Trama presentation for ICOMS[1].pptx1.pptx

7/28/2019 Trama presentation for ICOMS[1].pptx1.pptx

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Dr Manisha Chauhan Solanki (M.D.S)

Associate Professor

Dept of Oral & Maxillofacial Surgery,

Christian Dental College,

Christian Medical College,

Ludhiana, Punjab


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Christian Dental College, Ludhiana, Punjab, India


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Published in-- Gandhi S, Ranganathan LK, Solanki M,

Mathew GC, Singh I, Bither S. Pattern of maxillofacial

fractures at a tertiary hospital in northern India: a 4-year

retrospective study of 718 patients. Dent Traumatol.2011 Aug;27(4):257-62.


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Ludhiana

Ludhiana, one of the old-established and

biggest cities of Punjab, with a population that

has increased during recent years to around 3.1

million, lies 300 km north-west of New Delhi and

around 150 km from the border with Pakistan.


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The etiology of maxillofacial injuries varies-- From one country to another and

Even within the same country

Depending on---

Prevailing socio-economic,

Cultural

Environmental factors


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To know the pattern, incidence and etiology of

maxillofacial injuries and to understand the

changing trends.

To suggest measures to reduce injuries


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All patients who reported to emergency and

trauma centre of Christian Medical College and

Hospital, Ludhiana with maxillofacial fractures

from January 2006 to December 2009.


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Patients who

Expired before examination

Refused to undergo treatment

Admitted and treated with soft tissue injuries

Readmitted with complications

Data was incomplete or non-available


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Age Range 1year to 85 years

Mean age 31.8 yrs

Male : Female 6.6:1


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Study Male : Female

Chandra Shekhar & Reddy (Mysore,India)

4.7:1

Lee et al (Korea) 3.2:1

Subhasraj et al (Chennai, India) 8:1

Van Beek andMerkx (New Zealand) 6.6:1

Bagheri et al (USA) 3:1

Gandhi et al (Ludhiana, India) 6.6:1


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Male predominance is because of the factthat

Mostly males are involved in outdoor

activities

while females are confined to household

activities especially in the rural areas.

Male drivers outnumber female drivers.


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Most common

cause forinjuries

Developed

nations

Developing

nations

Our study

Most common

cause

Interpersonal

Violence (IPV)

RTA RTA

Second most

common cause

Sports related

injuries

IPV Accidental fall

Hutchison IL, Magennis P, Shepherd JP, Brown AE.The BAOMS United Kingdom survey of facial injuries part 1: aetiology

and the association with alcohol consumption. British Association of Oral and Maxillofacial Surgeons. Br J Oral Maxillofac

Surg. 1998 Feb; 36(1):3-13.

Hill CM, Burford K, Martin A, Thomas DW. A one year review of maxillofacial sports injuries treated at an accident

and emergency department. Br J Oral Maxillofac Surg. 1998,36,44-47


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1. Sawhney CP, Ahuja RB. Faciomaxillary fractures in north India. A statistical analysis and review of management. Br J Oral Maxillofac Surg 1988;26:4304.

2. Subhasraj K, Nandakumar C, Ravindran C. Review of maxillofacial injuries in Chennai, India: a

st2748 cases. Br J Oral Maxillofac Surg 2007;45:6379.

3. Chandra Shekar BR, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in

patients admitted and treated at two hospitals of Mysore city. Indian J Dent Res 2008;19:3048.

4. Bither S, Mahindra U, Halli R, Kini Y. Incidence and pattern of mandibular fractures in rural

population: a review of 324 patients at a tertiary hospital in Loni, Maharashtra, India. Dent Traumatol2008;24:46870.

Authors Population

Covered

Cause of Injuries Percentage of

patients

Sawhney andAhuja (1988)1

Urban & Rural RTA 50%

Subhas Raj (2007)2 Urban RTA 61.3%

Chandra Shekhar

and Reddy (2008) 3

Urban RTA 60.0%

Bither et al (2008) 4 Rural RTA 42.9%

Gandhi et al (2010)

5

Urban & Rural RTA 72.0%

Various studies done in India from 1988-till date


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There was no reported case of domestic violencein our study.

