face e cabeça. Esse traumatismo pode estar associado à exposição desta região do corpo nos eventos envolvendo acidentes de trânsito ou uma eventual tentativa de atingir a face das vítimas de agressão física. Este estudo analisou os casos de traumatismos maxilofaciais enquanto marcadores de violência urbana, caracterizando-os segundo gênero, grupos etários, tipos de violência, tipos de traumatismo, modalidades de tratamento, dias e horários de ocorrência e buscou compreender o padrão espacial dos casos associando-os ao local de resiência das vítimas. Trata-se de um estudo transversal com dados coletados em três hospitais de urgência e emergência especializados no atendimento a politraumatismos em Belo Horizonte-MG...

The prevalence of psychological distress in a sample of facial trauma victims. A comparative cross-sectional study between UK and Australia.

AIM: The potential psycho-social sequelae of traumatic facial injury have received increasing attention in recent years, however there remains paucity of cross-national comparative data on the prevalence of psychological distress following such trauma. The aim of the present study was to investigate and compare the prevalence of anxiety and depression in an adult patient group who have been treated for maxillofacial trauma, and who attend a follow-up clinic in either the West Midlands, UK or New South Wales (NSW), Australia. By using an identical methodological and statistical approach, we hoped to add to the available information on the incidence of early psychological distress in patients following facial trauma. METHOD: This was a comparative cross-sectional study. A sample of fifty consecutive adult victims of facial trauma in the West Midlands UK, was compared to a group of fifty-two facially injured patients in NSW, Australia. Demographic data was collected, following which the Hospital Depression and Anxiety Scale (HADS) were applied to both groups of patients. RESULTS: Psychometric scores suggestive of anxiety and depressive state were common in both groups of patients. The mean HADS depression subscale score for UK patients compared to Australian patients was not significantly different (5.94 versus 5.54 p=0.62). This was also the case for the HADS anxiety subscale (5.96 versus 5.94 p=0.98). Although the number of patients achieving scores suggestive of a 'caseness' for co-morbid psychological state was higher within the UK sample when compared to the Australian group (20% versus 11.5% for HADS depression subscale, and 20% versus 15% for HADS anxiety subscales respectively); these differences did not reach statistical significance. CONCLUSION: This cross-national comparative study has shown that anxiety and depression in facial trauma victims were comparable in both settings.

Health literacy impact on patient-provider interactions involving the treatment of dental problems.

Health literacy-related problems can interfere with effective doctor-patient communication and effective patient care. This study examined several health literacy-related markers for patients seeking treatment in hospital emergency departments and physician and dentist offices for dental problems and injuries. Participants consisted of low-income white, black, and Hispanic adults who had experienced a dental problem or injury during the previous twelve months and who visited a hospital emergency department, physician, or dentist for treatment. A stratified random sample of Maryland households participated in a cross- sectional telephone survey. Interviews were completed with 94.8 percent of 423 eligible individuals. Multivariable logistic regression analyses were performed. Only 10.0 percent of the respondents expressed a difficulty understanding what they were told by the health provider, while 4.9 percent expressed a difficulty understanding the dental or medical forms they were asked to complete and 6.9 percent reported that they had difficulty getting the health provider to understand their dental problem or injury. Logistic regression analysis found that males and Hispanics were significantly (p<0.05) more likely to experience health literacy-related problems. In general, respondents did not express health literacy-related problems. Additional research is needed to identify health literacy-related barriers to effective patient-provider communication.

Psychological care for maxillofacial trauma patients: a preliminary survey of oral and maxillofacial surgeons.

INTRODUCTION: Psychological morbidities are major complications following maxillofacial injuries. The aim of this study was to assess self-evaluation of oral and maxillofacial surgeons on posttraumatic psychological care. METHODS: Using a cross-sectional study design, we enrolled a sample of surgeons in 261 oral and maxillofacial surgery (OMFS) departments in the United States, United Kingdom and France. A self-administered e-mail questionnaire was used to evaluate knowledge, attitude and practice of the surgeons regarding psychological problems in maxillofacial injury patients, and their collaboration with psychological personnel. Appropriate descriptive and univariate statistics were computed, and P<0.05 was considered statistically significant. RESULTS: The response rate was 28.1% (112 of 398), but we included only 100 respondents from 107 OMS units. 60% of the surgeons disclosed a moderate or high level of relevant knowledge. Only 28 OMS departments (26.2%) had intra-service psychological staff (commonly in France [P<0.05]), and five surgeons revealed considerable deficits in access to psychological care. Frequent reasons for patient referral to psychological staff were depression, body dysmorphic disorder, posttraumatic stress disorder, suicidal idea, anxiety and behavioural changes. Eighty-eight surgeons linked patient's non-compliance with changes or difficulties in practice, and 58 surgeons experienced it already. CONCLUSIONS: Despite several limitations, the results of this study suggest that oral and maxillofacial surgeons have a great interest and experience in posttraumatic psychological problems. Psychological professionals in charge will improve surgical care quality. Well-designed studies with larger sample size are desirable to confirm our results. Ethical issues of maxillofacial trauma care are also discussed.

Adolescent orofacial injury: association with psychological symptoms.

