Maxillofacial Trauma in the Ultimate Fighting Championship.

PURPOSE: The Ultimate Fighting Championship (UFC) is an American mixed martial art (MMA) company. This study aims to characterize patterns and trends of maxillofacial injuries in MMA. MATERIALS AND METHODS: The study design is a retrospective cohort study. Study sample consisted of fighters that suffered injuries during the matches from January 2015 to December 2019 (N = 259). The Athletic Commissions and corresponding fighting regulatory departments from 16 states and 24 countries were screened for medical reports released by UFC ringside physicians. Predictor variables were sex, weight division, injury location, injury type, and fight outcome (i.e., Technical Knockout/Knockout, Submission, Decision). Primary outcome variables were need for medical suspension and duration of medical suspension, secondary outcome variable was frequency of injury. Chi-square test was used to determine any statistical significance between predictor variables. One-way analysis of variance was used to determine any statistically significant differences between medical suspension times, sex, injury location, type of injury, weight divisions and fight outcome throughout the years. P value less than .05 (95% confidence interval [CI]) was considered statistically significant. RESULTS: A total of 259 fighters suffered injuries. Of the 319 total injuries, 291 (91.2%) occurred in male fighters, and 28 (8.8%) in females. Middle facial third injuries were the most common for both males and females; lower facial third injuries were proportionally similar. The male weight division with the longest medical suspensions were the light heavyweight (110.68 days) and welterweight (108.25 days) (P < .10166); the female weight division with the longest medical suspension was strawweight (88.92 days) and shortest was bantamweight (81.75 days) (P < .921123). CONCLUSIONS: Upper and midface trauma was predominant with fractures concentrated in the light heavyweight and welterweight divisions. Medical suspensions duration were longer in the light heavyweight and welterweight divisions.

[Effect of pulsed dye laser on inhibiting early scar after maxillofacial trauma].

PURPOSE: The study was designed to explore an effective method to control early scar after maxillofacial trauma and improve the satisfaction of clinical treatment. METHODS: Fifty skin lesions after maxillofacial trauma were divided into the experimental group and control group. Patients in the experimental group were treated with pulsed dye laser when taking out stitches, 15, 30 and 60 days later. Digital microscope photos were taken and lesion area was measured before and 3 months after laser irradiation. Adverse effects were recorded during and after each treatment as well. All patients were asked to rate their satisfaction at 3-month of follow-up. Statistical analysis was performed using SPSS 13.0 software package. RESULTS: The efficiency of the experimental group was 74% and 37 lesions were cured or significantly improved, while the efficiency rate was 22% in the control group. Area reduction of maxillofacial lesions before and after treatment between the two groups was significantly different (P＜0.05). Patients in the experimental group were highly satisfied with the final outcomes. No severe adverse events were observed. CONCLUSIONS: Pulsed dye laser is safe and effective in inhibiting early scar following maxillofacial trauma.

Influence of low-level laser therapy on the healing of human bone maxillofacial defects: A systematic review.

PURPOSE: This systematic review evaluates the effectiveness of low-level laser therapy (LLLT) to enhance maxillofacial area bone repair. METHODS: A comprehensive search of studies published up to February 2017 and listed in PubMed/MEDLINE, Scopus, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: The 15 selected studies evaluated a total of 374 patients (mean age, 28.5years) who were treated with LLLT. Gallium-arsenide (GaAs) and gallium aluminium arsenide (GaAlAs) were the most commonly used devices, and LLLT parameters varied greatly. Wavelengths varied from 500 to 1000nm. Tooth extraction, distraction osteogenesis, maxillary expansion, periodontal defects, orthodontic movement and maxillary cystic defects were evaluated. From the 15 selected studies, six evaluated bone repair (primary outcomes). Of these, four studies showed improvement in bone formation after using LLLT, two demonstrated improved results for only one follow up period, and one showed no additional benefits. The other 9 studies evaluated secondary parameters related to healing (secondary outcomes) in the maxillofacial area after applying LLLT, including anti-inflammatory, analgesic, and healing accelerator effects, and quality of life related to oral health. There were no adverse or negative effects of LLLT reported. CONCLUSION: Within the limitation of this review, a possible improvement in bone density can be found when LLLT is applied postoperatively in maxillofacial bony defects. LLLT also seems to promote anti-inflammatory and analgesic effects and accelerate healing, as well as enhance quality of life related to oral health. However, LLLT use protocols need to be standardized before more specific conclusions can be drawn about this subject.