Possible reasons

Females usually report the cases of domestic

violence as accidental fall.

Lesser nuclear families/ Joint families.


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One case of a 12-year-old male child wasreported, who suffered work place injury.

Despite a Government legislation againstthe child labour in India, such practices are

common.

Poverty, illiteracy and lack ofimplementation of laws are the factors for

the same


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Facial fracture occurred most frequently in

people in third decade of their life

A d S i di t ib ti f


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0

50

100

150

200

250

0-10 11_20 21-30 31-40 41-50 51-60 61-70 >70

Male Female

Age and Sex wise distribution of

maxillofacial injury patients


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Out of the total 718 patients, 184 patients

[25.6%] had associated injuries

Head injury

56%Orthopaedic

injury

29%

Other injuries

15%

Patients with associated Injuries


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Anatomical site of injuries

Isolated mandibular

fractures

231

Isolated middle-third

fractures

394

Pan facial fractures 93

s r u on o an u ar


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s r u on o an u ar fractures

Dento-

alveolar

Symphysis Body Angle Ramus Condyle Total

RTA 23 158 35 62 2 38 318

Accidental

fall

6 52 5 18 0 26 107

IPV 5 15 4 7 1 3 35Sports

related

injuries

1 4 1 0 0 0 6

Work place

injuries

0 5 1 0 0 2 8

Injuries

caused by

animals

0 3 1 1 0 0 5

Total 35 237 47 88 3 69 479


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Distribution of Middle Third fracturesDento-

alveolar

Nasal Zygomatic

arch

ZMC Le

Fort I

Le

Fort II

Le

Fort

III

Total

RTA 35 115 22 140 52 77 23 464

Accident

al fall

12 22 3 17 7 8 3 72

IPV 4 30 0 13 1 1 0 49

Sports

related

injuries

0 2 0 0 0 0 0 2

Work

place

injuries

1 3 0 2 0 2 1 9

Injuries

caused

by

animals

0 0 0 0 0 0 0 0

Total 52 172 25 172 60 88 27 596


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Comparison of pattern of

fracture

ZMC Symphysis

Nasal Mandible MiddleThird

Subhasraj et

al

(Chennai,

India)

36% 17.9% 8% 30.3% 69.7%

Bakardjiev &

Pechalova

(Bulgaria)

16% Not

reported

4% 74% 26%

Ugboko et al

(Nigeria)

15.2% 23.1% 11% 64% 36%

Al Khateeb

(UAE)

12.8% 15.6% 18.1% 61.1% 38.9%

Lee et al

(Jeju, Korea)

15.2% 2.2% 42.5% 7.9% 92.1%

Gandhi et al 28.9% 20% 28.9% 44.6% 55.4%


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Low incidence of dentoalveolar fractures is

probably due to the reason that such patients

are usually treated at smaller hospitals andremain unreported.

A total of 390 mandibular injuries (81.4%) and

290 middle third injuries (48.7%) were treatedwith open reduction and fixation.

Increasing expertise of the surgeons indeveloping countries led to increased number of

patients undergoing open reduction and fixation

in the recent times than to past.


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Strict implementation of road safety norms

such as use of seat belts, wearing of

helmets, use of air bags and speed limits.

Education of people about the road safety

rules.

Prevent drunken and underage driving.


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Due to better socio-economic status ofIndian population in the last two decades,pattern of maxillofacial injuries haschanged as RTA has emerged as the major

cause of maxillofacial injuries.

Periodic verification of the aetiology of

maxillofacial injuries helps us torecommend ways by which such injuriescan be averted.


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Proper education and strict implementation

of road safety laws can reduce RTA, as all

such injuries are accompanied by loss of

working hours and increase in litigation.

Hence, they also act as a deterrent to the

rising economy of the country.


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