Ethnic minority youth living in urban areas experience disproportionately high rates of violent intentional injuries. This study investigates the association of violent intentional injuries with psychological distress and alcohol use among adolescents treated in trauma centers for facial injuries. Interviews were conducted with 67 adolescents treated at two urban trauma centers (predominantly males [86%], and minority [Latino, 72%; African American, 19%]). Adolescents reported experiencing several different types of accidental and assault-related injuries that required medical attention in the past six months. About half (53%) reported experiencing only unintentional injuries (e.g. car accidents, falls, sports injury); 23% experienced one type of intentional injury resulting from either fighting or being attacked; and 24% experienced two types of intentional injuries resulting from both fighting and being attacked. Measures of alcohol use and psychological distress were examined in relation to these three types of injuries. Overall, 30% of study participants reported they had been drinking alcohol at the time of injury. Compared to adolescents without intentional injuries, those who experienced a physical fight and/or attack had higher levels of alcohol problems, depression, paranoia and somatic symptoms, and were more likely to have family members with alcohol problems. There is a considerable need for adolescents with intentional assault-related injuries to be screened for alcohol and mental health problems, and to be referred for appropriate treatment interventions if they score at problem levels.

The psychosocial characteristics and needs of patients presenting with orofacial injury.

Individuals with orofacial injury presenting to urban trauma centers in the United States tend to be disproportionately socioeconomically disadvantaged, young, adult, ethnic minority men. Most injuries are assaultive in origin, suggesting poor impulse control and maladaptive social behaviors. Compared with matched control populations, patients with orofacial injuries are more likely to report higher levels of substance use behaviors and to manifest greater levels of hostility, anxiety, and depression. Although they have significantly greater current and lifetime need for mental health service and social service, actual use of social services is low. The underlying psychosocial characteristics of many patients with orofacial injury, along with unmet service needs, render them vulnerable for posttrauma psychological sequelae and may compromise functional outcomes and recovery.

The long-term psychological sequelae of orofacial injury.

Significant subsets of patients who experience orofacial injury are at risk for developing adverse psychological sequelae such as posttraumatic stress disorder and depression. If undetected and untreated, the psychopathology can become recalcitrant and burden the social and vocational functioning of the patients and greatly diminish their quality of life. The hospital encounter and follow-up care visits provide the oral and maxillofacial surgeon with opportunities to screen for emerging psychological problems. Several screening instruments are available to assist the surgeon in identifying individuals who are at risk for subsequent mental health problems. Facilitated referrals to mental health services can be a practical approach for improving comprehensive medical care for vulnerable individuals and for reducing the potential morbidity of these covert, but disabling, sequelae.

Screening for psychiatric problems in the orofacial trauma setting.

After facial trauma, a subset of patients develops mental health problems, particularly posttraumatic stress disorder (PTSD) and major depression. Early identification of patients who may be at risk for these disorders can facilitate referral for further psychiatric evaluation and possible treatment. Brief, easy-to-use screening tools are available to assist in the process of recognizing these individuals. This article provides a review of some of the most commonly used short screeners for PTSD and major depression. Incorporating information gleaned from these self-administered screeners into the routine evaluation of patients with facial trauma will help to address the mental health needs that are associated with orofacial injury.

Presence of pre-existing psychological comorbidity in a group of facially injured patients: a preliminary investigation.

PURPOSE: To document the presence and demographics of an adult patient cohort who were identified as having a pre-existing psychiatric condition while being treated for a facial injury. MATERIALS AND METHODS: A retrospective medical chart audit was conducted on 300 consecutive patients electing public treatment and subsequently admitted to a tertiary referral teaching hospital with a facial injury over a 21-month period from April 2006 to January 2008. Patients who were recruited into the study were identified as having features suggestive of psychological disturbance sufficient to confirm a pretraumatic psychiatric diagnosis as formally established by psychiatry trained staff. RESULTS: Of the 300 patients initially included in the study, 16 were subsequently identified as having a psychiatric diagnosis. Most cases attracted dual diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for Axis I and II disorders. The most common were substance abuse/dependence (n = 10), followed by mood disorder (n = 6) and schizophrenia (n = 4). Four patients had a co-occurring personality disorder. No significant correlation between sociodemographic and clinical characteristics and psychological outcomes was identified in this study. Those at risk of psychological deterioration were referred to liaison psychiatry for formal intervention. CONCLUSION: This preliminary study indicates that a small but significant number of patients (5%, n = 16) presented with a demonstrated pretraumatic psychiatric comorbidity. As such, they have some requirement for psychiatric input into their peri- and postoperative care. The broad spectrum of psychiatric disorders that we identified in this study highlights the need for vigilance by surgeons and other health care providers when dealing with facially injured patients and that, where appropriate, early referral to liaison psychiatry for management advice is desirable.

Psychological issues in oral and maxillofacial reconstructive surgery.

Many psychological problems affect patients who have oral and maxillofacial operations. This article reviews these problems among patients with craniofacial conditions, facial injuries, facial cancer, and those having orthognathic surgery. Facial cosmetic surgery is not addressed. Problems such as depression, anxiety, low self-esteem, poor social relationships, and changes in body image are considered. The roles of mental health professionals is emphasised to enhance postoperative satisfaction and to provide a better quality of life for these patients.