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.

Timing of maxillofacial-oral injuries in an individual of the ancient city of Herculaneum (79 AD, Naples, Italy): a case report.

BACKGROUND: This study is based on the skeletal remains of an adult female from the ancient city of Herculaneum (Naples, Italy), who was a victim of the eruption of the nearby Vesuvius Volcano on 24-25 August, AD 79. RESULTS AND DISCUSSION: Examination of the maxillofacial region revealed evidence of unilateral condylar fracture and dislocation, as well as traumatic dental injuries. The injuries observed might have been the consequence of a direct blow to the mental region that was transmitted in a direction that raised the mandible, causing an indirect fracture in the right condylar neck when the condylar head collided directly with the temporal glenoid fossa. This indirect impact also resulted in partial fracture of three dental crowns due to the violent impact of the arches between them, and the sharp impact together of the upper and lower teeth. It is suggested that these injuries were sustained due to an accidental fall when the individual was between 7 and 15 years old, which is supported by the morphology, location and extension of the injuries, and the characterization of the impact. CONCLUSION: These results are an illustration of how dental anthropology and forensic approaches can be applied with great benefit to archaeological skeletal remains.

Cri-du-Chat syndrome: conservative dental treatment in an 8-year old child / Síndrome de Cri-du-Chat: tratamento odontológico conservador em uma criança de 8 anos de idade

O objetivo deste artigo é relatar o caso de uma paciente de 8 anos de idade com a síndrome do miado do gato (CdCS) que foi encaminhada à clínica de odontopediatria para tratamento odontológico de urgência. As principais queixas eram uma lesão traumática nos incisivos centrais superiores permanentes e dificuldade em realizar a higiene oral. A paciente foi extremamente cooperativa durante a avaliação clínica, demonstrando capacidade de colaborar com opções de tratamentos conservadores sob anestesia local. O exame clínico mostrou overjet acentuado, lesões de cárie e uma higiene oral muito pobre. Avaliações clínicas e radiográficas foram necessárias para diagnosticar e determinar estratégias de tratamento das lesões traumáticas, lesões de cárie e gengivite, as quais foram realizadas ao longo de cinco consultas odontológicas. Os desfechos do tratamento são descritos. Este caso ilustra a variedade de achados clínicos que os odontopediatras podem encontrar na cavidade oral e face de pacientes com CdCS e os problemas que essas alterações podem causar. No atendimento desses pacientes, os dentistas devem tentar fornecer o melhor tratamento possível, priorizando o uso de técnicas conservadoras.

The aim of this article was to report the case of an 8-year old patient with Cri-du-Chat syndrome (CdCS) referred to the pediatric dental clinic for urgent dental treatment. The chief complaints were a traumatic injury to both permanent maxillary central incisors and difficulty performing oral hygiene. The patient was extremely cooperative during clinical evaluation, demonstrating ability to withstand conservative treatment options. Dental examination revealed accentuated overjet, carious lesions, and very poor oral hygiene. Clinical and radiographic evaluations were necessary to diagnose and determine treatment strategies for the traumatic injuries, carious lesions, and gingivitis, which were implemented over a total of five dental visits. Outcomes of the treatment strategies adopted are described. This case report illustrates the variety of clinical findings that pediatric dentists may encounter in the oral cavity and face of patients with CdCS and the problems that these alterations may cause. When faced with a CdCS patient, dentists should try to provide the best treatment possible and prioritize the use of conservative techniques.

