Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

OBJECTIVES: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures. STUDY DESIGN: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1. RESULTS: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures. CONCLUSIONS: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.

Prevalence and predictive factors of psychological morbidity following facial injury: a prospective study of patients attending a maxillofacial outpatient clinic within a major UK city.

Adults presenting to maxillofacial surgery services are at high risk of psychological morbidity. This study examined the prevalence of depression, post-traumatic stress disorder (PTSD), anxiety, drug and alcohol use, and appearance-related distress among maxillofacial trauma outpatients over medium-term follow-up. It also explored socio-demographic and injury-related variables associated with psychological distress to inform targeted psychological screening protocols for maxillofacial trauma services. Significant associations were found between level of distress at time of injury and number of traumatic life events with levels of depression at 3 months. No significant associations were found between predictor variables and PTSD at 3 months, or with any psychiatric diagnosis at 6 months. The lack of evidence for an identifiable subgroup of patients who were at higher risk of psychological distress indicated that routine screening of all maxillofacial trauma outpatients should be offered in order to best respond to their mental health needs. The feasibility of the medical team facilitating this is challenging and should ideally be undertaken by psychologists integrated within the MDT. This study led to the funding of a clinical psychologist to provide collaborative care with the maxillofacial surgeons, resulting in brief assessment and treatment to over 600 patients in the first year of the service.

Los adultos que consultan en los servicios de cirugía máxilo-facial tienen un alto riesgo de presentar morbilidad psicológica. Este estudio examinó la prevalencia de depresión, trastorno por estrés postraumático (TEPT), ansiedad, uso de alcohol y drogas, y distrés relacionado con la apariencia entre los pacientes con trauma máxilofacial en un seguimiento ambulatorio de mediano plazo. También se exploraron variables socio-demográficas y otras relacionadas con las lesiones que se asocian con distrés psicológico para contar con protocolos de evaluación psicológica orientados a los servicios de trauma máxilo-facial. Se encontraron asociaciones significativas entre el nivel de distrés al momento de la lesión y el número de acontecimientos traumáticos con los niveles de depresión a los tres meses. En cambio, no hubo asociaciones significativas entre las variables predictoras y el TEPT a los tres meses, o con algún diagnóstico psiquiátrico a los seis meses. La falta de evidencia de un subgrupo identificable de pacientes que estuvieron en alto riesgo de distrés psicológico indicaron que se debe ofrecer la evaluación de rutina a todos los pacientes ambulatorios con trauma máxilo-facial para responder mejor a sus necesidades de salud mental. Constituye un desafío configurar un equipo médico que permita esto y lo ideal es que se forme un equipo multidisciplinario en que estén integrados psicólogos. Este estudio permitió el financiamiento de un psicólogo clínico, quien aportó atención en colaboración con los cirujanos máxilo-faciales, lo que se tradujo en una evaluación breve y el tratamiento de más de 600 pacientes durante el primer año de funcionamiento del servicio.

Les adultes hospitalisés des services de chirurgie maxillo-faciale sont à risque élevé de morbidité psychologique. Cette étude analyse la prévalence de la dépression, du syndrome de stress post-traumatique (SSPT), de l'anxiété, de la consommation de drogues et d'alcool ainsi que de la détresse liée à l'apparence chez des patients ayant subi un traumatisme maxillo-facial, avec un suivi à moyen terme en ambulatoire. Les variables socio-démographiques et liées à la lésion ainsi que la détresse psychologique sont également examinées afin de renseigner des protocoles ciblés de dépistage psychologique pour les services de chirurgie maxillo-faciale. Le niveau de détresse au moment de la lésion et le nombre d'événements traumatiques de la vie sont significativement associés aux niveaux de dépression à 3 mois. Aucune association significative n'a été trouvée entre les variables prédictives et le SSPT à 3 mois ou un diagnostic psychiatrique quel qu'il soit à 6 mois. L'identification d'un sous-groupe de patients à risque élevé de détresse psychologique est difficile : le dépistage de routine de tous les patients suivis en ambulatoire après chirurgie maxillo-faciale devrait donc être proposé afin de mieux répondre à leurs besoins en santé mentale. Créer l'équipe médicale qui le permettrait est compliqué ; idéalement, cette tâche devrait être confiée à des psychologues au sein d'une équipe pluridisciplinaire. Grâce à l'étude, le poste d'un psychologue clinicien a été financé, qui travaille en collaboration avec les chirurgiens maxillo-faciaux. C'est ainsi que plus de 600 patients ont été évalués et traités au cours de la première année.

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

OBJECTIVE: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. STUDY DESIGN: Demographic and injury data were recorded for each patient who was a victim of an assault. RESULTS: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. CONCLUSIONS: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

OBJECTIVE: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. STUDY DESIGN: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. RESULTS: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. CONCLUSIONS: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.