Ocorrência de injúrias orofaciais em praticantes de esportes de luta / Orofacial injuries in combat sports practitioners

Objetivo: Analisar a ocorrência de lesões orofaciais em praticantes de esportes de luta. Método: Realizou-se um estudo transversal, descritivo-analítico, com abordagem indutiva e técnica de pesquisa a observação direta extensiva. A amostra do tipo não probabilística foi composta por 85 praticantes de esportes de luta matriculados em academias de Campina Grande-PB. Os dados foram coletados mediante a aplicação de um questionário composto por perguntas abertas e fechadas, dicotômicas e de múltipla escolha. As variáveis analisadas foram: sexo, idade, número e tipo de esporte praticado, importância e uso do protetor bucal, tipo de protetor bucal (pré-fabricado, termoplástico ou confeccionado pelo cirurgião-dentista), ocorrência de lesão associada à prática esportiva, região acometida e injúria na cavidade bucal. Os dados foram apresentados por meio da estatística descritiva. Para a análise bivariada utilizou-se os testes Exato de Fisher e Qui-quadrado (p menor que 0,05%). Resultados: A maioria dos atletas eram homens (76,5%), sendo a média de idade de 27,4 anos (±8,7). Quanto ao número de esportes, observou-se que a maioria fazia um único esporte de luta (90,6%). No que concerne ao tipo de esporte, verificou-se um predomínio do boxe (46,2%), seguido do Jiu-Jitsu (25,8%). A quase totalidade dos indivíduos (95,3%) afirmou conhecer a importância dos protetores bucais, porém apenas 41,7% relataram utilizá-lo, durante a prática esportiva existindo diferença estatisticamente significante entre o uso e o sexo do atleta (P=0,023). O tipo de protetor bucal mais utilizado foi o termoplástico (51,4%). Com relação à ocorrência de lesões nas distintas regiões do corpo, 43,5% afirmaram ter sofrido injúrias, existindo associação entre o sexo e a presença de lesão (P=0,002). Lesões na cavidade bucal foram reportadas por 16,5% dos praticantes, sendo todos do sexo masculino, existindo, portanto, associação estatisticamente significante entre o sexo e a presença de lesões na cavidade bucal (P=0,016). Conclusão: Há um predomínio do sexo masculino entre os atletas de esportes de luta, porém nem todos fazem uso dos protetores bucais durante a prática esportiva, apesar da alta ocorrência de injúrias nas regiões da cabeça e face. As lesões na cavidade bucal apresentaram uma baixa frequência nesses desportistas.

Objective: The purpose of this study was to evaluate the occurrence of orofacial injuries among combat sports practitioners. Method: A cross-sectional descriptive-analytical study was conducted in a sample of 85 combat sports practitioners from fitness gyms in the city of Campina Grande, PB, Brazil. The data were collected using a questionnaire applied to the participants and referred to gender, age, type and number of the practiced sports, importance and use of mouthguard, type of mouthguard, occurrence of injuries related to sports practice, affected region, and oral injury. The data were processed by Epi Info 3.5.1 software and presented by descriptive statistics. Fisher's exact and chi-square tests were employed for bivariate analysis (p less than 0.05). Results: Most athletes were men (76.5%) and the mean age was 27.4 ± 8.7 years. The prevailing sports practices were boxing (46.2%) and jiu-jitsu (25.8%). Only 41.7% of the interviewers used a mouthguard during sports practice and there was a statistically significant difference for its use between the genders (p=0.023). Thermoplastic mouthguard was the most frequently used type (51.4%). Occurrence of diverse injuries in different regions of the body was reported by 43.5% of the subjects, with a statistically significant association between gender and presence of injury (p=0.002). Oral injuries were reported by 16.5% of the practitioners, all of them male, with a statistically significant association between gender and presence of oral injuries (p=0.016). Conclusion: Mouthguard is not properly used by combat sports practitioners, in spite of the high rate of injuries in the head and face region. There was a low frequency of oral injuries among these athletes.

Preservation of an injured vital tooth using ultrasonic device and mineral trioxide aggregate.

The purpose of this case report is to present a root fracture repair procedure for non devitalized injured tooth. One injured, non-endodontically treated maxillary anterior tooth in which an incomplete vertical root fracture involving only the buccal side was suspected, underwent an exploratory flap to visualize the pattern of bone loss and assess the type of root fracture. The pre-operative diagnosis was confirmed. A groove following fracture line was prepared using retro-tips driven by an ultrasonic device and sealed with Mineral Trioxide Aggregate (MTA), following filling of the bone defect with Calcium Sulphate. At 24 months follow up the case showed clinical and radiographic success. The present surgical approach showed preservation of function and vitality of tooth with a shallow incomplete vertical root fracture.

[Retrospective analysis of 2461 patients with maxillofacial fractures].

OBJECTIVE: To review the 2461 cases of maxillofacial fractures. METHODS: From 2003 to 2009, 2461 maxillofacial fracture cases were treated in Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine. Data regarding sex, age, cause of injury, occupation, geographic distribution, blood type, fracture site, multiple associated injuries, injury severity, the patient's first admitted department, treatment results were reviewed. RESULTS: The male and female ratio was 4.28:1, 1424(57.86 %) patients were between 20 and 40 years of age. The most common cause of injury was road traffic accident (938 cases, 40.98%). People in tertiary industry (900 cases, 78.53%) were most vulnerable to injuries. The zygomatic complex (22.08%), nasal bone (20.67%) and mandible (16.35%) were the most frequent fracture sites, which were often associated with skull (21.74%), brain (38.36%) and soft tissue contusion injury (48.84%). 85.98% (2116/2461 cases), of patients' AIS score was less than 2. Orthopaedics (939/2461 cases, 38.16%) was the first admitted department. CONCLUSIONS: The traffic accidents are the main cause of the maxillofacial fractures. Most injuries are found in the young and middle-aged people.

Retrospective analysis of 2461 patients with maxillofacial fractures / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To review the 2461 cases of maxillofacial fractures.</p><p><b>METHODS</b>From 2003 to 2009, 2461 maxillofacial fracture cases were treated in Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine. Data regarding sex, age, cause of injury, occupation, geographic distribution, blood type, fracture site, multiple associated injuries, injury severity, the patient's first admitted department, treatment results were reviewed.</p><p><b>RESULTS</b>The male and female ratio was 4.28:1, 1424(57.86 %) patients were between 20 and 40 years of age. The most common cause of injury was road traffic accident (938 cases, 40.98%). People in tertiary industry (900 cases, 78.53%) were most vulnerable to injuries. The zygomatic complex (22.08%), nasal bone (20.67%) and mandible (16.35%) were the most frequent fracture sites, which were often associated with skull (21.74%), brain (38.36%) and soft tissue contusion injury (48.84%). 85.98% (2116/2461 cases), of patients' AIS score was less than 2. Orthopaedics (939/2461 cases, 38.16%) was the first admitted department.</p><p><b>CONCLUSIONS</b>The traffic accidents are the main cause of the maxillofacial fractures. Most injuries are found in the young and middle-aged people.</p>

Barriers to the collaborative care of patients with orofacial injury.

Collaborative care interventions show significant promise in facilitating integrative care, which addresses the physical and mental health needs of patients with orofacial trauma. Ensuring the successful implementation of collaborative care interventions depends on having an adequate understanding of the potential barriers to the provision and receipt of mental health services within specific clinical settings. This article reviews recent findings on the patients' and providers' perceptions of barriers to psychosocial aftercare services in oral and maxillofacial trauma care settings. These findings indicate that although patients and providers recognize the need for psychosocial aftercare, they report substantial barriers to these services. Structural barriers, such as not knowing where to obtain services and financial cost, are the major obstacles among patients. Among providers, structural barriers also serve as significant impediments to the provision of psychosocial services. Some of the most common structural barriers reported by providers include a shortage of financial resources, trained clinical staff, and space. Although collaborative care interventions may be well suited to capitalize on patients' and providers' interests in psychosocial aftercare programs, further research is needed to determine the viability of this promising aftercare model within oral and maxillofacial trauma care settings.

Review of methods used in the reconstruction and rehabilitation of the maxillofacial region.

Maxillofacial and dental defects often have detrimental effects on patient health and appearance. A holistic approach of restoring lost dentition along with bone and soft tissue is now the standard treatment of these defects. Recent improvements in reconstructive techniques, especially osseointegration, microvascular free tissue transfer, and improvements in bone engineering, have yielded excellent functional and aesthetic outcomes. This article reviews the literature on these modern reconstructive and rehabilitation techniques.

[Evaluation of the efficacy of porous alumina ceramic use for defects elimination in maxillofacial region].

To study the biocompatibility of porous glass ceramics, experiments were conducted on: 75 white mice (Vistar); 11 rabbits (Shinshila) and 6 dogs. The porous alumina ceramic implants were embedded subperiostaly without additional fixation to bone surface. The osseointegration of implants, the size and form maintaining, changing of physical properties and long-term results in bone substitution were studied. The handling properties during surgery were also evaluated.

Clinical Epidemiologic Study of Facial Bone Fractures in Daegu

PURPOSE: There are many reports about facial bone fractures, but limited to retrospective data of a single hospital. Etiology and severity of the facial bone fracture have been changed and treatment method and materials have been advanced. In order to reflect those changes and provide up-to-date data of the facial bone fractures in Daegu, we gathered the data and analyzed the epidemiologic study. METHODS: The medical records of 1058 fractures in 895 patients were gathered from 5 general hospitals in Daegu during last year and these data were analyzed by following parameters: age, sex, place of residence, occupation, cause of injury, time of injury, location of fracture, length of in-hospital stay, time of operation, treatment method, associated injury, complication. Statistical analysis was performed using the Chi-square test. RESULTS: Most commonly involved age group was 20s(26%) and the sex ratio was 3.4:1(male predominance). Fractures were occurred more in unban and white-color workers. Among variable etiology of injury, traffic accident was the most common cause. Time of injury was heighest at 6 to 7 P.M., on Sunday, in July. Locations of fractures were following sequence: nasal, zygoma, mandible, orbit, maxilla. Mean length of in- hospital stay and time of operation after injury were 6.3 and 3.2 days, respectively. In treatment methods, operative methods were dominant than conservative management and general anesthesia were favored than local anesthesia. Associated injuries were noticed in 188 cases(21.2%) and complications were in 94 cases(8.9%) and among them, ocular problem were common. CONCLUSION: Compared to previous studies, mean age of occurrence was lowered and the etiologies showed age-specific pattern and reflected the change of lifestyle. In young age groups, sports injury, violence were more dominant and the other hand, traffic accident and fall were dominant in older groups.

Modulação do processo inflamatório agudo: terapia medicamentosa e laser não ablativo: revisão de literatura / Modulation of acute inflammatory process

Os traumatismos, os mais diversos, poderão dar origem a processos inflamatórios exacerbados nas regiões anatõmicas tratadas na especialidade de cirurgia e traumatologia bucomaxilofacial. A modulação desse processo ocorre quando as manifestações inflámatórias iniciais superam o benefício da regeneração tecidual. O objetivo deste trabalho é realizar uma revisão sobre a modulação do processo inflamatório agudo por meio de terapia medicamentosa de rotina e sobre a efetividade do uso do laser não ablativo neste processo

Epidemiología del trauma maxilofacial por accidente ciclístico / Epidemiology of the maxillofacial trauma caused by bicycle accident

Se realizó un estudio descriptivo y transversal sobre aspectos epidemiológicos del trauma maxilofacial por accidentes ciclísticos en 194 pacientes con diagnóstico clínico, radiográfico o ambos, de lesiones en esta región, que fueron recibidos y atendidos en el Servicio de Urgencia de Cirugía Maxilofacial del Hospital Clinicoquirúrgico "Saturnino Lora" de Santiago de Cuba, durante el período comprendido desde el 1 de octubre de 1998 hasta el 31 de diciembre de 1999. Entre los resultados más sobresalientes figuraron el predominio de los adultos jóvenes de 20 a 39 años de edad, sobre todo de los varones, la caída como modalidad de accidente, la colisión como la causante del mayor número de lesionados graves y defunciones. La imprudencia e ingestión de alcohol en conductores laboralmente activos resultaron ser las causas y víctimas que prevalecieron en este tipo de accidente, particularmente en el horario de 4 p.m. a 12 a.m. y en la calle, esta última la vía donde más accidentes y lesionados se produjeron. Las contusiones y laceraciones dentro de los tejidos blandos y las fracturas zigomáticas, nasales y palatoalveolares dentro del tejido duro, resultaron los patrones de lesiones predominantes(AU)

A descriptive cross-sectional study on epidemiological aspects of the maxillofacial trauma caused by bicycle accidents was conducted among 194 patients with clinical or radiographic diagnosis, or both, of injuries in this region. They received attention at the Emergency Service of Maxillofacial Surgery of "Saturnino Lora" Clinical and Surgical Hospital, in Santiago de Cuba, from October 1st, 1998 to December 31st, 1999. Some of the most significant results were: the predominance of young adults aged 20-39, mainly males, among the victims, the fall as an accident modality, the collision as the cause of the highest number of severe injures and deaths, and imprudence and alcohol ingestion in working drivers. These were some of the prevailing causes in this type of accident, ocurring particularly from 4 pm to 12 am, in the street, where most of the accidents and injuries are reported. The contusions and lacerations within the soft tissues and the zygomatic, nasal and palatoalveolar fractures in the hard tissue were the predominating injury patterns(AU)

An assessment of maxillofacial fractures: a 5-year study of 237 patients.

PURPOSE: This descriptive analytical study assesses the cause, type, incidence, demographic, and treatment data of maxillofacial fractures managed at our medical center during a 5-year period and compares them with the existing body of literature on the subject. PATIENTS AND METHODS: A 5-year retrospective clinical and epidemiologic study evaluated 237 patients treated for maxillofacial fractures from 1996 to 2001 at one medical center. There were 211 male patients (89%) and 26 (11%) female patients. The patients ranged in age from 3 to 73 years, with 59.0% (140 patients) in the 20- to 29-year age group. A number of parameters, including age, gender, cause of injury, site of injury, type of injury, treatment modalities, and complications, were evaluated. All maxillofacial injuries were assessed and treated by a single oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by appropriate consultant specialists. RESULTS: There were 173 (72.9%) mandibular, 33 (13.9%) maxillary, 32 (13.5%) zygomatic, 57 (24.0%) zygomatico-orbital, 5 (2.1%) cranial, 5 (2.1%) nasal, and 4 (1.6%) frontal injuries. Car accidents caused 73 (30.8%), motorcycle accidents caused 55 (23.2%), altercations 23 (9.7%), sports 15 (6.3%), and warfare caused 23 (9.7%) of the maxillofacial injuries. Regarding distribution of mandibular fractures, 32% were seen in the condylar region, 29.3% in the symphyseal-parasymphyseal region, 20% in the angle region, 12.5% in the body, 3.1% in the ramus, 1.9% in the dentoalveolar, and 1.2% in the coronoid region. The distribution of maxillary fractures was Le Fort II in 18 (54.6%), Le Fort I in 8 (24.2%), Le Fort III in 4 (12.1%), and alveolar in 3 (9.1%). Of the 173 mandibular fractures, 56.9% were treated by closed reduction, 39.8% by open reduction, and 3.5% by observation only. Of 33 maxillary fractures, 54.6% were treated using closed reduction, 40.9% using open reduction, and 4.5% with observation only. Approximately 52.1% of the patients were treated under general anesthesia, and 47.9% were treated under local anesthesia and sedation. Postsurgical complications were recorded in 5% of patients. These complications included infection, asymmetry, and malocclusion. Overall mortality in this series was 0.84% (2 patients); mortality was caused by pulmonary infection. CONCLUSION: The findings of this study, compared with similar studies reported in the literature, support the view that the causes and incidence of maxillofacial injuries vary from 1 country to another.